Why Patients Don't Comply with Treatments: a Sociological Analysis

“Drugs don’t work in patients who don’t take them” - Ex Surgeon General C. Everett Koop.

It is both needful and needless to say that when a doctor tenders a prescription to a patient, it will be filled by a pharmacist that the patient will do well to take it as they have been advised. Even if it involves giving a referral to a specialist or lifestyle change recommendation, it is important for the patient to follow through meticulously. As simple as that may seem, an alarming number of people don’t make good on their treatment plans, thus, non-compliance.

Data from the World Health Organization has shown that some 125,000 people with treatable ailments die every year in the United States, and all cases are a result of a lack of regard for proper medication take. WHO also reveals that 10 to 25 percent of hospital and nursing home admissions are a result of patients’ non-compliance. More so, 50 percent of chronic disease-filled prescriptions in developed countries are not followed through correctly, and some 40 percent of patients fluff their treatment regimens.

A variety of studies buttress the problem of non-adherence on the part of patients. According to a review in the Annals of Internal Medicine, 20 to 30 percent of medication prescriptions never get filled, while approximately of 50 percent of chronic disease medications are not taken according to prescription. A 2016 research discovered that a third of kidney transplant patients were negligent towards their anti-rejection medications. Another found that 41 percent of patients suffering from heart attack fail to take their blood pressure medications.

While this non-compliance among patients is definitely risky and in some cases fatal, one cannot help but wonder what factors are at play in the conundrum. There are dozens of them - perhaps more - but some of the reasons for this problem can be attributed to the sociological category - where patients don’t comply with their medications as a result of relationships with people, upbringing, exposure, and other around-the-zone considerations.

Opinions are like noses; everybody has one. Most patients are often deterred from complying with their medications are a result of their personal views of that of people around them. Inasmuch as decisions regarding these treatments ought to follow as directed by the doctor, some patients still find themselves wanting because they either listen to their personal thoughts or the judgments of other people - who may also be non-compliance sticklers themselves.

For example, patients with schizophrenic conditions - mild cases - would rather believe that taking medication will only make the situation worse. As a matter of fact, it is an almost common belief that taking drugs to suppress this condition only makes matter worse. Some are of the opinion that it will inhibit your mental capacity and almost leave you clueless if the mind’s capacity it not at its fullest. Others’ thoughts are awash with thoughts that they will develop an eerie feeling that will come from staying on such seemingly scary drugs for the rest of their lives.

When patients buy into the mind over matter stock, they often find themselves tossing their meds in public trash cans and deciding to let the natural process take its full sweep. If Freddie has a friend who was once diagnosed with schizophrenia but seems to be doing okay despite not taking his medications, then Freddie will most likely join the bandwagon and probably blame it on the system. Rather than paying a listening ear and religiously following their treatments, they let the fad-like perspectives lead them into making decisions contrary to what the healthcare industry directs. Just like the Wentworth Miller-played character Michael Scofield in Prison Break was told by Haywire, the meds are mental handcuffs that leave you basically numb. Perhaps that’s the trend many patients in these conditions follow.

The doctor’s job is more than just diagnosing and prescribing. Beyond sticking needles and collecting blood samples, doctors are expected to establish long-term relationships that help them build trust with their patients. More often than not, trust is often confused with confidence, which actually follows trust. It has been found that in most cases, doctors don’t make it easy for their patients to come close to them and bridge the information asymmetry.

When patients don’t trust the person writing the prescription, probably some grad school stranger who just started working in the facility, they are unlikely to comply with the given medications. Some patients also may grow suspicious of certain doctors and their motives for recommending certain medications. It could be as a result of the patients’ exposure to news coverage of marketing efforts by pharmaceutical companies gaining influence on physician prescription patterns.

In other cases, non- to medications is as a result of trust for the medication itself. As said earlier, a patient with schizophrenia may decide to go natural because they don’t believe the drugs will do any good for their condition. When this happens, the patient is most likely to jump the medications and perhaps seek other more natural alternatives. Patients usually go for the holistic approach because they cannot stand the sight of pills, and because they are not on “healthy” terms with their doctors, they would rather DIY, which could lead to further complications if not watched piously.

It’s no news that some patients are embarrassed by the conditions from which they suffer. Not everyone goes to the public singing that they have cancer, and certainly not the ones with some mental disorder. Patients suffering from schizophrenia would rather keep it a secret that use it as an excuse to get pitied on. And because they want it locked away in a far-away castle, they would choose not to take their meds so people wouldn't find out about it. This is usually common among patients who don’t live alone, and the ones always around people. When there is as little as an iota of contempt for the condition, it becomes an in-house affair or almost no affair at all.

It is very comparable to women suffering from a global disease known as breast cancer. When diagnosed with the condition, the patients often get some low self-esteem that makes them feel less of themselves. It doesn’t take long before an inferiority complex sets in and takes control of their social life. According to many reports, many women diagnosed with breast cancer would rather not engage themselves in romantic relationships. Some even completely take themselves off the market and become disinterested with making friends with the opposite sex. Now, such patients would most likely want to toss their medications aside because they don't want another finding out they have breast cancer.

Embarrassment among patients in common in the medical field. It is pretty much like when a teenager goes to get an abortion for the first time. It is always awkward, but it always depends on the relationship between the doctor and the patient. Many people have literally died in silence because they are afraid people will get to find out they’re sick with one disease or the other. More often than not, it is about avoiding the situation where other people’s perception of the patient changes because they have been found to have schizophrenia or some dreaded cancerous cells. While it is a move to preserve personal reputation in some cases, it is out of sheer pride and ego that patients would have to do away with their meds and risk the repercussions.

Studies have been able to discover that patients who are depressed in one way or the other, are often less likely to stick with their medications. Be it bipolar disorder or chronic mood swings seemingly unexplainable, anything that alters a patient’s mood has a chance of stopping him or her from going through with treatment.

In the case where a patient is diagnosed with schizophrenia and the news of the development is rather too heavy to handle, the patient may go into depression. The same could also happen for breast cancer patients if they don’t have friends and loved ones around to give them a reason to not just fight through the phase, but be happy. Basically, no one is happy when they find out they’ve fallen sick with one disease or the other. Like grieving, we all handle ailments in our own way. While some will be motivated to take medications correctly and recover as soon as possible, others could plunge deep into depression that could even make the sickness worse. And, when a patient is not in the right emotional state of mind, medications are often the least of their worries.

Depression can also set in by way of human behavior. Especially in cases where the sickness is contagious, people will steer clear of the patient’s paths to avoid contact. That sudden alone feeling could lead to extreme loneliness, followed by sadness and then depression. In such a state, where no one is around to give comfort or to just make the patient feel less lonely, they are likely to join the non-compliant group. As far as we know, it usually occurs in cases where the ailment is transferable. While society could or could not be blamed for this, it finally lies on the patient’s decision and resolves to go ahead with the treatment or just stay and grieve over the fact that her condition has left them with fewer or no friends.

Perhaps this is the most potent factor of them all, one you and I may be very well guilty of - the choice to not just do. Similar to choosing not to participate in politics or simply vote for a preferred candidate, medical apathy is mostly found among patients who just don’t have an interest in medications at all. In some cases, patients do not fully realize or recognize the importance of the meds they have been given. The just put it down as a mere medical formality and dump them in a bin on their way out of the pharmacy.

It could be something personal or a habit garnered from someone else. Because it is a social factor, medical apathy can be gotten from someone else, perhaps a friend who always skips checkups and makes it a religion not to pop pills. It is hard to figure out what this set of people rely on, but what we are sure of is that sheer apathy is keeping them away from drugs and other types of treatment. When patients frequently associate with people who have such a mindset, it will be very easy for them to just adopt the belief and decide to stay pill-less. The problem has really escalated in some parts.

There are other cases where the patient simply does not care if the treatment works or not. When this is the case, it is a 50-50 percent matter between taking the pills or shoving them aside. In the event where the ailment has not developed to a stage enough to weigh the patient down - or will never do so - the patient may opt to keep the pills unpopped. There are also patients who would rather rely on their immune system to do the trick, rather than having to gulp down tacky pills every now and then. This is also a kind of apathy, best described as the I-don’t-really-care attitude toward treatment.

Conclusion

Patients can be reluctant to divulge that they have been dissing their drugs. If you don't have foolproof that the patient actually complied - perhaps a picture - one may needlessly escalate the treatment, which could culminate in potential harm to the patient. This is often unnecessary work for the practice and could result in increased overall costs. Patients’ non-adherence to treatment is a problem many countries are trying to solve, both the developed and the developing. With proper awareness campaigns and a disciplined healthcare system, the world will be steps closer to a fully compliant set of patients, and soon.