Trust, communication vital part of therapy

One of the most frustrating aspects of a health care professional’s work is non-compliance on the part of the patient.

Compliance occurs when the patient’s behavior coincides with medical or health advice given. Blood pressure management, diabetes, heart disease, as well as reducing anxiety and depression are affected by the extent to which a patient cooperates with his/her physician. This means that, if advised, the patient will:

Take medication in the prescribed dosage.

Follow a recommended diet.

Begin an exercise program.

Stop smoking.

Seek to implement needed psychological changes.

Although the problem can be complex, there are a number of common reasons a patient and a health care professional do not reach satisfactory compliance:


The attitude and behavior of the health care professional.

The psychological makeup and beliefs of the patient.

The nature of the patient’s problem and its treatment.

The manner in which the patient and health care professional relate and interact.

The patient may select a health care professional who is not open and with whom he is unable to communicate effectively. This prevents establishing necessary trust and caring.

Or the patient may deny problems or withhold information. This makes it difficult to devise an effective treatment strategy.

Extenuating circumstances may exist. The prescribed treatment may conflict with the patient’s daily routine or lifestyle. Or, the patient may have a lack of concern about the problem.

In some cases the patient may have impaired memory or the inability to comprehend and follow directions. Certainly, a patient who is overly suspicious or in poor contact with reality is difficult to treat.

A big factor may be the expense and/or side effects of medications. These may discourage adhering to the treatment.

Still another factor is called secondary gain. This occurs, for example, when a patient receives a lot of attention from family members because of the condition. Or the patient may not want to follow professional advice because improvement would necessitate returning to work.

The reasons for non-compliance are unique and individual in each case, but the following suggestions may help:

Obtain a thorough examination by a health care professional to determine what factors may be contributing to non-compliance.

Insist on an honest and open discussion between the patient and health care professional.

Get support from the family. Family members should contribute any information that may lead to a better understanding of the patient, including cultural or religious factors.

Utilize home health care nurses or other extended services if needed. Group support from hospitals or medical associations can provide resources.

Seek professional assistance from a mental health counselor, if necessary.

Both patient and the health care professional will benefit through mutual trust and better communication.

Harold H. LeCrone, Jr., Ph.D. Copyright © 1993