Why Patients Don’t Follow Doctors’ Orders

An exchange between physician and patient says a lot about how we treat the subject of our health.


Dr. Suzanne Koven is a physician who blogs for Boston.com’s Health section. She recently wrote about a patient — one she’s been fighting with for more than 20 years — who finally started taking her advice seriously.

It’s not an uncommon scenario, as she explains at the start with some stats: In 2011, almost 500,000 patients who had been admitted to a hospital got up and left against medical advice. A 2010 study found that one in five first-time prescriptions never get filled. And the U.S. Centers for Disease Control and Prevention say fewer than two-thirds of adults over age 50 get recommended screenings for colon cancer.

What makes the anecdote more interesting than the data is how the patient, Paul, answers when Koven asks why. Paul has a family history of heart disease, but wouldn’t take medication for his high blood pressure and routinely skipped appointments. Even after developing diabetes, he wouldn’t listen to her, she says, until a couple years ago.

Paul says he started paying attention when “symptoms … finally started catching up with me.” Fatigue, anxiety, circulatory problems, and a nightmare about becoming a double amputee like one of his diabetic relatives caused him to exercise more, take his medication, and keep his appointments.

He says his previous stubbornness had three main causes:

  • The idea of taking a pill to solve his problems “feels like a defeat,” while changing his own behavior felt like the right answer.
  • He had a deep mistrust of pharmaceutical companies, which he felt were pushing medicine he didn’t need.
  • He didn’t want to be forced into a routine.

Paul ultimately realized that a pharmaceutical profit motive could still work to his benefit, and that some sacrifices were necessary for his health. Koven realized that 20 years of chastising a patient can’t do what the patient has to do for himself. She wrote:

“… I realized that there was probably little I could have said to change Paul’s mind. He was in command. The orders he awaited were his own.”

How do you explain your reluctance to follow your doctor’s instructions — or do you adhere to every word?

Stacy Johnson

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