by Thomas Dahlborg
Recently a Harvard-trained practitioner shared his philosophy with me. The physician's job is to determine the appropriate healing protocol based on existing evidence-based research, he said, and the patient's job is to obey the physician and follow the prescribed protocol. If the patient does not follow the protocol, he/she is "non-compliant."
Clearly this is a very hierarchical model and probably very much the norm in our broken health care "system." It doesn't help that by some estimates only 15 percent of medical care is based on valid science. Evidence-based research is not fail-safe when in fact each human is a complex adaptive system with thousands of variables in play at any given time. No study can account for all of those variables, which may be one reason why the Institute of Medicine has said that only 50 percent of medicine is based on valid science.
In Leadership on the Line: Staying Alive Through the Dangers of Leading, Ronald A. Heifetz and Marty Linsky, described how doctors, who encounter patients who resist taking medicine and advice, give little more than lip service to the part of their job that involves engaging patients and their families in reshaping their values, attitudes and long-standing habits. They wonder why people "avoid reality and resist following" their instructions. "But then [the physicians] would take the easy road," Heifetz and Linsky write, "playing it safe by pandering to the desire for a technical fix, avoiding the difficult conversations rather than disturbing people in an attempt to change the ways they lived."
Patient "non-compliance" (that's the medical industry's term) is actually not a patient failure but rather another data point to be assessed and another opportunity to re-engage creatively with the patient, perhaps with the help of others.
To re-engage creatively, it's important to create a healing environment where trust can grow. This allows the patient the space to tell his or her story, the opportunity to share in a safe place fears, goals and dreams. And with time, nurturing and trust, the patient and physician can co-create a strategy to address the patient's fears and achieve the patient's goals and dreams.
Sometimes a patient is not ready to hear, to believe, or to follow a physician-defined and dictated care plan. Sometimes a patient needs to first overcome a mental health barrier, a financial barrier, an environmental barrier, or a spiritual barrier before being ready to address a physical challenge and follow a prescribed care plan.
These patients are not "non-compliant," they simply have more steps to complete at the beginning of the process before engaging and arriving at a place where they are ready to either accept the advice and input of the physician or ideally co-create a patient-specific healing journey.
If we truly want to create a healthy health care system than we must create an environment where the practitioner has the time, relationship and patient's trust to assess and identify the real barriers to healing (those early steps in the process that must be addressed). Then together they must take the opportunity to co-create a healing journey that will best position the patient to achieve specific health goals. To meet the patient where he/she is at and begin the co-created plan at that point. . .a truly patient-centered and patient-specific approach to healing is key.
We must lose the ego that exists in the system, lose the hierarchical approach to healing, and truly engage with and help patients get well.