Changing doctor’s public image can improve compliance

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Academy of Public Administration under the aegis of the President of the Republic of Belarus

Changing doctor's public image can improve compliance

Selivanava Tatyana Valerievna

External doctorate student, Department of Public Administration of Social Sphere and Belarus Studies

Abstract

The article discusses the compliance problem, its causes and consequences as well as suggests that changing the doctor's public image is the most important factor in improving compliance. Altering the public image of a doctor will ensure more effective interaction between a doctor and a patient, improve medical services quality, and help preserve and improve patients' health.

Keywords: doctor's public image; doctor-patient relationship; compliance; non-compliance; compliant behavior; paternalism; interpersonal relationship.

Introduction

According to the World Health Organization, nonadherence to medical recommendations is recognized as one of the most significant issues for modern health care. Patients fulfill only part of their prescriptions, tend to self-medicate, resort to alternative medicine methods, and even completely refuse any treatment. [1] The efforts of healthcare providers to prevent and treat diseases, especially chronic ones, do not always bring positive results, and in 30-50% of cases the treatment ineffectiveness is attributed to medical recommendations non-adherence. [2]

Definitions of Compliance and Non-Compliance Under these circumstances, healthcare providers are becoming more and more concerned about the compliance problem. [3]

Compliance is a patient's adherence to a recommended course of treatment, namely taking prescribed drugs, going on a diet, exercising, changing their lifestyle, and visiting medical institutions the recommended number of times. [4, 5]

The term non-compliance is also widely used. It describes a situation when patients do not follow medical advice. In the modern world, non-compliance is a leading obstacle to the effective delivery of health care.

Reasons for Reduced Compliance There are many causes of non-compliance, but the factors listed below have the most adverse effect on adherence to medical advice.

Poor doctor-patient relationship. The effective interpersonal communication between a doctor and a patient is just as important as the doctor's expertise. This means that moral and ethical principles should become a part of the interaction between a doctor and a patient. [6]

Medication regimen complexity. Some patients do not understand their doctor's recommendations, while for others the treatment regimen is too complicated and time-consuming.

Poor health literacy. Without proper education, patients do not understand the treatment benefits and consequences of self-treatment.

High medication cost. Some people completely stop their course of treatment, while others have to take half the prescribed dose.

Informatization. Patients have gained access to scientific and popular science resources that do not always contain reliable information, while the quality of these resources is very much in question.

Medicalization. Today, health care is becoming an increasingly important social institution that is actively involved in society sustenance. [7] Therefore, medicalization -- the influence of health care on areas of life previously not affected by medicine -- has both positive and negative effects on the compliance level.

Paternalism -- an interaction model that does not involve the active participation of a patient -- is no longer suitable for communication with patients. However, one-third of healthcare providers still consider paternalism the only acceptable form of interaction [8]. At the same time, modern patients are focused on active participation in their treatment, choose cooperation, and advocate for freedom of choice. A 21st-century patient wants to have comprehensive information on their disease, treatment regimen, and any side effects. [9]

Also, the compliance level is affected by globalization, insufficient level of medical education, outdated treatment regimens, decreased interest in obtaining medical education, and even the immigration of the most professional doctors to other countries.

Consequences of Non-Compliance

Healthcare providers often pay attention only to the short-term consequences of non-compliance. For example, they are concerned about the transition of a disease to a chronic form or the decreasing respect to healthcare workers. However, if we consider the longterm consequences of non-compliance, we'll find out that the compliance problem affects not only patients and healthcare providers, but also has a far-reaching influence on all social spheres and living standards in general. First, non-compliance is decreasing the nation's health level. When patients do not follow medical recommendations, their treatment lasts longer and disease becomes chronic. As a result, the quality of life is deteriorating, the birth rate is decreasing, and the number of deaths due to non-adherence to medical advice is surging.

Besides, non-compliance leads to repeated treatment of patients that could have been avoided. As a result, healthcare providers spend extra money and time, which could be allocated on education or treatment of other patients.

Another consequence of low compliance is the outflow of patients from traditional healthcare institutions and the influx of patients into alternative medicine. Consequently, traditional health care is getting poorer financing, which may adversely affect the medical services quality, equipment base, and staff qualifications.

Ways of Improving Compliance

As non-compliance has an adverse effect on all areas of life, the problem of non-adherence to medical recommendations should be resolved as soon as possible. Below are some ways to increase the compliance level.

Building effective interpersonal communication between a patient and a doctor.

Simplifying medication packaging -- for example, limiting the number of medications prescribed simultaneously, promoting the usage of smart devices, providing effective medication reminders, and so on.

Improving health literacy. A person who knows the consequences of their disease will more willingly follow their doctor's advice.

Monitoring the patient's regimen more carefully. This can be carried out in hospitals or remotely using smart devices.

Reducing the cost of prescription medicine.

All these options deserve attention, but a positive doctor-patient relationship is recognized as the most important factor in improving compliance. [3] In our opinion, changing the public image of a doctor will help build and strengthen the doctor-patient relationship.

Research on the Compliance Problem

From 2016 to 2018, we have studied the compliance problem in Belarusian healthcare institutions. The object of the study was healthcare providers and patients of the Minsk region hospitals and polyclinics. The goal of the study was to identify doctor's qualities that positively affect the compliance level.

To study the opinions of healthcare providers, we have used the expert evaluation method. The experts included heads of healthcare institutions (28 people), medical doctors (27 people), and senior nurses (25 people) -- a total of 80 people. The objects selection was based on the healthcare workers selfassessment and other objective parameters -- experience of at least 10 years, an appropriate level of education, and a high degree of qualification.

To study the opinions of patients, we have used the questionnaire method. The survey contained both closed and open questions. We have interviewed the most active patients who wanted to take part in the survey -- a total of 550 people. However, to assess the questionnaire results, we have analyzed the answers of patients that trusted their doctors, i.e., had a high level of compliance.

Public Image of a Modern Professional Doctor

To define a public image of an “ideal” doctor, we have systematized and ranked doctor's qualities obtained during the expert evaluations and patients' questionnaire. The qualities, for which the highest level of matching was found among opinions of healthcare providers and patients, have become the basis of the doctor's public image. compliance image doctor medical

Among the individual and personal qualities, good manners and honesty were highlighted, while interpersonal skills are deemed the most essential among professionally important personal qualities. Professionalism is considered as an absolutely necessary quality that is important both for the experts and their patients. Healthcare providers appreciate the responsibility and can-do attitude of their colleagues, while a doctor's visual appearance, his humanity, and intellectuality are important for patient Thus, the public image of a doctor who can increase the compliance level is as follows: this visually appealing doctor that is honest, humane, and intelligent; this person has good manners and interpersonal skills as well as is a responsible professional with a can-do attitude (Figure 1).

Figure 1 - Doctor's qualities that can improve compliance

Conclusion

According to the studies conducted in the United States, 25 to 33% of patients do not follow their doctors' recommendations. [3] This happens due to complex treatment regimens, poor communication between a doctor and a patient, high medication costs, and health illiteracy.

There are many ways to increase compliance -- simplify medication regimens, reduce drugs cost, improve health literacy, or more diligently monitor patients. Nevertheless, a positive doctor-patient relationship is the most important factor in improving compliance, which can be achieved by changing the public image of a doctor.

Altering the doctor's image will improve the communication between a patient and a healthcare provider, increase medical services quality, and help preserve and improve our health.

References

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