Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Adverse Effect of Injury Mediation

Compliance is an extremely frustrating aspect of patient management. A patient insists that they are not comfortable with their doctor, with care or with their lack of progress and want another opinion. Then they fail to show for that appointment.

Or before the patient becomes frustrated (or even frightened) of care, you realize that they would benefit from a second (or third) opinion. You set it up, and they fail to show.

Patients insist that they are depressed and then fail to show, intermittently show or suddenly break off care. They have the disabling symptoms of posttraumatic stress disorder which they insist are destroying their lives. Yet they fail to show for initial or follow-up appointment.

This is a greater problem in workers’ compensation than in other areas of health care.

A great part of it arises because they are not paying for the appointment, they are not scheduling the appointment and there are no consequences to not showing for the appointment.

This noncompliance becomes another aspect of their decreased motivation and self-responsibility. They know that somehow, someway, someone will take care of it for them, and it will not stop the flow of money, medication or result in any consequences with which they need to concern themselves.

A partial solution may reside in directly telling the patient that “when you fail to show for an appointment, everyone is aware of it, and it makes us all concerned with not only your motivation to help yourself but also your honesty. If there is any reason that you are not going to show for the appointment, you need to let us know now.”

This, of course, is only a partial solution since the injured worker always has the seemingly contradictory excuse that “I was too sick to come.”

I strongly recommend that noncompliance be meticulously recorded and reported to all involved in the patient’s care; not only to determine if there is a consistent pattern of this behavior but also out of the awareness that there are a limited number of patient care hours in a given day. It is unfair for those who will comply to have their appointment postponed while the noncompliant patient simply keeps that appointment time open.”

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