One such segment are those who react to a trustworthy clinician’s explanations of a medication’s uses, side-effects, and alternatives with a rational rejection of the recommended treatment or with a rational agreement to follow the prescribed treatment which they effectively implement. Other subgroups, however, include

Those who grow glassy-eyed after the first words of the side-effect spiel, wait patiently for the completion of the physician’s explanation, and then ask, “So, it’s one pill in the morning and one at bedtime, right?” (I cannot count the number of times this happened in my practice.)

Those who view the clinician as a hired hand whose job description is following the patient’s instructions. (I had an Ex who chose her physicians based on the litmus test of who would or wouldn’t follow her orders, a strategy which led, for example, to her demanding – and undergoing – a surgical procedure when standard practice would have been medical treatment, casually dismissing her surgeon’s own concerns.)

Those who are enamored of their clinicians, are enchanted by his or her every word, and prefer following an authoritatively issued treatment plan to listening to pros and cons that introduce the notions that (1) no treatment carries a guarantee of success or even safety and (2) their clinician seems to be admitting that he or she could be wrong.

Those who don’t trust anyone, especially doctors, and are therefore psychologically incapable of considering the benefits and risks of a treatment plan, regardless of how eruditely and empathetically presented.

The research does show that there is no silver bullet for noncompliance. The most effective compliance enhancements are individualized and complex. That’s no excuse for not knowing ones patients or not presenting adequate information to allow a patient to make a reasonable choice about a specific treatment. It does mean that those tactics are not sufficient for all patients.

Now that it seems that I take more medications than I prescribe, I am way sympathetic with the concerns about expense. My only response is that, assuming one agrees to the use of a medication, taking that medication as scheduled is more efficient, effective, and economical than missing doses, unilaterally changing dosages, etc.

And, it only took me a few weeks in private practice to institute a policy of always hiring receptionists who were nicer than me (not that this was a high hurdle for most candidates)

We do KNOW that pharmaceutical companies have marketing departments.

Prescriptions are inconvenient, expensive and secretly we suspect that either we don’t really need them or that they don’t really do anything. That and the fact that they come with slick designer pamphlets doesn’t help. Scrawl the medication specifics (and list of potential death causing side effects) on a piece of torn off brown paper bag — in pencil and have the receptionist hand it to the patients, we actually get to know her while we are waiting on you.