Tag Archives: Patient Compliance

Patients With Their Pants On Fire, Bloodletting, Surgeon General DrHGuy, & Treatment Adherence

Some recent posts at AlignMap, my web site and blog about adherence to treatment (or, more pertinently, to the lack of adherence to treatment), may prove interesting to Heck Of A Guy readers.

Patients Who Lie To Their Clinicians

Of special interest are patients who lie about adherence, i.e., whether or not they took their medications as prescribed, because doing so is common1 and because doing so triggers cascades of risk to the patient and costs to everyone. I argue that the current patient compliance paradigm encourages patients to mislead their clinicians and, of course, offer a solution.

Beyond Patient Compliance: Patients Who Lie

My Application For Surgeon General

Flag of the Surgeon General Of The U.S.

President Obama has yet to appoint a permanent Surgeon General of the United States.2 I don’t have a job. Is this a match made in heaven or what?

5 Reasons I Should Be Named Surgeon General

The AMA Resolution On Abusive And Hostile Patients

At the recent annual AMA meeting, Resolution 710, “Identifying Abusive, Hostile or Non-Compliant Patients,” surfaced. It wasn’t pretty. In case you missed it, the opening paragraph sets the tone for the document:

Whereas, Many patients are becoming more abusive and hostile toward physicians for many reasons not limited to the economy, increasing co-pays and deductibles, unreasonable expectations and demands, a lack of instantaneous cure, arrogance and/or the belief that they “own” their physicians;

Three posts were launched in the effort to determine why the AMA was trying to self-destruct:

There Will Be Blood
Bloodletting As A Model For Adherence

Bloodletting Machine

Bloodletting Machine

I’m campaigning for radical changes in the current view of patient compliance because – well, because the current view of patient compliance doesn’t work. In this post, I point out the parallels between bloodletting and the prevalent concept of patient compliance and the similar dangers each entails.

Why Today’s Treatment Adherence Paradigm Must Be Destroyed – Part 1

  1. Precise measures are impossible to garner, but studies suggest that at least 30% of patients both do not take medication as prescribed and tell their doctors they have been adherent and dump their medications to support the lie. []
  2. Rear Admiral Steven K. Galson, USPHS, is the Acting Surgeon General of the United States. []

Lottery Chances, Calvin and Hobbes, and Wacky Healthcare IT Standards Humor Featured At AlignMap

Three recent posts at AlignMap, the blog and web site where I write about patient adherence to treatment,1 may prove interesting to the intellectually curious general reader.2

Compliance Program Combines Healthy and Wealthy, But Is It Wise?

The Medication Blister Pack Lottery Ticket
The slogan for the Illinois lottery was once You can’t win if you don’t play; the parallel slogan for the lottery referenced in this post would be You can’t win if you don’t adhere to your prescribed coumadin regimen.

The Aetna Foundation has funded a clinical trial to determine if chances to win a daily low-stakes lottery encourages adherence among patients taking coumadin. This has created controversy about the practical and ethical aspects of offering cash incentives for medication compliance.(It has also inspired my own contribution to pharmaceutical packaging, the Medication Blister Pack Lottery Ticket, pictured above.) You can read about it at

Calvin and Hobbes, Sidewalks, Advice, and Patient Compliance

It turns out to be only a short step from Calvin philosophizing about life as a sidewalk to the effectiveness of healthcare professionals recommending patients do what they already know they should do – quit smoking, follow a diet, etc.

And, as a bonus, check out Calvin on motivation.

The Calvin and Hobbes contribution to patient compliance can be found at

The Seedy SEEDIE Site

I recommend this post for two reasons:

  1. I am a rabid fan of satiric spoof web sites.
  2. SEEDIE is the “Society for Exorbitantly Expensive and Difficult to Implement Electronic Health Records.”

Irresistible, right?

Well, in any case, you can read about it at SEEDIE and Patient Compliance

  1. “Adherence to treatment,” “patient compliance,” “concordance,” and the various combination and permutations of these terms are, on this context, synonyms. []
  2. Viewers are also welcome to peruse other posts, but my hunch is that the appeal of pieces such as Treatment Nonadherence Among Individuals With Schizophrenia: Risk Factors and Strategies for Improvement and Negative Effect Of Depression On Adherence To HIV Treatment Dissipates With SSRIs may be limited to a much smaller, more specialized audience. []

Patient Education Goes Bollywood

Today’s post at AlignMap, the blog and web site where I write about treatment adherence, takes patient education and medication compliance from the sad and drab ghetto of mainstream materials such as posters, pamphlets, and sideshows, to the fab world of entertainment.

Check out Tracey Ullman’s conceptualization of patient counseling performed by Padma Perkish, an Indian pharmacist in Oak Ridge, Tennessee, who provides more than full service.

The videos of Tracey Ullman as Padma Perkish, the pharmacist with the unique take on patient education, can be found at The Tracey Ullman Patient Compliance Videos.

Slate Story On Patient Compliance May Sound Familiar


Returning Heck of a Guy readers will, I suspect, find little new in “Doctors Without Orders,” an article about medication noncompliance by Jessica Wagner in today’s Slate.

The material may seem, in fact, distinctly familiar to those readers I’ve successfully harangued into reading posts at AlignMap, the blog and web site where I write about treatment adherence.

Yep, the article is based, in large part, on an interview with me and data drawn from the AlignMap site.

But, while the material may have be old hat to some viewers, it is, I must admit, altogether more impressive when Ms Wagner writes it under the Slate aegis.

Jessica Wagner’s Slate.com essay on medication noncompliance can be found at

What's New In Patient Compliance

enrichimap logo header

AlignMap, EnrichMap, and The Scourge of Treatment Noncompliance

Many returning readers know I maintain another blog and web site, AlignMap.com, which focuses on patient compliance and adherence to treatment.

For those who are unaware of the significance of patient compliance, I’ve included the following excerpts from AlignMap.com.


Noncompliance with treatment is a healthcare catastrophe.

Because many otherwise effective treatment plans are inadequately implemented or are not implemented at all,1

  • Millions of unnecessary hospital admissions and thousands of preventable deaths (in the US alone) take place every year
  • Innumerable patients suffer needlessly prolonged, severe, or relapsed diseases
  • Healthcare dollars go to waste at an annual rate of $100 – $300 billion (in the US), losses in workplace productivity take an even higher toll, and patients, their families, and their communities endure profound financial, social, and psychological damage
  • Cascading misinformation, mistrust, and inefficiencies impair medical research, corrode the morale of clinicians, and imperil the healthcare system itself
There is no impending pharmaceutical discovery, surgical innovation, or governmental policy change with greater potential for improving the health of patients and the efficacy of the healthcare system than simply increasing the percentage of treatment plans that patients carry out as prescribed.


Some readers may also know that, in my pre-AlignMap, pre-Heck of a Guy life, three colleagues and I formed a group called EnrichMap to develop a system for grouping patients according to their behavioral patterns pertinent to compliance. That information would allow customized, group-specific strategies to minimize unnecessary treatment failures caused by noncompliance. That decrease in treatment failures would, in turn, reduce the consequent morbidity and mortality, research confoundments, delays, and financial waste.

Humanity in general and healthcare in particular would be enhanced, the American economy would be saved, and apropos of this new Age of Aquarius, peace will guide the planets and love will steer the stars. Oh, and the four of us would be rewarded with appreciation, a sense of accomplishment, and vast sums of money.

And, indeed, we were able to construct what has become the Emap Profile, a model that, based on an individual’s responses to a brief (20-25 items) questionnaire, divides the adult, cognitively-intact population into six segments, each with different implications for patient compliance:

  1. Sage and Satisfied
  2. Security Seeking
  3. Self Starting
  4. Uncertain and Concerned
  5. Spontaneous and Impulsive
  6. Vigilant and Suspicious

The problem was that we were unable to find a practical means of testing the tool.2 Consequently, we set the project aside. I began the AlignMap web site and blog, in fact, to provide an outlet for my continuing interest in treatment adherence.3

It now appears likely that my partners and I will be able to work with one of the companies involved in clinical trials to find out if the Emap Profile does what we think it does – make meaningful distinctions between how patients respond to treatment proposals.

And thus is reincarnation accomplished in the business world.

One manifestation of EnrichMap’s revitalization is the EnrichMap.com web site, which just came online. EnrichMap.com offers, naturally, more information about the Emap Profile, including the opportunity for a visitor to determine which of the six groups best describes his or her pattern of responses to healthcare instructions.

So, if you are interested in the impact of healthcare noncompliance, if you want to take the survey to find out where you fit in the Emap Profile, or if you’re just curious about how I’ve spent my so-called free time lately, check out the EnrichMap web site

  1. The scope & effect of noncompliance is elaborated at
    ~Noncompliance Fact & Fiction~ []
  2. “Practical means of testing the tool” translates into “a clinically and statistically valid method for testing our hypothesis that we could afford out of pocket.” []
  3. Yes, if I had known we would be resuscitating EnrichMap, I might have chosen a name for that site other than “AlignMap,” which will inevitably be confused with “EnrichMap.” If it helps, AlignMap covers patient compliance in general; EnrichMap deals with a specific solution, identifying subtypes of patients with respect to adherence and customizing enhancements for those groups []

The High Cost, Thank Goodness, Of Placebo R&D

From Research To Retail In 24 Hours

Tonight’s AlignMap1 post, Breakthrough In Placebo Science – High End Retail, is my response to the news of a study published this week in The Journal of the American Medical Association indicating that expensive placebos are more effective than cheaper placebos.

Immediately recognizing the opportunity this insight afforded me, I have established a new AlignMap-Heck of a Guy enterprise, the placeboutique, to produce and, more to the point, to sell what our slogan describes as High Priced & Highly Effective Placebos


the placeboutique
The Sign Of High Priced & Highly Effective Placebos

Check out the business strategy and offerings of the placeboutique at Breakthrough In Placebo Science – High End Retail

  1. AlignMap is my professional web site and blog that focus on patient compliance, also known as adherence to treatment []