Dealing with a patient’s noncompliant behavior

iStock_000012115736SmallWebAll health care providers, regardless of specialty, encounter patients who are noncompliant with medical advice or treatment recommendations. In many cases, the patients are not being deliberately noncompliant, and their providers can help them become more compliant.

Good communication skills, including active listening, are essential for good patient care and compliant behavior. A provider’s choice of words, body language, and even silence all play a role in how a patient receives the provider’s information and advice. A provider who appears rushed and doesn’t allow a patient time to fully explain symptoms or ask questions may be setting the patient up for failure. Other factors that can lead to patient noncompliance include the following:

  • Misunderstandings due to medical terminology
  • Misunderstandings due to language, a hearing disability, or mental barriers
  • Patient not realizing the seriousness of the condition or urgency of the situation
  • Patient not having insurance coverage or money to pay for the recommended medications, tests, or treatment
  • Patient believing the treatment will be embarrassing or uncomfortable
  • Patient deciding to go elsewhere for treatment
  • Patient simply forgetting

It is important to provide patients with enough information regarding their condition and your treatment recommendations, and to provide it in a format that is easy to understand. Stressing the significance of the condition and the need for timely follow-up should help with patient compliance.

A patient certainly has the right to refuse recommended treatment or tests. Providers are responsible for informing the patient of any risks associated with a refusal of care and documenting this discussion in the patient’s chart.

Providers may choose to dismiss a habitually noncompliant patient. Allowing a patient to continue noncompliant behavior can not only be detrimental to the patient’s health but can also increase a provider’s professional liability exposure. Any dismissal letter to the patient should include a reiteration of the treatment recommendations and the risks associated with not receiving the recommended treatment.

Generally, a provider can terminate a relationship with a patient at any time and for any reason. The exceptions are that a provider may not stop treating a hospital inpatient, a patient in unstable condition, or a number of patients from any specially protected population or socioeconomic group. In addition, federal and state law protecting the disabled may prevent a provider from discharging a patient whose noncompliance is the result of a physical or psychological disorder.

Strategies to combat patient noncompliance:

  • Educate patients regarding the recommended treatment or test and why it is necessary.
  • Inform patients regarding any alternatives, benefits, risks, and complications associated with the proposed treatment or test.
  • Provide clear oral and written instructions to patients, using interpreters as necessary.
  • Emphasize the seriousness of the condition and the urgency of the recommended treatment or test.
  • Schedule referral and follow-up appointments before the patient leaves.
  • Place reminder calls to patients regarding upcoming appointments.
  • Follow up on failed appointments.
  • Document all noncompliant behavior including no-shows, cancellations without reappointments, and failure to follow recommendations regarding treatment, diagnostic studies, referrals to specialists, medication use, etc.

It is reasonable to expect a patient to share responsibility for compliance with your follow-up recommendations. However, whether a patient is compliant or not, providers should document in the medical record their instructions and advice to the patient regarding treatment recommendations, referrals, and follow-up care.

Physicians Insurance members can access guidelines on our Web site related to properly terminating care for a noncompliant patient.

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