White Coat Adherence

Do you brush your teeth more before you go to the dentist?

Are you more likely to take your medications the week before you go back for your physician visit?


But, do we make that clear to the physician? No. When the physician asks if you’re taking your medications, the answer is yes. That’s not a lie. What they need to know is how many pills are left since you last filled your medication? How many pills did you start with? How many did you lose?…

You get the picture. I like the term here that our Chief Medical Officer used – “white coat adherence”.

Now, let’s imagine that the physician orders a blood test for your cholesterol and your LDL hasn’t dropped, there are three scenarios:
1. They go back and really push you on your adherence (or diet and exercise);
2. They believe you but they assume the medication dose isn’t strong enough and increase your dose; or
3. They believe you but they assume the medication isn’t working and change your medication.

These are minimally issues for the healthcare system – wasted costs – but there is also the potential for giving you an unnecessarily high dose or changing you to a riskier medication since the default one didn’t work.

How do we address this? It’s not easy. This involves a few things:
1. Improving physician access to data (i.e., adherence data);
2. Improving physician – patient communications; and
3. Helping patients stay adherent and understand the impact of their medication (and lifestyle decisions) on their health.

I continue to see more and more data on the physician patient gap in communications. This is from a few years ago, but a study showed that 40 to 60% of patients could not correctly report medication expectations 10 to 80 minutes after physicians provided information, AND more than 60% of patients misunderstood prescription directions immediately after doctor visits. (source)

Pretty scary!

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