Setting Expectations As First Line Therapy

I read a great article the other day about adherence.  It took a great big picture view of the topic.

You can’t expect a patient to be adherence to a medication or compliant with your orders if they don’t understand their condition and/or the medication.  This is a very necessary topic even if they’re not a newly diagnosed patient.

This brings into account their literacy level, their plan design, their experience with you as a provider, their experience with the drug, their home life, and many other factors.

I’m going to use an experience from this past week outside medicine to reinforce this point…

I was down in the Destin Beach area this past week and wanted to go out on a charter fishing boat with my family.  We finally found a boat and rented it.  At 6:30 am when we were about to get there, the captain called to cancel because the boat wouldn’t start.  We were disappointed, but I’d rather be stuck on land then trapped at sea.

But, with 4 others in tow, I wanted to make good on my coordinated plan so I walked the docks for 20 minutes and found a captain who’s charter had no showed.  I’ve been on a few charters so I had some expectations.  But, in the end, I was very disappointed.

  • The captain drove the boat like a madman bouncing all of us around and never really gave any directions.
  • His first mate had only been doing this for 2 weeks and while more personable wasn’t much help.
  • Apparently, they have to catch their live bait every morning which ate up over an hour of our trip before someone shared some of theirs with him.
  • And, after a 4 hour trip, we only caught two catfish.

To make it worse, when we pulled in there were boats unloading all kinds of huge fish.

So, did we hire the wrong boat?  Did we get ripped off?

I don’t know, but I know that the paper said that the waves were so ruff that 4 boats capsized the day before leaving fishers in the water being tossed around and requiring the coast guard to save them.  (This was certainly not what I wanted.)  I also know I had a choice between bay fishing (more calm) and gulf fishing (more rough).

My point with this comparison was:

  • Although I’ve been fishing before, like a patient going to a new provider, they could have set some expectations for me by knowing what they do compared to others.
  • Communications are key.  If the captain had provided some perspective on what he was doing instead of just doing it, I might have had a better expectation and perspective.  Do fish bite in rough water?  Why would they catch a lot in the gulf and nothing in the bay?  Were others catching more?

Now if only fishing would move to a pay-for-performance experience then I would have left there disappointed but not having paid for being disappointed.

2 Responses to “Setting Expectations As First Line Therapy”

  1. Great post and analogy George. I think the quality of any experience would improve if consumers paid for performance. Furthermore, communication between physician and patient is extremely important, but remember that “communication is a two way street paved on trust”. With that in mind, here is a great article that provides some tips to patients about asking the right questions when you visit the doctor.

  2. I definitely agree that you need to educate patients and discuss their expectations and well as what is reality.

    In the end, the patient is the one who will decide whether or not to be complaint and understanding goes a long way. That said, often, there is a good deal of denial to wade through as well.

    Do you know of any studies of improved complaince when patients had continued counseling or therapy alongside the medical tratment. Would make an interesting study.

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