Patient COMPLIANCE & MOTIVATION.

MOTIVATION  means  teaching one to long for the long boundless sea.

• to achieve a change in the behaviour of the patient, discussion is the predominant instrument for motivation.
• the success of a doctor’s involvement is closely related to his own conviction about the advice & recommendations for therapy.the example of the doctor is itself a motivating & demotivating factor of major importance.
• it is persuasion by logic,psychology & rhetoric.
• it is going into conviction & the objective must be recognizable, attainable, realistic & desired by the patient.
• particular grounds for motivation aggregate from the range of reasons for action such as hopes, ideals, needs.
• it is not manipulation by consciously using prohibited techniques/ doubtful tricks & suggestions or creating anxiety/guilt/shame or attacking deeply established habits/articles of faith lead to demotivation.
• cognitive/intellectual impairment or differrent cultural values block motivation from the very onset.

The art of attaining the most optimal compliance possible finally rests on exhausting all of the measures which encourage motivation  and on clearing away as many factors which lead to non-compliance as possible.

COMPLIANCE  is willingness to follow a recommendation, cooperation as a result of partnership-like-relationship between doctor & patient, not training/instant obedience/patronizing the patients.

• one must  convince about a thing, mere proof is not enough.
• it is less the result of ethics but much more of the art of successful speech.

Non-compliance:

• cannot be taken for granted as natural weakness out of old habits or forgetfulness.
• it arises due to descrepency in subjective estimation & objective findings, & undeveloped trusting relation between doctor & patient.
• its the way one resolves the internal pressure arising out of cognitive dissociation between one’s beliefs & acceptance of truth.

Compliance depends on factors pertaining to the instructions, both the doctor & patient perspectives, the particular therapy & disease.

Instructional factors hindering compliance:

success depends on well-founded recommendations given in a comprehensible content, reasonable extent & empathizing delivery.

• unspecific objective without a quantified value.
• unilaterally exaggerating the objective or overestimation of a certain type of therapy.
• usage of specialized jargon instead of conveying in simple understandable statements.
• cognitive overloading without consideration to the patient’s attention span.
• unprioritized recommendations instead of approaching one step at a time & presenting positive consequences.
• insufficient involvement of patient’s responsibility & independence.
• uncompromising & authoritative pressure on objectives without taking risks & failures into account.
• dealing in differing realities, not fulfilling the expectation of the patient & the opportunity to present his own view & experience.
• impersonal/universal statement instead of focusing on the patient’s situation.
• hypothetical statements instead of presenting a standard & present positive consequences.
• threats/shock/anxiety provoking statements  instead of giving strenght at the point where the patient could not continue any longer & awakening  hope that the therapy will be effective.
• self-worth/ self-respect attacks instead of driving performance through self-assurance & assertion.

Doctor factors:

Doctor should be a trusted confident, helper, psychologist with a motto ‘victory is possible’  & willingness to compromise for aiding sustenance towards objective.

• credibility/competence which the patient ascribes to his doctor.
• extent to which doctor established a trusting relation with the patient.
• not being a respected example.
• cool distant routine approach, not accentuating the importance of prescription.
• unanswered questions hinders the patient’s self-initiative.
• although risks to health are accepted generally, they are not applied to the patient himself.
• lecturing/preaching instead of recommending actions on appropriate facts.
• authoritative behaviour instead of partnership.
• unmotivation from the doctor himself.
• not probing the patient’s personality.

Patient factors for unsuccessful motivation:

These need persistent long-term intervention for successful compliance.

• negative attitude towards health or medicine.
• playing down of the risks to health (often from defence mechanisms).
• passive attitude favorized by excess health insurance, puts off responsibility/ self-initiative.
• habits, prejudices, fixed ideas or psuedo arguments [can balance with sport, till now nothing happened so, one cant live for health alone].
• hypochondria, limited cognition or concentration.
• fear of addiction, high anticipation of side-effects usually from the type of medication or extent of explanation or those around the patient.

Treatment factors causing non-compliance:

• impractical/stressful/incovenient & limits life quality or individual situation.
• taste,shape,size,smell of medication.
• type/extent of side-effects or detailed list of all possible side-effects provokes uncertainity/suspicion.

Disease factors causing non-compliance:

• image of disease in soceity or from media reports/critical approach on behalf of patient.
• extent of suffering.
• objective severity of disease.

Optimal measures :

1. tangible objective -standard, attainable & worthwhile, focusing on situation of patient, one step at a time.
2. present positive consequences – motto ‘victory is possible’
3. take risks & failures into account -show willingness to compromise & agreeing appointments for checking progress. [ not only does this support the patient in the belief that the doctor is really concerned about him and interested in his progress, but it also affords the doctor the chance to check compliance]

Supportive measures:

1. written info as memory aids.
2. involve a key person – concerned & acceptable, introduce a helpful person.
3. encourage self-checking, independence & self-responsibility.

Checking compliance:

1. signs of the major pharmacological response.
2. specific side-effects.
3. direct questioning of the patient.Questions such as: “Many people find it difficult to remember to take their tablets regularly. Do you find that you sometimes forget to take your tablets?” are usually answered.