Have you ever checked your schedule for the week and noticed you have an upcoming appointment with your dentist and started to sweat a little? Remember 6 months ago when you promised her that you would start flossing every day? And yet, you have fallen short of that goal. Very short. You haven’t even bought dental floss yet. You’ve thought about it and it might be sitting in your Amazon cart, but you haven’t hit, “place your order” yet. But since the appointment is coming up in just a few days, you start flossing to impress your dentist…and to alleviate the guilt of not following through.
We all get that honeymoon phase with new relationships. Similarly, a honeymoon phase also occurs with starting a diet or exercising where we are pumped up and excited to embark on a new routine with a goal in mind. The same thing can happen with a skin treatment regimen prescribed by your doctor. Initially, you’re enthusiastic and dedicated, but that might not last. Skin treatment relationships are fraught with commitment issues. Look at acne for example. Everyone wants their skin better yesterday and when we initiate a regimen (and let’s assume the regimen is concise and doable), we must set the expectation that often it takes 10-12 weeks of consistent treatment to see major results. But no one wants to wait that long. After a few days, many patients fall off the schedule or decide to head back to Sephora to try another product. Sound familiar? Commitment is hard!
Now there can also be mixed signals, sometimes from the patient, other times from the provider. Perhaps your dermatology provider didn’t explain how to use the medication or didn’t address some concerning side effects in the package insert. Or maybe they created a 10-step routine that has you overwhelmed or dizzy. Believe it or not, but we are taught to streamline treatment. Sometimes though, the regimen can get too complicated and we set patients up for failure. On the other hand, there might be mixed signals from the patient, like not telling the provider that they can’t swallow pills or prefer topicals only. A common mixed signal scenario we often face is when a patient states that they aren’t any better, but the lack of improvement isn’t because the medications didn’t work. It’s because the patient, for whatever reason, didn’t use them.
As for relationship red flags, we’ve seen them all. Some that might give you pause and others that we just tend to ignore. For treatment, that might include potential side effects or irritation from topical therapy or a treatment that just doesn’t fit your lifestyle. Cost might also be a relationship red flag as well.
The question is, should we stay together? This is the pivotal point around patient adherence. When do we decide to give treatment more time and when do you talk with your dermatologist about changing plans or breaking up with your treatment? You might feel like the medications aren’t working or that it’s a lost cause. Instead of just throwing in the towel or calling it quits, maybe the better route is to communicate. Tell your dermatology provider what you like and don’t like about the regimen. Be honest if the steps are too numerous or complicated and if you haven’t been able to follow it. Provide some solutions and work it out. Or if you just can’t agree, maybe it’s time to break up. Sometimes a new treatment truly is the best option.
Some argue that it’s on the patient’s end to follow through with their treatment and others claim it’s the prescribers responsibility. Like any relationship, it takes two to tango. Patients need to be honest and communicate their wants and needs and providers need to be clear on expectations. Providers also need to ask more questions about patient preference, lifestyle, etc. and suggest creative ways to assist patients with following their regimen. The most dangerous attitude for a provider to take is, “It’s all on the patient.” Part of treating a patient effectively and being an impactful provider is helping them carry out the treatment plan. Our responsibility doesn’t stop with just writing the prescription.
Trotter’s Take: Adherence is often misunderstood and rooted in miscommunication but it is a powerful aspect of what we do as providers to ensure positive outcomes for our patients.
Want to understand why it’s hard to follow through with your prescription regimen? Then listen to my podcast with Dr. Steve Feldman, who is an expert in why treatment plans don’t work.
