I have a patient, and the patient is “non-compliant” with their medications.

I don’t like the term “non-compliant”. There are so many reasons for not taking medications that are missed due to the term “non-compliance” and the biases and judgements around the term #MedTwitter /1

I work in a hospital. We ward round as a team, and there are definitely not enough chairs in the room for the medical team.

But, I make a point of sitting down. Not only is it easier to write in the handwritten patient notes if they are on my lap, /2

But even when I am holding the bedside file with observations in it, or if I am running the ward round, I sit.

Partially, it’s because I faint

But mostly it’s because I don’t like the power differential that exists when I stand over the patient /3

I am not better than my patient. I have more formal medical qualifications, but I don’t think that’s a good enough reason to create a power differential. My patient may have a rare disease I’ve never heard of, or may be an expert in their disease. Who knows? I certainly don’t /4

Even if they don’t know anything about what’s going on, they are experiencing it. They are the expert in their lived experience. It is a privilege to have patients share their experiences with us /5

So I always try and sit, so I am on the same level as my patient. And I talk to my patient. I really try to see them. I’m professional, but I try and make them comfortable and signpost things that they might find awkward /6

Now this patient in particular was an older man. I signposted that we were going to talk about not taking his tablets: I told him that I had found that there were lots of reasons to not take tablets, /7

such as forgetting, or not realising what they were for, so people didn’t prioritise taking them. I told him that I struggled to remember to take tablets when I needed them, too /8

And this reserved, older gentleman, who has been “non-compliant” for years, told me that he didn’t forget, he just didn’t see the point /9

He was passively suicidal. So I explored that. I did a risk assessment. And I asked if he would feel comfortable talking to someone about how he was feeling, and he said yes. I thanked him for sharing how he felt with me /10

And I told him gently that some of the medications that his GP had him on could help with how he was feeling. He was shocked /11

I told him that sometimes, doctors and patients walk out of a room thinking that the other person had understood what they were saying, and that isn’t always the case. I told him that I wanted clear communication with my patients, /12

And I asked him to please let me know if he didn’t understand anything I said. I told him that after 10+ years of ongoing medical education, sometimes I forget that the word I used isn’t a commonly used word. /12

I showed him the action for dysdidokinesia, and we had a laugh about how long it took me to be able to spell such a long word, and the irony of having such a long word for something that looked so simple /14

I then went through his medication list. I explained every. single. medication. I explained how not taking each medication could be contributing to his symptoms. He asked questions, and I answered them /15

At the end of it, he thanked me for taking the time, and told me that now he was going to take his tablets, because they were given to him to help him feel better. I told him that we would also give him a printout of when to take his tablets, and what each of them were for /16

Because we are all human and sometimes, even with the best of intentions, we forget to take our tablets /17

And look, this consult took a lot longer than a normal consult. My patient list was smaller than normal, and I had the time. There are many days when I don’t have the time, and other doctors don’t have the time /18

And I wonder just how many patients are falling through the cracks because we don’t have time. And how many of them are not feeling seen or heard, and are struggling, feeling alone, because the systems are built efficiently, and doesn’t give us enough time /19

Everyone is trying the hardest they can, with the skills and information they have. We need to believe in our patients, and believe this of ourselves /20

And I think I am blessed with more time with my patients than a lot of other doctors. But I know that, even when I am feeling more rushed, I will take the time to sit, look my patient in the eye without judgement, communicate clearly, and see them as a person /21

Because if it makes a difference to one person’s life, I’m going to keep trying to make a difference with others. Connecting with my patients makes us both feel better, it helps us both, and it leads to better outcomes /22

So please, next time you see the word “non-compliant” take some time to talk to your patient about why they don’t take their meds. They just might surprise you, make your day, and change your practice for the better /23