Challenges to physician–patient communication about medication use: a window into the skeptical patient’s world

Tanya Bezreh¹, M Barton Laws¹, Tatiana Taubin¹, Dena E Rifkin², Ira B Wilson^1
1Health Services Policy and Practice, Brown University, Providence, RI, USA; ²Divisions of Nephrology and of Preventive Medicine, University of California, San Diego, CA, USA

Abstract: Patients frequently do not take medicines as prescribed and often do not communicate with their physicians about their medication-taking behavior. The movement for “patient-centered” care has led to relabeling of this problem from “noncompliance” to “nonadherence” and later to a rhetoric of “concordance” and “shared decision making” in which physicians and patients are viewed as partners who ideally come to agreement about appropriate treatment. We conducted a qualitative content analysis of online comments to a New York Times article on low rates of medication adherence. The online discussion provides data about how a highly selected, educated sample of patients thinks about medication use and the doctor–patient relationship. Our analysis revealed patient empowerment and self-reliance, considerable mistrust of medications and medical practice, and frequent noncommunication about medication adherence issues. We discuss how these observations can potentially be understood with reference to Habermas’s theory of communicative action, and conclude that physicians can benefit from better understanding the negative ways in which some patients perceive physicians’ prescribing practices.

Keywords: patient–provider communication, trust, medical decision making, dissent and disputes, culture of medicine, health literacy