Taking Responsibility

Discuss all medical advice, diagnosis, and treatment with your healthcare provider.

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The Basics

Introduction

Good healthcare is achieved through an active and positive partnership between you and your healthcare professional (your doctor, nurse practitioner, physician assistant, or whomever is taking care of you, also referred to as your clinician). When you discuss a problem with your healthcare professional, you will often be given advice on how you can improve or help your health condition. This may include suggesting that you change aspects of your lifestyle, take some medication, come for regular checkups or consult a specialist for more information on your problem. Often these suggestions involve specific instructions for you to follow. Understanding and following the instructions of your healthcare professional is called adherence and/or compliance.

Each individual chooses whether to follow these instructions and become adherent and compliant with his or her clinician's approach to addressing a particular health problem. Your healthcare professional, of course, believes that following the instructions is the best way to address your problem. If you have concerns about this, you should talk to your healthcare professional about why you may not be comfortable with his or her instructions. Think of your individual healthcare system as a team of interested people, perhaps including your spouse, family member, or a friend in addition to the healthcare professionals you consult. Because it is important that you be part of the decision making process, you will need to speak up, ask questions, and take some responsibility for your health—no one person or medicine can 'fix' you without your involvement. Becoming involved in your own health will make an important difference in solving your health problems and keeping you well. You will need to understand why your healthcare professional has given you certain instructions so that you will be inclined to adhere to his or her directions. This will enable you to more likely agree to the recommendations or discuss with your healthcare professional why you might choose not follow them.

In the sections below, you will learn about good communication, the importance of following instructions and being adherent or compliant, and how this will improve your health.

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What do we mean by good communication?

Communication is very important in improving your health care, and it is important for you to be prepared to ask questions when you visit your healthcare professional. The term 'clinician' is also used to describe a person who is your healthcare professional; this person could be a doctor, nurse practitioner, physician assistant, nurse, or any qualified healthcare professional you have chosen. Everyone communicates differently, but it is important for you to think about how you communicate with your healthcare professional. Here are some questions to ask yourself about this:

• Do you feel comfortable talking to your healthcare professional?
• Do you feel that your healthcare professional understands the problems you have?
• Do you explain your problems in a way that provides important information to your healthcare professional when he or she is making a diagnosis?
• Do you leave out certain details because you may have forgotten them or you are nervous or embarrassed about bringing them up?
• Do you try to ask your healthcare professional questions about your problem(s) and the treatment for them in a way that allows you to have a better understanding yourself of the reason for your visit?
• Do you feel that your healthcare professional is sensitive to your feelings and your personal cultural background?

Of course, it is also important for your healthcare professional to think about how he or she can communicate effectively with you.

The result of good communication between you and your healthcare professional is that you will feel that you are being listened to and that your problems are being taken seriously, which means you can have confidence that you are getting the best possible advice. If you are feeling uncomfortable or unsatisfied with your healthcare professional—or even angry—then communication with this person may need to be improved. This is something you and your healthcare professional should work on together.

How will better communication with your healthcare professional improve your adherence to treatment management and better health outcomes?

Good communication is very important to improving your health care. In fact, people who communicate with their healthcare professionals tend to be more adherent to the instructions they are given and more satisfied with their overall healthcare. Of course, communication works both ways. When healthcare professionals communicate well with the patients who see them for their health problems, statistics show that these patients experience a greater improvement in their health outcomes.

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Feeling safe with your health care

Health care is complicated. For example, there can be many possible reasons for a particular health problem, and the reason may not become clear until certain tests have been performed and/or after a period of time passes. Since it is complicated, things may not always go the way you want them to, and sometimes events occur that are different from what you originally expected. Sometimes things can even go wrong in such a way that they cause harm. Unfortunately, this occurs in about one out of every 10 hospital admissions before, during, or after a hospital stay.

Most problems occur because errors were made, and it is the responsibility of healthcare professionals to look for ways to prevent errors from occurring. However, improving safety in health care is not just the responsibility of healthcare professionals and there may be things that you can do to help prevent your health care from going wrong. Here are some suggestions:

• Take an active role in your health care
• Learn as much as you can about your health conditions and their treatments
• Keep an up-to-date list of all the medicines that you take (including prescription and over-the-counter medicines, vitamins, and herbs)
• Understand why you are taking the medicines that you have been prescribed
• Take responsibility for finding out the results of every test that your doctor orders for you
• Make sure you understand what the different treatment options are for your health conditions
• If you need an operation, make sure you understand everything about it and what to expect before, during, and after
• After you see your healthcare professional, make sure you have a clear idea of the necessary steps you should take and ask when to schedule the next visit

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Communicating with Your Healthcare Professional

Before the Appointment

1. Be prepared. Prepare for your visit by organizing ahead of time. Write notes about any symptoms or problems you've experienced since your last visit. Be specific; don't just say, "My arm hurts." Describe what happens when you move your arm in certain ways—when you dry your hair or get laundry out of the washing machine, for example. Jot down how often you experience pain, how long the pain lasts, and what you do to make it go away.

Not having enough time can be a big problem when you're seeing your healthcare professional. Taking charge and being organized can improve the quality of your visit. Keeping a notebook of your health can help you save time. Try to keep track of the following items by writing them down:

1. Symptoms—location, duration, and what they prevent you from doing; write down what brings them on, what makes them worse, and what makes them better
2. List all your healthcare professionals and why you see them.
3. List all your medications, including their strengths and your dosing schedule. IMPORTANT: List all the vitamins, herbs, minerals, supplements, and over the counter medicines you take, even if only occasionally.
4. List prior and current medical conditions and surgeries. If you went to the emergency room for anything, list the date and reason.
5. List tests you've taken in the past 24 months including mammograms, blood tests, and X-rays.

During the appointment: It is a good idea to always take someone with you when you see your healthcare professional to listen, help take notes, and/or clarify something you might not understand. But don't just show up, be prepared.

1. Expectations: Tell your healthcare professional how much information you want and what you want out of the visit. Let your clinician know what you expect to happen at your visit. Do you want to know the cause of your problem or just how to manage it? Do you want to know how the diagnosis will be made and how accurate the test is for diagnosing your condition? Do you want to know about treatment options or just the treatments your clinician selects for you? Learning about your condition can help you become a better patient in identifying certain signs and symptoms that might help your healthcare professional help you. If you want to learn more about your condition, ask him or her to give you some information—or perhaps to recommend a Website if you have access to a computer—so you can read and learn more. Be sure you are only looking at trustworthy sites such as www.healthfinder.gov or www.nlm.nih.gov; both are reliable government sites. Look for sites where the content has been written by healthcare professionals and is updated regularly.
2. Speak up: Be honest; don't be afraid or embarrassed. You are a major component of the team that is going to make you better, so you have a responsibility to trust and talk openly about everything that could have an impact on your condition. Your lifestyle is important, and you may not be proud of the fact that you smoke or use illegal substances, but you must tell the clinician the truth. If you don't understand something, ask for an explanation and don't be afraid to ask questions. It's okay to ask the person who's explaining something to you to slow down, to draw you a picture, or to repeat something. You should ask for an alternative treatment if you don't think you're going to comply with the one that's being proposed. It's also okay to think about a decision you make during an office visit or to change your mind. Keep in mind that you are the most signifcant partner in your own care.
3. No-no's: Emotions, unrealistic expectations, and anger can all get in the way of good communication. When emotions are high, logic is low. Anger, fatigue, and frustration are all normal feelings, but reason and common sense are important to help improve communication and get positive results from your office visit. Time limitation is a factor in all medical visits, so it is critical to present the facts. List your reasons for being there in the order of their importance and explain what you expect in a reasonable manner. Try not to get emotional when you present the specific data.
4. Before you leave: Are you satisfied? Take a moment before you leave the office to think about what took place during your visit. Do you understand what you are supposed to do and what medication you are to take? Or are you confused? Do you need written instructions? Ask someone in the office to clarify what isn't clear to you before you leave. Leave feeling confident that you understand what just took place and you know what you need to do.

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Empower Yourself

You have been prescribed a medication; the following are some questions you might want to ask your healthcare professional:

• What is the medicine's name, and what is it supposed to do?
• How and when do I take it, and for how long?
• While taking this medicine, should I avoid
  • certain foods or dietary supplements?
  • caffeine, alcohol, dairy products, or other foods or beverages?
  • other medicines, both prescription and over-the-counter?
  • certain activities, such as driving or smoking?
• Will this new medicine work safely with the other prescriptions and over-the-counter medicines that I'm already taking?
• Are there side effects, and what should I do if they occur?
• Will the medicine affect my sleep or activity level?
• What should I do if I miss a dose?
• Is there written information available about the medicine? (At the very least, ask the doctor or pharmacist to write out complicated directions and the names of medicines.)

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Tips on taking your medications: Always get your prescription filled immediately and begin taking the medications immediately.

1. Talk to your healthcare professional and pharmacist regularly about your medication. Understand why you are taking a drug and what results you can expect from taking the medication, including both the benefits and possible side effects and when you might expect to notice them.
2. Do NOT stop taking any drugs without telling your clinician immediately, and always tell him or her why you've decided to stop.
3. Ask what you should do if you miss a dose; there may be different instructions for different drugs, so if you are taking more than one drug, write down what you should do if you miss a dose for each drug you take.
4. Be sure to order your refills at least 3 to 5 days in advance of running out.
5. If you cannot afford your drugs, speak to your pharmacist or healthcare professional immediately.

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Tips to help you comply with taking your medicines correctly each day

Always get your prescription filled immediately and begin taking the medication immediately.

1. Take your medicine at the same time every day.
2. Coordinate the time you take your medicine with something you do every day at more or less the same time, such as brushing your teeth, going to bed, or with meals. (Make sure you know whether to take your medicine with food, on an empty stomach, without dairy or other food restrictions; this is very important.)
3. Keep a calendar, perhaps on the refrigerator or some other convenient place, and write down when you've taken your medication. Use a different colored pen for each pill.
4. Try using a pill box marked with the day of the week; this is especially good when you go away from home.
5. Use a beeping alarm on your watch, stove, or computer as a reminder.
6. Ask a friend to phone you to remind you, and offer to do the same for them.
7. Ask your pharmacist to recommend ways to help you organize your medications and when you should take them.

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Glossary of adherence terms

Healthcare professional—A doctor, nurse practitioner, physician assistant, nurse, or qualified healthcare professional you have chosen, also known as a clinician

Adherence—The extent to which a person continues an agreed-upon regimen of treatment under limited supervision, oftentimes under conflicting demands. Adherence with recommended and/or prescribed health treatments means that a person is following a clinician's instructions. Adherence is more likely when there is agreement and confidence regarding the medical diagnosis; it is less likely if there is uncertainty about the nature of an illness and/or the effects of certain treatments for the illness, especially when it comes to medications. Another word for adherence is compliance.

Adherent—Agreeable to following instructions over time on one's own.

Compliance—Compliance with recommended and/or prescribed health treatments means that a person is following a clinician's instructions. Compliance is more likely when there is agreement and confidence regarding the medical diagnosis; it is less likely if there is uncertainty about the nature of an illness and/or the effects of certain treatments for the illness, especially when it comes to medications. Another word for compliance is adherence.

Compliant—Obedient and agreeable to follow instructions on one's own.

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Resources

Personal medical history chart; includes past history and schedule of preventive activities (for example, Pap smears, mammograms, blood pressure and cholesterol checks)
Medication list
Mood diary
Food diary
Sleep diary
Exercise diary
Compliance diary: medications, meals, exercise, etc
Asthma management plan
Diabetes management tool: recording your blood levels and targets
Fiber diary (IBS)

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References

1. Thomas EJ, Studdert DM, Runciman WB, et al. A Comparison of Iatrogenic Injury Studies in Australia and America. 1: Context, Methods, Case mix, Population, Patient and Hospital Characteristics. Int J Qual Health C. 1999;12:371-378.

2. Post DM, Cegala DJ, Miser WF. The other half of the whole: teaching patients to communicate with physicians. Family Medicine. 2002;34:344-352.

3. The Royal Australian College of General Practitioners. 10 tips for safer healthcare: what everyone needs to know. Available at http://www.racgp.org.au/10tips. Accessed July 10, 2007.

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