A Tuesday Must Read: “Confessions of a non-compliant patient”

Carolyn Thomas is the ‘Heart Sister’ of the eponymous blog, and has been a guest columnist and commenter in these pages. Via Twitter she brought to her followers’ attention this back posting which chronicles how a person who normally copes with a chronic disease can be absolutely kicked in the kishkes* when a few other physical troubles are added to the pile. Alone, they could be coped with; aggregated and on top of difficulty functioning, they make for Misery. And Misery makes for Non-Compliance. And Non-Adherence. And the Burden of Treatment gets ever heavier, and the frustration of both patient and doctor (pressed to quantify and meet goals) ever grows.

If you are designing technology around compliance, don’t be surprised if many of the people you could benefit treat it like measles if it’s not positioned right or is thinly disguised Nanny Tech. (See ‘Uninvited Guests‘)

Editor Donna will let Ms Thomas take it from here.

Related reading: Is how we are treating patients for chronic diseases (and pre-diseases) all wrong?

*Kishkes (New York Yiddish, antique) = guts.

ELabNYC Pitch Day

10 April, Microsoft HQ, NYC

The Entrepreneurship Lab NYC (ELabNYC) presented its second annual class of companies to nearly 200 life science funders, foundations, pharmaceutical companies, healthcare organizations, universities and the occasional Editor. Of the cohort of 19 companies finishing the three-month program, 56% are now funded and 25% had first customer revenue by the end of the program. Each company pitched for five minutes on its concept, its current state of advancement (including pilots/customers), its team and a funding timeline. This Editor will concentrate on the five companies with a digital health component; she was intrigued by their diversity and focus on difficult problems of compliance and diagnosis, especially dementia and concussion. (more…)

Patient non-compliance=toxic healthcare system?

Updated 20 June

A decidely contrarian view. Medication and treatment non-compliance is listed as one of the top ‘evils’ that patients inflict on the system which negatively affect outcomes and increase health costs. The doctor/hospital/insurance company laments, Why don’t they do what we tell them to do, exactly? Can’t we punish the patient for this?  But what if non-compliance indicates a bigger problem to be solved in the system, comparable to a canary’s silence in the mine when toxic gases are present? Maybe it’s because clinicians don’t take the time to understand the patient’s life and how to fit the treatment. Victor Montori, MD of the Mayo Clinic, at MedCityNews’ ENGAGE conference last week pointed out that patient non-engagement can point to the following:

  • The treatment isn’t right for that patient to begin with, and asking him to do more of it is only going to make matters worse.
  • The medication and patient options aren’t adequately explained prior to the protocol starting or the prescription–after going home and reading the side effects of the drug, or talking to a friend, the patient opts out. Or the patient doesn’t understand or trust the drug, protocol or doctor.
  • The burden of treatment or change is too much (temporarily or permanently) to handle for the sick patient (e.g. additional monitoring, diet)

To Dr. Montori, the best health system is not a ubiquitous, authoritarian one permeating every facet of life, but one that actually shrinks in size, makes it easier for the patient to follow treatment, focuses on treatments that reasonably match a patient’s lifestyle so that the person is ‘able to fully play the role he plays in his life’–in other words, meets the patient ‘job to be done.’ Mayo doc: Stop blaming patients. Healthcare industry’s take on non-compliance is all wrong (MedCityNews) Video excerpt 01:50.

Update 20 June: Full video of Dr. Montori’s talk via YouTube, Patient Centered Care–The Right Thing to Do Right (29:03)

Previously in TTA: Type 1 diabetes self-monitoring as a perpetual Battle of Stalingrad in The diabetic experience: the fly in the Quantified Selfing ointment.