Taking Our Medicine — Improving Adherence in the Accountability Era

A new patient with an abnormal electrocardiogram comes to your office. He is 53, smokes, and has hypertension and hyperlipidemia. Though he comes for preoperative risk evaluation, he needs more than “medical clearance” — he needs a primary doctor. Given his risk factors and hesitance to change his lifestyle, you recommend aspirin, a statin, and an antihypertensive. When he doesn’t show up for his stress test, you call him, and he says he doesn’t understand what the fuss is all about — he feels fine. “Why don’t you wait until something is wrong with me to give me these medications?” he asks, launching into a litany of justifications for not taking them: cost, nuisance, potential side effects, not wanting to put anything “unnatural” in his body, and lack of perceived benefit. You attempt to educate him about his risk, but he says, “No disrespect to you, Doctor, but I’ve just never been a pill person. But,” he adds, “if something were to happen, you would still take care of me, right?”