Why patients don’t adhere to doctors’ orders

Outcomes in chronic disease management are directly affected by patients taking the medications and making the lifestyle changes that doctors prescribe. The Centers for Disease Control and Prevention report that between $100 and $289 billion is wasted every year on patient nonadherence.[1] That is between 100 and 289 BILLION dollars a year wasted on healthcare just because people don’t take action on their doctor’s prescriptions.

And the issue is not simply the high cost of prescription meds.

According to an article in the New England Journal of Medicine, written by David M. Cutler, Ph.D. and Wendy Everett, Sc.D., “even if drugs were free, nonadherence would persist: one recent study showed that even among patients who have health plans with no cost sharing for medications, rates of nonadherence were nearly 40%.”[2] If nearly 40% of patients who don’t have to pay for their meds still don’t comply with doctor’s orders, then this shows us that clearly, cost isn’t the only issue.

Reasons Besides Cost

Cutler and Everett cite several reasons why patients don’t take their meds, among them: lifestyle, psychological barriers, and health literacy, but they cite the “patients’ personal attributes” as having the strongest influence over whether they comply with the doctor or not.[2] Indeed, they go on to say that “[e]ngaging and supporting patients in improving their adherence are critical to improving health outcomes. In today’s system, however, there are neither the incentives nor the support systems to do so.”[2] Wearables present a potential addition to the system that could support both the doctor and the patient by helping a patient overcome their “learned helplessness” through empowerment and community building.

Psychological Barriers and Chronic Disease

In their famous 1965 study, Martin Seligman and his colleague, Steven Maier, coined the phrase “learned helplessness,” a phenomenon that causes an individual to passively accept their plight and make no attempt to change it. This theory has been applied to the way patients deal with depression and other chronic illnesses and still applies today. Scott Coulter, in his 2015 article “Diabetes and Learned Helplessness,” explains: “Learned helplessness, as the name implies, refers to a phenomenon where we start to project failure onto every decision; where we start to overthink every step; and where we start to give away the power of leadership in our own lives.”[3] So, despite the vicious, and expensive (either personal or systemic), remission cycles, it is people’s personal attributes, their human nature and the force of long-standing habits, that leads them to avoid the issue entirely—and in doing so, they avoid making healthful changes and taking medication.

Interestingly, in 2016 Seligman and Maier took a fresh look at their 50-year-old theory, and revealed that people can, in fact, change. People can learn to control their own destinies as this excerpt from their chapter, “Learned Helplessness at Fifty” states, “This passivity can be overcome by learning control,” they go on to say that “We speculate that default passivity and the compensating detection and expectation of control may have substantial implications for how to treat depression.[4]

This is encouraging news. If people can unlearn passive reactions and then learn to control their situations, then exponentially rising healthcare costs and chronic disease diagnoses won’t look so bleak. All doctors have to do to help patients break out of learned helplessness is provide patients with tools that empower them which will inevitably move us in a positive direction, and it could all happen sooner than we think.

Conclusions: Wearable Medical Devices can Encourage Improvement in Patient Adherence

Patients with long-term diseases often feel helpless; they need outside influences to help empower them. Wearable medical devices can help control a patient’s risk factors by encouraging, empowering and including them every day in making the right choices. Take heart disease and diabetes, for example, two chronic conditions that require adherence to long-term regimens. The more information a patient has, the more they are involved in, and understanding, their own health care, and the more likely they are to stick with their therapy. A wearable device could be the solution.  A wearable can offer reminders that ping a patient to take her prescribed meds, or take her walk, they could improve long-term adherence and help her feel connected to her physician even when she is home and miles away from the clinic. A wearable can offer human connection between patient and doctor, community building amongst other patients, and a way for the patient to stay on track with instant access to instructions on what to do next via clinical-grade information.

The combination of socio-economic and psychological factors of chronically-ill patients have created such a massive effect that no one solution, in and of itself, can combat chronic illness. However, one thing is certain: the more information patients have, the more they take agency in their own treatment, the more in control they feel, and the more in control they are, the more likely they are to adhere to doctors’ orders and move towards wellness.


[1] http://medcitynews.com/2016/03/the-3-billion-wasted-drop-in-the-well/?rf=1

[2] http://www.nejm.org/doi/full/10.1056/NEJMp1002305

[3] http://www.diabetesselfmanagement.com/blog/diabetes-and-learned-helplessness/

[4] http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2016-30868-001