Do we really do what the doctor advises?

I saw my rheumatologist today and the first thing he wanted to know was whether or not I am actually taking  the drugs he has prescribed and how closely I am following the dosage and frequency instructions.  I imagine he has seen the recent stories and the study about adherence to medications in RA and wants to see for himself if those numbers reflect the habits of his own patients.

This is not a a subject we have ever discussed but perhaps the current headlines from EULAR data have made him wonder if he has been wrong in his assumptions.

It was impressive that he wanted to find out for himself and was refraining from blaming patients until he had more data to work with.  

                                          answersincme.com

We can see from Dr Montori's work on noncompliance that there are many reasons people may not follow the advice of their doctors exactly. And the reasons he lists do not even consider the cost of medications which forces some people to make their medications last longer by taking them sparingly.

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Even the most careful of us sometime alter the scheduling of our medications if they have a negative effect on another important facet of our life. It's such a struggle to live a normal life with chronic illness that when it comes to graduations, weddings, work and other life events, I think most of us have changed the dosing schedule on occasion to something that spares our longed for "real" lives.

methotrexate vials

I would argue that this is both minor and necessary. I just watched a depiction of my life in jellybeans as seen on Eric Alper's blog and I think we all want to make the most of the few jellybeans we have left for ourselves.  

my jellybeans

We would all like to have concordance between us and our doctors and the current movement to patient empowerment is helping us to move in that direction.

Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature.