Everything you do, you do for your patients—to help them lead healthier, happier, more pain-free lives. So, I can only imagine how frustrating it must be when a patient misses an appointment, skips home exercises, or in some other way fails to comply with your well-meaning requests. You are, after all, a doctor—a musculoskeletal expert who wants nothing more than to see your patients recover. If begging and pleading has gotten you nowhere, here are five things you can do to improve patient compliance in your clinic:
1. Communicate Clearly
Let’s start by giving patients the benefit of the doubt. After all, most of them genuinely want to get better, too. So, maybe they just misunderstood what you were saying. In this article, Heidi Dawson, a sports injury therapist in the UK, writes that she often sees patients who have already sought treatment elsewhere but still don’t understand the clinical nature of their injury or the previous therapists’ goals for their treatment. When they come to her, Dawson explains the problem and the cause of their pain in “a way they can understand, avoiding overly complex details or confusing Latin or scientific names.” Dawson also uses “images, models, or physical demonstrations to help make [her] point.” According to Dawson, “Clients appreciate this and like to know what is hurting and why it is hurting. If they understand at least the basics of their injury, they are more inclined to adhere to a rehab program as they can see why they are doing it.”
2. Focus on the Positives
To borrow a phrase from WebPT writer Brooke Andrus, there are no Negative Nancies or Pessimistic Peters allowed in therapy—and that goes for you, too. After all, positivity is contagious, so start smiling and focusing on even the tiniest improvements in your patients health and wellbeing. That way, he or she will be more likely to keep up the good work and not get discouraged by hitting a healing plateau. Dawson writes, “Reassurance, positivity, and praise…can make all the difference and help encourage patients to continue with their efforts.”
3. Send Automatic Appointment Reminders
In our increasingly busy lives, it’s becoming more and more challenging to remember things like where we put our car keys or our sunglasses. But we rarely forget our phones. Take advantage of this umbilical-cord-like attachment and implement automatic appointment reminders for your clinic. A few days before your patient’s next treatment session, he or she will receive a custom reminder message from you via phone call, email, or text with the date and time of the appointment. Sounds simple, but it could help you reduce no-shows by up to 30%.
4. Use A Multimedia Home Exercise Program
Just as I said above, clear communication is key. And that’s especially true for home exercise programs. One of the main reasons patients report not completing their home exercises is that they’re not confident in their understanding of the exercises or how to execute proper form. As Dawson writes, “Clients forgetting to do exercises or how to perform them correctly is a big problem for therapists and can seriously hinder progress.” While she recommends providing patients with “exercise handouts” to facilitate their learning, we recommend going several steps further and providing patients with an emailable multimedia home exercise program that includes pictures, videos, and step-by-step instructions. This way, regardless of your patient’s learning style, he or she will be able to follow along.
In addition to providing patients with the right tools to complete their home exercises, Dawson also recommends keeping the exercise list short and to the point: “Keep the exercises to a minimum. It’s better that they perform only two or three key exercises that they can fit into their day, than not performing a long list of exercises.” Additionally, she suggests linking the exercises to an every-day ritual to help patients remember. For example, “standing stretches or calf raises can be performed while cleaning their teeth, washing up or waiting for the bus.”
5. Get a Verbal or Written Commitment
Taking a page from Dr. Robert Cialdini’s research on the psychology of persuasion (Influence, Principle #3 Commitment and Consistency), people are more likely to follow through when they’ve made a verbal or written commitment. You see, people want “to be and look consistent within their words, beliefs, attitudes, and deeds.” Not only is this positively reinforced within our society, but also inconsistencies lead to all sorts of cognitive dissonance and antagonizing internal questions, like: “Am I a flake?” “Am I irresponsible?” or “Am I a liar?” And no one wants to think of themselves like that.
The trick for upping compliance, though, is to start out small and build. Don’t ask your patients to commit to doing every single prescribed exercise every day for the next month—that’s simply too big a bite. Instead, start by asking them to complete their homework for the time leading up to their next session. Then, do the same thing at the next session—and so on and so forth. This should work especially well in a group therapy setting, when the patient makes the commitment—and demonstrates follow-through—in public. According to Cialdini, “Commitments are most effective when they are active, public, effortful, and viewed as internally motivated (uncoerced).”
What have you done to increase patient compliance in your clinic? What worked and what didn’t? Tell us in the comment section below.