Thiruvananthapuram: Physicians are concerned about the increasing levels of non-compliance to medical prescriptions by patients, which have been resulting in drug resistance, recurrent infections as well as rising health care costs.

Doctors attribute this to the exorbitant pricing of drugs and also to the fact that the number of patients with multiple conditions requiring multiple medications has been going up. Lack of communication between doctors and patients has only made matters worse.

While compliance to prescriptions by patients is never one hundred per cent any where in the world, it is less than 50 per cent in our settings, says Mathew Thomas, former Professor of Medicine, Medical College.

"Often, the doctor might have been too busy to explain the prescription to the patient. Generally, if a prescription has too many drugs — a patient with diabetes, cholesterol, hypertension and heart problems might have six to 10 drugs in the prescription — then the compliance is found to be quite low," he says.

This non-compliance can often result in serious complications, about which a patient is seldom aware or is seldom told by the doctor. Taking a double dose to make up for the missed dose may turn out to be a costly mistake. Patients with chronic conditions like diabetes or hypertension, conditions that are apparently without symptoms, are more likely to be non-compliant to doctor's orders.

Tuberculosis is one disease wherein missing drug doses can lead to drug-resistant tuberculosis. Hypertension is another condition that requires the patient to be on the drugs for a lifetime. Often, when the blood pressure levels stabilise, patients skip drugs; the next time the levels elevate, it might be difficult to bring it down.

There was a time when a general physician was in full charge of a patient's health. In the age of super specialisation, patients are referred from one specialist to the other, with each doctor adding on different drugs.

"The possibilities of drug interactions are not taken into account at all by doctors sometimes and when side effects like rashes manifest, the patient might decide on his own to do away with a drug or two. Doctors should give proper instructions about every prescription, keep the number of drugs to the minimum and as far as possible, avoid drugs that are too expensive for the patient," says K. P. Paulose, consultant physician, SUT hospital.

A patient, who cannot afford to buy expensive drugs, might not complete the treatment course and this can create more harm than good, he points out.

The interval between drug doses is also important. Compliance is found to be more if a patient has to take medication only twice rather than four times a day.

Language or cultural barriers between a patient and his doctor can also lead to non-compliance. Sometimes, the patient might not have fully understood the doctor's explanation and if the doctor is perceived to be `strict,' the patient might be reluctant to ask for another explanation.

Problems of non-compliance results because doctors today hardly spend time talking to their patients, says Dr. Mathew Thomas. "Even on a busy day, spending five minutes to smile and talk to a patient can give dramatic results. If a doctor is able to establish a relationship of trust between himself and his patient, then compliance improves," he says. Major hospitals have patient counsellors to explain prescriptions to patients, as doctors are often pressed for time. According to Dr. Srijith N. Kumar, a physician, the nurse-educator concept should be encouraged in hospitals to educate patients.

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