Steven R. Feldman - Treatment Adherence in Dermatology

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Successful medical care rests upon three pillars: making the right diagnosis, prescribing the right treatment, and getting patients to take the medication. Medical school and postgraduate training focus heavily on two of those elements: making the right diagnosis and prescribing the right medication. Far less attentionmuch too littleis paid to what it takes to get patients to take their medication.

As a result, the foundation for treatment success is rotten, and too often patients have less than optimal outcome because they have less than optimal adherence to treatment. Everyone knows thisincluding patients, doctors, pharmaceutical companies, insurers, and government regulators. Everyone wants adherence to be better. Improving adherence would be a win-win-win for all concerned.

How can we get there? Thch Nht Hnh, a Vietnamese Buddhist, had some very good advice: When you plant lettuce, if it does not grow well, you don't blame the lettuce. You look for reasons it is not doing well. It may need fertilizer or more water or less sun. You never blame the lettuce. Blaming the patient for poor adherence is not helpful. The responsibility is on us. The way we in the healthcare system prescribe medication is simply not a good approach for getting patients to take their treatment.

In this book, we discuss how poor adherence to treatment is or, in other words, how poorly we in the healthcare system are at getting our patients to take medication. We describe novel, basic, fundamental truths about what must be done to have any hope of getting patients to take medication well. We focus on practical tools and advance psychological methods to help patients achieve what we all want: better adherence and better outcomes.

We would like to thank Raj Balkrishnan, Scott Davis, Christie Carroll, Leah Cardwell, Elias Oussedik, and the other fellows who have conducted adherence research at Wake Forest. We would also like to thank Dr. Joe Jorizzo, Dr. Alan Fleischer, and Dr. Amy McMichael for their ongoing support, mentorship, and contribution to our research. Lastly, we would like to thank all of the students who have helped us with our research.