Why Your Kidney Disease Management FAILS

In the advanced healthcare systems of the world, the term "non-compliance" is often used to describe a patient's behavior when they fail to follow medical advice or treatment plans. Non-compliance is an indication that the patient is not acting in their best interest regarding their health or managing their disease. There are several factors contributing to non-compliance; some are within the patient's control, while others are beyond it.

However, in Pakistan, the term "non-compliance" is not commonly used. The primary reason is that our healthcare system is not advanced enough to place the entire blame on the patient. Secondly, the educational and intellectual levels of patients in Pakistan vary greatly. These are two different concepts that I will explain further at another time. The reality is that the average Pakistani patient's level of education and intellectual understanding isn't high enough to even perceive what non-compliance truly is.

Challenges in the Pakistani Healthcare System

Having observed and followed up with hundreds of patients, I can confidently say that our follow-up rate is around 90-95%. Very few patients completely stop following up with us. This extensive experience has provided us with significant data on patient behavior, and we are increasingly identifying clear patterns in this regard.

In today's discussion, I want to share this information with you, focusing on how healthcare views patient non-compliance. Small actions that patients often ignore or don't bother with can shape their image in the eyes of healthcare providers and doctors.

The Unique Dynamics of Patient-Doctor Relationships in Pakistan

Hello, I'm Dr. Awaz from Expert Kons Clinic in Lahore. Currently, I'm speaking from my travel studio, but I hope to record the next episode, or the one after, from my home studio or the Expert Kons Clinic studio in Pakistan.

This video is essentially a collection of my grievances with patients. You might be thinking that it's unusual for a healthcare provider to have complaints against patients—usually, it's the other way around, with patients complaining about doctors and the healthcare system. But today, I invite you to explore this perspective from my side as well.

The Issue of Non-Compliance

Non-compliance among patients is something I wish to reduce, as it significantly impacts their health and the management of their conditions. The first and foremost issue is patients not following the basic instructions given by their doctors. Let's start with diet.

Unfortunately, most doctors in our healthcare system do not focus on or discuss healthy lifestyles. This is why our approach to patients is quite unique. Typically, patients are handed a diet chart with little explanation, and whether they follow it or not is of no concern to the doctor. There's no follow-up or emphasis on why these instructions are important.

However, in our practice, we genuinely care about our patients' well-being. We spend a considerable amount of time with each patient during their consultation, focusing a significant portion of that time on healthcare aspects like exercise, sleep, diet, and social management. I understand that some aspects, such as managing stress or maintaining a healthy social life, can be challenging. But there are certain things I absolutely do not compromise on, like exercise.

The Importance of Exercise and Diet

When a patient does not exercise, I almost write them off, predicting that their chances of improvement are slim and that their disease is likely to worsen. It seems as if they're just passing the time, taking one pill today, adding another tomorrow, and so on.

The second major issue where patients often disappoint me is their adherence to dietary instructions. If I have a 15-minute consultation, I spend around 10 minutes on improving the patient’s diet. In a 30-minute visit with a new patient, I dedicate about 15 to 17 minutes discussing how they can enhance their health through better eating habits. A key point in these discussions is the importance of consuming whole and healthy foods.

For example, I emphasize the need to increase the intake of fresh vegetables and salads, incorporate more protein sources like eggs, chicken, beef, and fish, and reduce the consumption of bread from three times a day to once a day.

Challenges in Patient Compliance

Unfortunately, when I follow up a week later and check the patient's progress, such as their kidney function through creatinine levels, I often find that they have not adhered to the dietary advice. Despite clear instructions, they continue to consume bread three times a day. This is a major issue in our 21st-century lifestyle. Overconsumption of bread and rice leads to insulin resistance, weight gain, and contributes to various diseases. It's crucial that we limit bread and rice to just once a day.

Non-Compliance with Medication

Another significant form of non-compliance involves medication. Patients often take it upon themselves to adjust the dosage, skip doses, or not start the medication at all. This behavior manifests in various forms, and it frustrates me to no end.

When patients fail to follow the prescribed medication regimen, it not only harms their health but also confuses the clinical outcomes we're trying to measure. For instance, if I expect a certain medication to reduce proteinuria from 1000-2000 milligrams to 200 milligrams after three months, I am left puzzled if the expected improvement doesn't occur. This leads to uncertainty about whether the medication was ineffective or if the patient did not take it correctly.

Communication and the Importance of Following Instructions

I urge patients to avoid non-compliance in both medication and diet. Follow your doctor’s instructions logically, and if you feel that something doesn’t seem right, discuss it with your doctor. Many of my patients frequently ask such questions, and I encourage this dialogue.

For instance, there's a common concern about eating egg yolks and beef, with patients worried that these foods might raise cholesterol levels. I address these concerns with simple logic: I advise them to eat these foods and then get their cholesterol levels checked. There’s no need to worry in advance; just follow the advice and then measure the outcomes.

If your doctor is unwilling to have such discussions with you, then I always say, "You are more than welcome at Expert Kons Clinic in Lahore," where we not only welcome your questions but also honor you for asking them. These questions help us better understand our culture and healthcare system.

The Issue of Appointment No-Shows

Another common form of non-compliance is patients not showing up for appointments. Unlike other systems where patients can just walk in, our system requires appointments to be made in advance through calls or texts. This process is lined up and organized, so it's not comparable to other systems.

Due to this non-compliance, we had to introduce upfront payments for online patients. Although I am a strong advocate of this policy and am working in Pakistan with the vision that healthcare, like any other service, should be paid for upfront. When every barber, cobbler, and tailor is paid for their work immediately, why should healthcare be any different? By taking payments upfront, we protect the dignity of the profession and ensure that patients value the services they receive.

Conclusion: Enhancing Patient Compliance for Better Outcomes

In summary, non-compliance is a significant issue in healthcare, particularly in Pakistan, where the educational and intellectual levels of patients may not always align with the expectations of the healthcare system. As healthcare providers, it is our responsibility to educate and guide our patients, but it is equally important for patients to trust and follow the advice given to them.

If you find yourself questioning your treatment plan, engage in an open and honest discussion with your doctor. And if your doctor isn’t willing to have this conversation, remember that there are places like Expert Kons Clinic where your questions are not only welcomed but also valued.

By working together, healthcare providers and patients can overcome the barriers of non-compliance, leading to better health outcomes and a more efficient healthcare system.