Communication
CPSA · Communication · Information giving
The patient not taking their medication
Non-adherence is usually rational from where the patient is standing. Find the actual reason — cost, side effects, belief, complexity, or never having understood why — before doing anything else.
The framework
Ask without judgement
- Normalise first, then ask openly. “Most people miss doses — how often does it happen for you?”
Find the reason
- Intentional: side effects, beliefs about harm, feeling well, distrust, cost.
- Unintentional: forgetting, complexity, dexterity, swallowing, packaging, chaotic circumstances.
Address that reason specifically
- Side effects: switch, reduce, or manage them — do not just reassure.
- Beliefs: explore rather than contradict, then give the specific information that matters.
- Complexity: simplify the regimen, once-daily where possible, dosette box, blister packs, reminders.
Agree and review
- A shared plan, one change at a time, with a review date. Respect an informed decision not to take it.
Phrases that work
- “Lots of people find it hard to take tablets every day. How have you been getting on with them?”
- “When you say they did not agree with you — what happened?”
- “Would it help if we could get this down from three tablets a day to one?”
- “It is your decision, and I will support it either way. I do want to make sure it is an informed one.”
Pitfalls that lose marks
- Asking “you are taking your tablets, aren’t you?” — which guarantees a yes.
- Repeating why the drug is important without finding out why it is not being taken.
- Dismissing a side effect the patient is genuinely experiencing.
- Adding a drug to fix a problem caused by not taking the existing ones.
- Treating an informed refusal as a failure to educate.