It Doesn’t Add Up

Poor adherence is a problem we all confront regularly. When I prescribe long-term medications, such as antibiotics for acne, I write the prescription for a 1-month supply, plus refills, and schedule a follow-up visit 2 months later. If at this visit the patient is not doing as well as expected, I ask how many pills he or she is taking each day. The answer is usually "You told me to take 2 a day" or "The bottle says 2 a day." I then ask how many bottles he has finished. Typically, the patient admits he is still on the first bottle. I point out that he could not have taken the required number of pills every day for the past 2 months and still be on the first bottle. It's hard to argue with the math. Thus, without my needing to lecture or scold, the patient realizes that the medication can't be expected to work when it remains in the bottle.