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All hail the non-compliers

Copperfield has seen the light – the saviours of the NHS will be patients who don’t take their pills.

Copperfield has seen the light – the saviours of the NHS will be patients who don't take their pills.

I realise it's hardly radical or edgy to knock those who knock DNAs. After all, you only have to spend 10 minutes in the pits of primary care, chipping away at its granite face with a toothpick, to realise that non-attenders are actually a gift from the god of general practice.

But I do think those worthies who'd fine DNAs deserve a good kicking. Let's be honest – I have a number of patients I'd actually pay to not show up, and so have you. In fact, should I ever be given a real budget to play with, that's how I'd splash some cash – stuff money in the orifice that heartsinks spout symptoms from to keep them away from the NHS. Even at £50 a pop, it would be great value.

But if you want radical or edgy, chew on this – I genuinely believe the punters should be encouraged not to comply with their medication. Why? Because, the other day, I had an epiphany. Mrs Walrus (not her real name, though she is large and has whiskers) is elderly, diabetic, cardiovascularly dodgy and liable to forget to shovel the contents of a small pharmacy down her throat every day. Solution? Ah yes, that poor-compliance panacea, the dossette box.

Want to guess what happened? She went from being a happy, bumbling walrus with suboptimal biometrics to a miserable, shambling walrus suffering hypos, muscle aches and dizziness. She might live a bit longer, but she'll wish she hadn't.

This isn't an isolated case, though.

I recall a research paper in a peer-reviewed journal not long ago reporting a trial in which community pharmacists visited patients at home to encourage drug compliance. And the result, gloriously, was a distinct deterioration in outcomes1.

So the patients have it right. They're simply humouring us by pretending to take all these pills.

Deep down, they know the awful truth – the medical profession causes net harm by prescribing too many drugs, too easily, to too many people. They don't want to hurt our feelings – so they nod, smile and say they understand as we hand over the wad of FP10s. But they will not comply. This is wise and noble – and, like the concept of failing to attend appointments, it should be encouraged.

Ideally, non-compliers would fail to take their prescriptions to the pharmacy, or simply not bother to collect their scripts at all. The result would be guidelines followed, money saved, patient outcomes improved and GP workload reduced.

What's not to like? Indeed, if you've followed the logic thus far, you'll realise it's quite possibly unethical to discourage non-compliance.

Provided, of course, patients don't go down the wasteful route of collecting their simvaspirinololapril and then flushing it down the loo. So some patient education is still required, obviously. I'll mention it to Mrs Walrus next time she doesn't attend. Some good news on her cardiovascular risk, though – she is eating plenty of fish.

Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com

Copperfield scream

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