Non-Compliance or Failure to Communicate?

By Howard Luks, MD

When surgeons publish their results, they include statistics regarding how many patients did well, and how many didn’t. And as the authors break down their failures, a major consideration is non-compliance.

It’s a very easy (and safe) assumption. We explained everything clearly, after all.

But did we? Did we ask the patient if he or she understood the restrictions? Did we ask if he or she understood the implications of non-compliance?

My own experience shows that despite long discussions, there is sometimes a gap between what I meant and what my patients heard – and what they understood.

It’s no wonder. For us, the information is familiar. Yet patients are hearing it all for the first time. Details are bound to be blurred and lost in memory and translation.

Slowing down a beat. Asking patients for their thoughts and questions – these practices offer invaluable clues to how the conversation is really going.

So is following-up, and while ever-increasing time constraints make it tough to do in the way we might like, there are alternatives: We can, for example, offer videos, website links, and written documents that underscore the points we made. Not only can these help patients remember information, but by presenting the key points slightly differently, they can also help ensure that patients have understood. Additionally, we can make ourselves or staff members available for follow-up questions by phone and email.

So the next time the failure of a surgical reconstruction or treatment is blamed on a patient due to non-compliance, perhaps we as surgeons should determine if it was instead a result of a communication gap.

And each time we engage with a patient, we can be mindful of this risk, and take the opportunity to share just a little bit more.


Howard Luks, MD, is an orthopedic surgeon with offices in Westchester and Duchess Counties. He is an associate professor of Orthopedic Surgery at New York Medical College, and serves as chief of Sports Medicine and Arthroscopy at University Orthopedics, PC and Westchester Medical Center. Follow him on Twitter @hjluks.

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