Table 1.

Examples of Actual Physician-Patient Interactions about Nonadherence

Example 1.
DOCTOR:	Are you still taking your Prilosec?
PATIENT:	I am. Two in the evening. Right now I am only taking two in the evening because Dr. X put me on tetracycline, 50 tablets. I have … 25 more, so I cut the Prilosec in the morning …
DOCTOR:	You only take two at night.
PATIENT:	Umm hmm.
DOCTOR:	Are you getting heartburn?
PATIENT:	Yes I do.
DOCTOR:	You are still getting heartburn. Why can’t you take your Prilosec in the morning too?
PATIENT:	Because I am on tetracycline.
DOCTOR:	So what?
PATIENT:	Because the antacids. …
DOCTOR:	It is not an antacid. Prilosec is not an antacid. Maalox is an antacid. Prilosec is a drug that turns off the acid … after your breakfast, take two Prilosec.
PATIENT:	Then I am going to two in the morning and two in the evening?
DOCTOR:	Umm hmm. Two in the morning and two in the evening. (intervening conversation)
DOCTOR:	You are not on a diuretic are you?
PATIENT:	I am but I am forgetting to take it. I take it maybe once in three to four weeks.
DOCTOR:	What is it?
PATIENT:	Hydrochlorothiazide, or something.
DOCTOR:	Is it once in three weeks?
PATIENT:	Yeah, because I am forgetting because I don’t want …
DOCTOR:	Why don’t you put with your medicines? … You know, most of your medications you can take at once.
Example 2.
DOCTOR:	OK. The only thing here is that your thyroid … it was a little bit high, this TSH level … and what that means is actually just the opposite, that your thyroid activity is slightly low …
PATIENT:	OK. Well I’m taking thyroid, then I wonder if we need to up the dose.
DOCTOR:	Right, we might need to increase cause last year I think yours was a little high like this, this is just barely high. But it was that way before and when we repeated it, it was normal. Now what, what sometimes happens is if you take the thyroid medicine ah, in a different relationship to food, sometimes it’ll be absorbed differently into your body.
PATIENT:	I take it every morning.
DOCTOR:	And you take it on an empty stomach?
PATIENT:	No, I take it with breakfast.
DOCTOR:	All right. It actually works better, it gets into your system better, if you take it on an empty stomach.
PATIENT:	Oh.
DOCTOR:	So one way to, to get more of that into your system would be to just take it on an empty stomach. The other thing is if you feel that you’re gonna continue taking it with food … is to raise the dose.
PATIENT:	OK. Because some of the other things I take have to be with food, … I’d rather do it with food.
DOCTOR:	But it’s important, the real important thing is to be consistent.
PATIENT:	Right.
DOCTOR:	Because if, if you sometimes take it with, with food, sometimes without food … then it kind of gets erratically absorbed and it’s harder to really adjust it.
PATIENT:	OK, well I have a little routine every morning, I take the Prozac, the diuretic, the Premarin, the thyroid, and the uh, U, let’s see, the Unifil, and the Voltaren. [Chuckles] And then at bedtime I take the, the others. So it would just, I mean, if I, if I try to say well gee I’m gonna take the thyroid first, the minute I get out of bed, you know it just isn’t practical, cause I forget. This way I usually can remember it.
DOCTOR:	Just trying to look up the dose here. Point zero seven five.
PATIENT:	It’s the gray cap, the tablets.
DOCTOR:	Yeah. Uh. That’s a fairly low dose so, what we might wanna do, the next step up would be zero point one.
PATIENT:	OK.
DOCTOR:	All right. So I’ll give you that.