ABSTRACT
Some patients don't use treatments because they don't trust their doctor. One patient of mine presented with pruritus associated with hepatic failure. He was suffering. I suggested phototherapy to him and his family. Since a phototherapy center wasn't convenient, I suggested he consider trying a tanning bed. He didn't return for a year. In the interval, he went to the Mayo Clinic for a liver transplant. He was still suffering from severe pruritus and hadn't tried the tanning bed. He and his family thought I was crazy to suggest a tanning bed for his itching. He asked the
Table 2: Reasons for poor adherence to treatment
Poor motivation to get better
Secondary gain from not getting better
Lack of trust in doctor
Fear of medication
Lack of knowledge of what they are supposed to do
Burden of treatment
Perceived burden of treatment
Passing the buck of responsibility
Forgetfulness
The patient may not be particularly bothered by their condition. Sometimes it may bother a family member more than the patient, and the patient only visits the doctor to placate the other family member.
