Takeaway
When patients don't take their medication, seek to understand why. The meaning behind their decisions often reveals barriers to care that we may not have considered.
Lifelong learning in clinical excellence | October 29, 2026 | 2 min read
By Maxwell Droznin, MD, MPH, Johns Hopkins Medicine
By the time the patient returned to clinic, the bottle had moved from beside the coffee maker to a kitchen drawer underneath the takeout menus. The copay was manageable and the pharmacy nearby. He could explain what the medicine was for. So I asked, “What bothers you about taking it?” At first, he said he didn’t know. Then he mentioned his father, who used to fill a pillbox at the kitchen table every Sunday. Eventually, his mother had taken over—he could still hear her reminding her husband to take his pills.
“I’m not ready for all that,” the patient said. Besides, his recent blood pressure readings had improved. He wondered if he even needed the medicine anymore.
What we haven’t asked
We’re right to ask patients about cost and access to medications—these barriers deserve practical help. But an affordable bottle within reach can still be difficult to open. A daily tablet can make illness feel permanent, particularly when the illness itself causes no symptoms. A relative’s decline despite years of treatment may make its promised benefits hard to believe. Fatigue or sexual changes may threaten parts of life a patient is reluctant to discuss.
Someone who says “I just forget to take it” with a partner in the room may, in private, describe a fear they’ve never said aloud. And they may also just forget to take it. Multiple explanations can be true at once.
We may be so worried about what happens to the patient without treatment that we start explaining before they’ve finished talking. If an earlier concern was brushed aside, bringing it up again may take more trust than they can manage that afternoon.
Change takes time
When the conversation returned to the patient’s blood pressure, we discussed both his readings and his fear of losing independence. But he still had reservations about taking the medication. Having repeated conversations like this may wear us down when we care about someone and worry about what lies ahead for them. And their medication choices may begin to feel like a verdict on our care.
A better idea is to identify the next step together with the patient. In any specialty, ask what the patient is actually taking, what changed for them if they stopped, and what concerns them now. Ensure a private place to talk. Explain benefits and risks plainly, consider alternatives, and agree on a safe plan with follow-up. Then share the plan with the rest of the care team.
We remain responsible for thoughtful care—the patient’s choices remain their own. Some visits will end with a smaller agreement than we hoped for—but there’s still value in being a person they can return to for help.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.