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Jun 4, 2026

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Photo by National Cancer Institute on Unsplash

There’s a moment that happens in almost every consultation. The patient nods, says “okay,” and walks out. Then life happens — the tablet gets left on the counter, the diet advice gets forgotten at the first family dinner, and two weeks later they’re back in the same chair.

For a long time, I thought this was a compliance problem. Patients weren’t following through. Then I started paying closer attention, and I realised I was wrong. It wasn’t a compliance problem. It was a communication problem — and most of it was on our side.

Medical advice, even when correct, often fails because it’s built for a clinic, not for real life. “Reduce your sodium intake” sounds reasonable in a consulting room. It sounds a lot less reasonable at 7pm when you’re tired, your children are hungry, and the only thing in the kitchen is whatever was affordable at the market that morning.

This isn’t weakness. It’s context. And for too long, medicine has designed solutions without accounting for context.

When I was rotating through internal medicine, I had a patient — a middle-aged man with poorly controlled hypertension — who had been on three different medications over two years. Each time, his blood pressure came down briefly, then crept back up. His previous doctors had documented “non-compliant” in his notes. When I sat with him properly, it turned out the medications gave him a dry cough that made sleeping difficult, and since he was the one in his household who had to wake up early to work, he quietly stopped taking them rather than complain. Nobody had asked him that question.

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Research in health behaviour consistently shows that people are more likely to act on advice when three things are true: they understand why it matters, they believe they can do it, and the advice fits into their actual life — not an idealised version of it.

Understanding why means going beyond “your blood pressure is high.” It means explaining that sustained high pressure is slowly stressing the walls of every artery in your body, including the ones feeding your brain and heart, in plain terms that connect to something a person already cares about.

Believing they can do it means the advice has to be specific and manageable. “Exercise more” is not advice. “Walk for 20 minutes after your evening meal, three times this week” is.

Fitting into real life is the hardest part, and it requires asking questions instead of talking. What does your typical day look like? Who cooks in your house? Do you have a regular schedule, or does it change? The answers change what good advice actually sounds like for that individual.

If you’re a patient reading this, here’s something worth knowing: you have more power in that consultation room than you might think. The advice you receive will only be as good as the information you give. If the recommended medication causes side effects you can live with, say so. If the diet plan doesn’t match how you actually eat, say so. A good doctor will adjust. And if yours doesn’t, that’s important information too.

Medicine works best when it’s a negotiation, not a prescription.