Hillary Clinton’s decision to press on and ignore her doctor’s advice to rest while recovering from pneumonia may have startled the nation, but will have come as little surprise to most physicians.
We’ve all had patients who hobble in with a minor sports injury, are told to lay off the football, and limp back the next week even worse for wear having decided they just had to play that “crucial” weekend match.
Clinton waiting until she “got off the road” on Friday before reporting her cough to her physician is also a classic scenario: Busy people often wait for a scheduling gap before attending to their own medical needs. Often this is a reasonable strategy — many illnesses get better of their own accord with a modicum of TLC — but sometimes it isn’t, and it can make a physician’s job harder.
Delays in seeking medical attention, ignoring advice or failure to take medications as prescribed may have consequences for the individual, worsening their condition or making it harder to treat.
It can also have ramifications for others. Who hasn’t encountered the stoic who soldiers on despite a streaming cold, only to spread it around the office, with costs to colleagues and employers alike?
Pneumonia isn’t terribly contagious — far less so than colds or flu — but may be more so among contacts with weakened immune systems. Stress and lack of sleep lower immunity. It’s not hard to envisage that prolonged hours under pressure, such as on a high-profile campaign team, might increase vulnerability to infection, and in circumstances where staff might be tempted to “struggle on.”
The campaign trail also exposes the team to innumerable members of the public and their germs, and vice versa. It is reported that at least six senior members of Clinton’s staff had been ill over the course of the previous week, though direction of spread cannot be proven. However, the Democrats’ candidate kept her diagnosis secret from most of her team throughout the weekend, during which she continued campaigning.
Unlike Donald Trump, who prefers fist bumps to shaking hands (which carries a higher risk of respiratory virus contagion even than intimate kissing), Clinton is not averse to contact with the public, and indeed was photographed hugging a little girl last weekend before her diagnosis was revealed.
Don’t doctors get frustrated by all this? Of course they do. It’s understandable that as modern medicine has become more complex and encroaches into ever more spheres, it becomes harder for patients to stick to treatment plans. Side effects may be a particular disincentive with preventive medications for disease risk factors with few or no symptoms, such as high blood pressure or cholesterol.
The dramatically increased accessibility of medical information on the Internet — much of it contradictory or wrong, and some of it frankly suspicious of medical “authority” — does not help matters.
Modern physicians’ expectation is that much of what they offer will be ignored. Patient noncompliance is an epidemic, estimated to affect 20% to 30% of short-term therapies, 50% to 60% of long-term medication and 70% to 80% of advice about lifestyle changes. Over 50% of the 3.8 billion prescriptions written annually in the United States are taken incorrectly or not at all.
This matters. Noncompliance increases the risks of hospital and nursing home admissions and premature death, and costs the US health care system more than $200 billion each year.
A survey from Consumer Reports showed that noncompliance with advice or treatment recommendations is the top complaint that primary care physicians have about patients. Most believe it affects their ability to provide optimal care, and one in three says it does so a lot.
Clearly there are extreme pressures on a presidential candidate and the temptation to “power through” must be immense — especially for someone like Clinton, who has seemingly been waiting her whole life for this moment. Yet while people may be shocked that Clinton concealed the truth, few will be surprised at her failure to follow medical advice: We’ve all done it (even doctors).
