During my years as a clinical pharmacist, I thought I understood why patients stopped taking long-term medications — one of the biggest challenges in medicine. They forgot to take them, became frustrated with side effects, or didn’t fully understand their conditions. But over time, my clinical experience showed me that these explanations only told part of the story.
I first noticed this pattern across very different medical specialties. In psychiatry, I saw patients with schizophrenia experience psychotic episodes after stopping their antipsychotics. Patients who abruptly discontinued their antidepressants often suffered withdrawal symptoms. Later, when I worked in a kidney transplant center, I encountered a surprisingly similar situation when patients stopped taking one or more of their immunosuppressants and developed acute rejection of their new kidneys. Colleagues in cardiology, primary care, and other specialties described similar experiences.