The treatment can be clinically sound, thoughtfully selected, and clearly prescribed. But if the patient doesn’t use it, none of that matters. In this episode of The Spot Check, Jamie Restivo, PA-C, is joined by Steve Feldman, MD, PhD, to explore one of the most persistent challenges in dermatology—adherence, and the surprisingly powerful role human behavior plays in whether a treatment plan succeeds.

Drawing from behavioral economics, Dr Feldman explains why patients don’t always make decisions through the rational risk-benefit calculus clinicians might expect. Together, he and Jamie look at some of the most common barriers to adherence, including overly complex regimens, treatment discomfort, and the perception that a therapy simply isn’t working. Their discussion moves quickly from theory to practical application; simplifying topical regimens, anticipating issues before they cause a patient to stop treatment, and thinking carefully about how risk and expectations are framed.

But some of the most useful interventions may be much smaller. Medication placed on top of one’s socks or at the bedside can make treatment harder to overlook by tying it to an existing habit. A seven-day pill container removes the need to remember whether today’s dose was taken. Written instructions account for what Dr Feldman calls the “curse of knowledge,” the tendency for clinicians to underestimate how difficult even seemingly simple directions can be to absorb outside of the exam room. These environmental cues and habits can make treatment easier to remember and harder to ignore.

Underlying it all is a concept Dr Feldman returns to throughout the conversation, accountability. Trust between clinician and patient creates the foundation, but the expectation of follow-up may be what turns intention into action. Rather than simply handing over a prescription and reconnecting months later, even the anticipation of a check-in can change behavior. For clinicians managing chronic disease, it is a reminder that adherence may depend not only on what we prescribe, but on how we design the experience around it.