The discord
between theoretically possible and desirable results and those obtained in current
xvi
practice implies numerous responsibilities. They fall roughly into three areas.
(1) The health care system in general, its imperfect organization, its limited accessibility.
(2) The people with a disease and their lack of adherence .
(3) The health care providers and their inertia.
Those who worked on chronic inflammatory rheumatism and hypertension had chosen the word of observance to express the concordance between patient behavior and doctor prescriptions, with a touch of religious rule which translated the physician-patient relationship such as it was conceived and wished at the beginning of the 1970s.
In a first analysis, the lack of adherence can be felt as disobedience by patients, and the inertia of doctors as lack of conscientiousness and a superficiality of their practices. I’m doing what you prescribed, says the patient, without following the entire diet and without always taking all medications. I’m doing enough for you, says the doctor to her patient, without modifying a treatment which is working poorly, or even not at all. According to this mode of reasoning, it is necessary to obtain a “confession” of her nonadherence from the patient, to make her correct it (no, doctor, I did not take your …, it gives me a stomach ache. Impossible, take it or I cannot make you better…) In the same way, one must just as rationally denounce inertia (it’s not perfect, but it’s better than nothing, says the doctor, and the common sense of both partners makes them prefer the probability of not having the disease which one wants to prevent over the complexity of the prescription and the risk of the treatment …)
Likewise, can medical inertia translate a distrust of the “rule of the hour”, and the norm? In a medicine defined by norms, is the justification of these norms sufficient to transform them into a quality requirement? In reality, the norm arises from clinical trials performed on volunteer people by volunteer health care providers , and their external validity is unreliable because 90 % of the people on whom the treatments are applied are not included in the scientific studies, generally due to a social, psychological or medical complexity.
The lower the better, it is said, for blood Foreword to the French Edition xvii pressure, glycated hemoglobin, or cholesterol levels, generally based on observational studies associated with randomized clinical trials . But in daily life, age is associated with multiple pathologies, prescriptions become longer, psychology includes distrust and doubt.
(1) The health care system in general, its imperfect organization, its limited accessibility.
(2) The people with a disease and their lack of adherence .
(3) The health care providers and their inertia.
Those who worked on chronic inflammatory rheumatism and hypertension had chosen the word of observance to express the concordance between patient behavior and doctor prescriptions, with a touch of religious rule which translated the physician-patient relationship such as it was conceived and wished at the beginning of the 1970s.
In a first analysis, the lack of adherence can be felt as disobedience by patients, and the inertia of doctors as lack of conscientiousness and a superficiality of their practices. I’m doing what you prescribed, says the patient, without following the entire diet and without always taking all medications. I’m doing enough for you, says the doctor to her patient, without modifying a treatment which is working poorly, or even not at all. According to this mode of reasoning, it is necessary to obtain a “confession” of her nonadherence from the patient, to make her correct it (no, doctor, I did not take your …, it gives me a stomach ache. Impossible, take it or I cannot make you better…) In the same way, one must just as rationally denounce inertia (it’s not perfect, but it’s better than nothing, says the doctor, and the common sense of both partners makes them prefer the probability of not having the disease which one wants to prevent over the complexity of the prescription and the risk of the treatment …)
Likewise, can medical inertia translate a distrust of the “rule of the hour”, and the norm? In a medicine defined by norms, is the justification of these norms sufficient to transform them into a quality requirement? In reality, the norm arises from clinical trials performed on volunteer people by volunteer health care providers , and their external validity is unreliable because 90 % of the people on whom the treatments are applied are not included in the scientific studies, generally due to a social, psychological or medical complexity.
The lower the better, it is said, for blood Foreword to the French Edition xvii pressure, glycated hemoglobin, or cholesterol levels, generally based on observational studies associated with randomized clinical trials . But in daily life, age is associated with multiple pathologies, prescriptions become longer, psychology includes distrust and doubt.
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