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The Mental Mechanisms of Patient Adherence to Long-Term Therapies pp 1–13Cite as

Introduction: The Doctor , Her Patient , and Their Reasons

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Part of the book series: Philosophy and Medicine ((PHME,volume 118))

Abstract

Patient nonadherence refers to a lack of coincidence between the patient ’s behavior and clinical prescriptions. At each step in the doctor -patient encounter—from making a first appointment , to undergoing screening tests, to taking medications and accepting changes in lifestyle , adherence is an issue: For instance, roughly half of the medication prescriptions are not filled. Nonadherence has been demonstrated repeatedly to erode the effectiveness of medical care and is linked with an increased rate in mortality. It has a major impact on health expenditures. A WHO report concluded that “increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatment.” In this book, I shall try to understand in general the phenomenon of nonadherence. To achieve this goal, I will attempt to describe what our patients are doing when they are adherent, for example, when they come to an office visit, take a tablet, stay on a diet or refuse a cigarette . These various manifestations of adherence must have something in common, i.e. their homology: My goal is precisely to discover what makes these phenomena homologous, without losing sight of differences. This will lead me to suggest that in each one of these cases we are dealing with not just a behavior , but an action . Thus I shall propose an interpretation of the mental mechanisms of adherence to long-term therapies based on the philosophy of human agency: Mind and Care.

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Notes

  1. 1.

    I am grateful to John Meyers for this remark.

  2. 2.

    An illustration given by John Meyers.

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  1. Avicenne Hospital and Paris 13 University, Sorbonne Paris Cité, Bobigny, France

    Gérard Reach

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  1. Gérard Reach
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Correspondence to Gérard Reach .

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Reach, G. (2015). Introduction: The Doctor , Her Patient , and Their Reasons. In: The Mental Mechanisms of Patient Adherence to Long-Term Therapies. Philosophy and Medicine, vol 118. Springer, Cham. https://doi.org/10.1007/978-3-319-12265-6_1

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