Exploring the intricate dynamics of patient adherence to long-term therapies, the book examines how beliefs, desires, and emotions influence health choices. It highlights the significant issue of non-adherence to medical prescriptions, which adversely affects health outcomes and costs. The author introduces the concept of "intertemporal choice" guided by a "principle of foresight," emphasizing the importance of prioritizing future health. Additionally, it addresses the phenomenon of clinical inertia among doctors, advocating for a balance between patient autonomy and the ethical obligation to promote well-being.
The book explores the disconnect between clinical practice guidelines and their implementation in patient care, highlighting the challenges physicians face in adhering to these guidelines despite their relevance. It delves into the reasons behind this phenomenon, examining factors such as individual physician judgment, patient-specific circumstances, and systemic barriers. By analyzing these dynamics, the book aims to enhance understanding of how to bridge the gap between evidence-based recommendations and actual clinical practice, ultimately improving patient outcomes.
The goal of this book is to describe the mechanisms of patients' adherence to long-term therapies, whose improvement, according to the World Health Organization (WHO), would be more beneficial than any biomedical progress. For example, approximately half of the patients do not regularly follow medical prescriptions, resulting in deleterious effects on people's health and a strong impact on health expenditure. This book describes how our beliefs, desires, and emotions intervene in our choices concerning our health, by referring to concepts developed within the framework of the philosophy of mind. In particular, it tries to explain how we can choose between an immediate pleasure and a remote reward--preserving our health and our life. We postulate that such an "intertemporal" choice can be directed by a "principle of foresight" which leads us to give priority to the future. Just like patients' non-adherence to prescribed medications, doctors often don't always do what they should: They are non-adherent to good practice guidelines. We propose that what was recently described as "clinical inertia" could also represent a case of myopia: From time to time doctors fail to consider the long-term interests of their patient. Both patients' non-adherence and doctors' clinical inertia represent major barriers to the efficiency of care. However, it is also necessary to respect patients' autonomy. The analysis of relationship between mind and care which is provided in this book sheds new light on the nature of the therapeutic alliance between doctor and patient, solving the dilemma between the ethical principles of beneficence and autonomy
