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Beyond Compliance, Adherence, & Concordance – Supporting The Patient’s Implementation Of Optimal Treatment

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You have to take your meds. Period. You do not negotiate.

March 7th, 2007 at 12:47 pm · · Enforced Treatment · 1 Comment



In Taking Lessons from Infectious Disease, Carrie Arnold at ED Bites makes an intriguing comparison between DOT and non-negotiable management of eating disorders. Hers is a unique perspective because her experience being treated for anorexia is complemented by her work as a state TB Program Coordinator, a position with the authority to invoke court-ordered hospitalization for noncompliant patients.

She points out the similarity of DOT and the Maudsley Approach to treating anorexia:

The point with DOT- and with Maudsley – is for the sufferer to take their medicine, whether it’s antibiotics or food. They don’t have to like it, they don’t have to agree with it, they don’t even have to think it’s necessary, but all measures will be taken to see that they do. Another interesting aspect of DOT is that all responsibility for treatment compliance is on the shoulders of the health department, NOT the patient. It’s rather similar in Maudsley- it’s up to the parents or carers to see that the sufferer eat, NOT the sufferer to rely on their own devices. And, there are firm backups in place. If you continually refuse your medication (typically by not showing up), we’ll put you in the hospital. Ditto for Maudsley.

You have to take your meds. Period. You do not negotiate.

Commentary

The entire post is worth reading if for no other reason than the author’s point of view and consequent insight into noncompliance with treatment.

In addition, however, the point that coerced treatment is sometimes necessary is important because it belies the typical, almost automatic, and all too simplistic responses clinicians and academicians offer when confronted with noncompliance – educating and empowering the patient. Those are indeed wonderful tactics, but only when they work.

In circumstances such as life-threatening anorexia and population-endangering infectious disease (see also Proposing Coerced Treatment Compliance), healthcare professionals dealing with a noncompliant patient have the obligation to recognize the when education and empowerment are ineffective and take appropriate action even when that places them in opposition to the patient.

In such situations, to paraphrase Ms Arnold,

All responsibility for treatment compliance is on the shoulders of the healthcare professional, NOT the patient

Tags: Enforced Treatment

1 response so far ↓

  • 1 Carrie Arnold // Mar 7, 2007 at 2:39 pm

    Dr. Showalter,

    I think you posed a very well thought-out commentary to my original post, and I’m flattered you adopted it in this manner.

    My ome comment is that compulsory treatment goes “against” the patient. Specifically in anorexia, Maudsley goes against the disease, NOT the patient. As someone who has suffered from anorexia, I actually wanted to eat during the course of my illness. I just couldn’t while the illness was in charge. It’s similar to TB. The patients don’t *want* to stay sick. They are just unable to take their meds. Part of the reason Maudsley (the modified version of it, anyways) worked for me is that I knew my parents were combating the anorexia and NOT me.