Doctor compliance

The customer might now be led to believe that the products are safer, because biological variability (huge, by comparison), medical practise (it is left to the doctor s discretion to adjust the dose), or compliance (dismal) are outside this discussion. 

Physicians reported mixed feelings about the impact of DTCA on their patients and practices— More than 70 percent felt that DTCA helped educate patients about available treatments 67% felt that DTCA helped them have better discussions with their patients, ffowever, four out of five doctors believed that DTCA did not provide information in a balanced manner, and a similar number felt that it encouraged patients to seek treatments they did not need. Physicians as a group were more equivocal about other impacts of DTCA, with 46 percent agreeing that it increased patients compliance and 32 percent that it made patients less confident in their doctors judgment. Overall, 40 percent felt that DTCA had a positive effect on their patients and their practices, 30% felt it had a negative effect, and 30% felt that it had no effect. ... 

Among the difficulties in pharmacological treatment is the frequent non-compliance. The biggest determinant of compliance is the quality of a patient s relationship with his doctor. But a further way to handle the issue has involved the development of long acting products (depot neuroleptics), even though their effectiveness in the absolute or compared to oral preparations has not been adequately explored. The most commonly used depot agents are fluphenazine and haloperidol decanoate (see David et al., 2004). 

As noted in Chapter 2, the medical literature on patient compliance with medication is enormous. The assumption underlying much of the discussion is that if only doctors could better communicate to patients the necessity of following a medication regimen, compliance would increase. This may be so. However, medical treatment built on the presumption of a two-person social system-doctor and patient—misses the way each of us is embedded in a network of significant others. As the accounts in this section demonstrate, people s attitudes toward psychotropic drug use are inseparable from the perspectives and concerns of those with whom they wish to build... 

In order to have a constructive, two-way conversation with doctors, patients must become well informed about medications. Too many years of unquestioning compliance led many to stress the importance of educating oneself... 

Failure Modes in Management. If the patient has not accepted the principle of drug treatment, then there is a need for renewed explanation and education to lay the groundwork for informed consent regarding a treatment plan. Those who fail to accept the principle of drug treatment usually take little or no medicine, and when they do take an occasional dose, it is often immediately prior to a scheduled visit to the doctor. Pre-visit dosing masks the clinical eye to otherwise poor compliance, but is readily identifiable with proper measurements (Feinstein, 1990). 

Drug response is likely to be the result of a complex function of the influence of many genes interacting with environmental and behavioral factors. Whether PK-PD variability translates into clinically relevant differences in drug response depends on further issues including compliance, the availability of alternate drugs and doctor/patient perception of side-effects [10]. 

Compliance. To an extraordinary extent, patients will tell doctors what the doctors want to hear. If a psychiatrist clearly wants to hear that a drug is helpful, and not harmful, many patients will comply by giving false information or by withholding contradictory evidence. 

There were fifty-four subjects whose blood pressures remained elevated despite the use of antihypertensive drugs. Often two or three different drugs are required to completely control hypertension, but such combinations frequently lead to side effects that commonly limit patients compliance with doctors prescriptions. Dr. Paran hoped that the tomato extract would offer an alternative to adding another drug or two. 

Efficacy and safety do not lie solely in the molecular structure of the drug. Doctors must choose which drugs to use and must apply them correctly in relation not only to their properties, but also to those of the patients and their disease. Then patients must use the prescribed medicine correctly (see Compliance/concordance). 

In some chronic diseases in which suppressive drugs will ultimately be needed they may not benefit the patient in the early stages. For example, victims of early parkinsonism or hypertension may be little inconvenienced or hazarded by the disease, as yet, and the premature use of drugs can exact such a price in side-effects that patients prefer the untreated state what patients will tolerate depends on their personality, their attitude to disease, their occupation, mode of life and relationship with their doctor (see Compliance). 

Failure of doctors to keep up-to-date (see Doctor compliance). 

Successful therapy, especially if it is long-term, comprises a great deal more than choosing a standard medicine. It involves patient and doctor compliance. The latter is liable to be overlooked (by doctors), for doctors prefer to dwell on the deficiencies of their patients rather than of themselves. 

Patient noncompliance is identified as a major factor in therapeutic failure in both routine practice and in scientific therapeutic trials but, sad to say, doctors, are too often noncompliant about remedying this. All patients are potential noncompliers " good compliance carmot be reliably predicted on clinical criteria, but noncompliance often can be. 

Doctor compliance is the extent to which the behaviour of doctors fulfils their professional duty ... 

Doctor, nurse and patient are faced with a lifetime of collaboration. Compliance is not a one-sided process, and the patients need all the consideration and support they can get. They should learn about their disease and its management, including home monitoring of blood glucose, and about the need for appropriate diet, exercise and avoidance of smoking. 

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