This excellent talk by Endocrinologist Doctor Victor Montori reflects on the reason for low levels of adherence to treatment. What is this signalling? What is the solution?
According to Montori education, coercion or a “disease specific, context blind” approach are not the answer.
It needs a different way of thinking that takes into account people’s capacity to deal with the “work of being a patient”. Patients need to be able to make sense of what is expected of them and support to develop the capacity to manage their conditions and fit treatment into the stuff of life. This is the “Minimally Disruptive Healthcare” he advocates – “minimally disruptive – maximally supportive”, involving self-management, shared decision making and capacity building.
He finishes with analogy of the canary in the coalmine. When it stops singing, it signals that the coalmine has become toxic. Maybe a patient’s “non-compliance” is telling us something vital.