Author's reply
Editor - Mitchell et al's critique of my article is a valuable addition to the debate about changes in the doctor-patient relationship. however, they have taken selected quotations out of context and ignored the message of my piece.
I never stated that patient obedience is "desirable." On the contrary, I discussed the importance of moving away from the outdated model of doctors preaching to their patients. I emphasised the need to explore "patients' beliefs about health and illness, their concerns about taking medicines, and the cultural factors affecting their ideas."
I am very troubled by their suggestion that I characterised "all non-compliant patients as self neglecting." I did not. I discussed how self neglect, which may include unhealthy behaviour, can be a marker of underlying personal, social, or psychiatric problems. As doctors, we do a great disservice to our patients if we fail to recognise such problems and to offer possible solutions.
Finally, I see no contradiction whatsoever between my promotion of concordance and my discussion of some helpful ways to take life enhancing medication. I deliberately discussed antiretroviral drugs, because these are often unpleasant to swallow, and yet in combination they can suppress hIFF in up to 90$ those who can tolerate them.1 If patients actively choose to take such medication, surely we have a duty to make it more palatable?
Gavin Yamey, editorial registrar, BMJ
Email: email
studentBMJ 2000;08:89-130 April ISSN 0966-6494
- Gottlieb S. Non.compliance often the cause when AIDS drugs "fail." BMJ 2000;320:208. (22 January.)
