Map of life expectancy at birth from Global Education Project.

Friday, March 14, 2008

Jersey City, Jersey City here I come . . .

They got some pretty little women there and .. .

Oh, never mind. Anyway, my jet setting lifestyle continues as I will be in Jersey City Sunday through Wednesday for the Third International Conference on Antiretroviral Adherence. Sounds a little narrow, I know, but the subject actually is quite revealing as a test case for physician-patient relationships and communication and disease management and stuff in general.

Conference presentations aren't as strictly and paranoically embargoed as journal articles, so I will tell you that in general terms, my colleagues and I have found that if you give doctors a report about their patients' medication taking behavior, they will indeed talk about it more during the visit -- twice as much, on average, in fact. However, that does not result in the patients being more adherent to their medication regimens.

In fact, it has the opposite effect.

Why is this? Can't nail it down as a 100% certain lead pipe cinch, but the way it looks, what the doctors do is hector and scold people and threatent them with death if they don't take the pills on time, every time. Well that just doesn't work. The people already know what the doctor thinks they need to do, and they already aren't doing it. Our friend Dr. Showalter (see the Align Map blog in the sidebar) already knows this, I think, but there's nothing like getting a little scientific proof to wake up the profession.

Doctors just aren't taught how to be effective partners with their patients in disease care. That doesn't happen in medical school, and it doesn't happen in the residency. A few are good at it because that's just the kind of person they are, but most of them, let's face, are kind of, well, arrogant. So, we hope to make our next step an effort to teach docs how to be better motivators and problem solvers, instead of just yelling at people. Who knows, it might not be completely hopeless.

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