Mental Mechanisms of Patient Adherence to Long-Term Therapies

The author is a diabetologist and Professor of Endocrinology, Diabetology and Metabolic Diseases at Paris 13 University. He has authored several books, including one published by Springer under the title: Clinical Inertia, A Critique of Medical Reason.

• 1 Introduction: The doctor, her patient, and their reasons.- 1. Adherence and nonadherence to therapies: A definition.- 2. Nonadherence: How frequent is it?.- 3. The consequences of nonadherence.- 4. Scope of the book.- 5. Some simple explanations for nonadherence.- 6. A typology of adherence? Analogous or homologous phenomena.- 7. The real question.- 8. From behavior to action.- 9. A philosophical interpretation of adherence to long-term therapies.- 2 The classic view: .- 1.   Determinants of nonadherence to long-term therapies 2.- Behavioral models of patient adherence.- 3. Limitations of psychological models.- 4. A new perspective.- 5.Psychology and philosophy, in search of mental mechanisms.- 6. Observation and explanation.- 7. Patient and agent.- 3 Intentionality.- 1. What is ‘in your head’.- 2. A mental puzzle and its formation.- 3. Actions: A causal theory.- 4 An intentionalist model of adherence.- 1. Therapeutic agency.- 2. Anintentionalist model of adherence.- 3. The pivotal role of emotions in patient adherence.- 4. Bringing action into play: Volition.- 5 The dynamics of intentionality.- 1. Motivational force.- 2. Self-control.- 3. The force of habit.- 4. Intention, decision, and willpower.- 5. The dynamics of intentionality.- 6 Medical irrationality.- 1. Akrasia.- 2. Patient nonadherence as a case of akrasia.- 3. Another example of irrationality: The denial of illness.- 4. Logical mechanisms of irrationality.- 7 Time and adherence: A principle of foresight.- 1. The effect of time.- 2. The principle of foresight.- 3. The appearance of adherence.- 4. A physiopathological point of view.- 5. A top-down model of adherence.- 8 An intentionalist account of doctor-patient relationship and biomedical ethics.- 1. Philosophical analysis of doctor-patient relationship.- 2. The principle of charity.- 3. Adherence and autonomy.- 9 Doctors’ clinical inertia as myopia.- 1. Clinical inertia: Definition and logical description.- 2. Empirical evidence: The paradigm case of psychological insulin resistance.- 3. Empathy and sympathy.- 4. The paradox of empathy in medical care.- 5. Another conception of sympathy.- 6. Care, sympathy, beneficence, and love.- 7. Care as a special form of sympathy.- 8. The respective values of immediacy and future.- 9. Empathy, sympathy, and the ethical dynamics of the pa-tient-doctor relationship.- 10. A model of chronic care involving patient education and trust.- 11. Conclusion: Mind and Care.- 10  Conclusion:  Adherence Generalized.- 1. A choice between two actions.- 2. Generalization of the problem.- 3. Defining adherence by its explanation.- 4. Eros and Thanatos.