Clinical practice guidelines were initially developed within the context of evidence-based medicine with the goal of putting medical research findings into practice. However, physicians do not always follow them, even when they seem to apply to the particular patient they have to treat. This phenomenon, known as clinical inertia, represents a significant obstacle to the efficiency of care and a major public health problem, the extent of which is demonstrated in this book.An analysis of its causes shows that it stems from a discrepancy between the objective, essentially statistical nature of evidence-based medicine on the one hand and the physician's own complex, subjective view (referred to here as "medical reason") on the other. This book proposes a critique of medical reason that may help to reconcile the principles of evidence-based medicine and individual practice.The author is a diabetologist and Professor of Endocrinology, Diabetology and Metabolic Diseases at Paris 13 University. He has authored several books, including one to be published by Springer (Philosophy and Medicine series) under the title: The Mental Mechanisms of Patient Adherence to Long Term Therapies, Mind and Care., Diabetology and Metabolic Diseases at the Paris 13-University. He has also published Pourquoi Se soigne-t-on, Enquête sur la rationalité morale de l'observance (2007), Clinique de l'Observance, L'Exemple des diabètes (2006), and Une théorie du soin, Souci et amour face à la maladie (2010). An English adaptation of the first book is published by Springer (Philosophy and Medicine) under the title: The Mental Mechanisms of Patient Adherence to Long Term Therapies, Mind and Care.
How can we accept that we ought to stop smoking, follow a diet, exercise, or take medications? The goal of this book is to describe the mechanisms of patients' adherence to long-term therapies, whose improvement, according to the World Health Organization (WHO), would be more beneficial than any biomedical progress. For example, approximately half of the patients do not regularly follow medical prescriptions, resulting in deleterious effects on people's health and a strong impact on health expenditure. This book describes how our beliefs, desires, and emotions intervene in our choices concerning our health, by referring to concepts developed within the framework of the philosophy of mind. In particular, it tries to explain how we can choose between an immediate pleasure and a remote reward-preserving our health and our life. We postulate that such an "intertemporal" choice can be directed by a "principle of foresight" which leads us to give priority to the future. Just like patients' non-adherence to prescribed medications, doctors often don't always do what they should: They are non-adherent to good practice guidelines. We propose that what was recently de-scribed as "clinical inertia" could also represent a case of myopia: From time to time doctors fail to consider the long-term interests of their patient. Both patients' non-adherence and doctors' clinical inertia represent major barriers to the efficiency of care. However, it is also necessary to respect patients' autonomy. The analysis of relationship between mind and care which is provided in this book sheds new light on the nature of the therapeutic alliance between doctor and patient, solving the dilemma between the ethical principles of beneficence and autonomy.
Entre la personne devenue malade et le médecin qui la soigne se noue une relation singulière, dont l'éthique médicale contemporaine, mettant fin au paternalisme, suggère qu'il devrait s'agir d'une relation d'égal à égal. Ce livre analyse la double signification du concept de soin : soin de soi du point de vue de la personne malade, soin du malade par le médecin. Son but est de montrer comment ces deux aspects du soin ne cessent de se correspondre dans une relation certes égalitaire, mais aussi asymétrique.
Soin et souci de soi s'apparentent car tous deux mettent en jeu une relation profonde à la temporalité : le malade se soigne s'il a le souci de son devenir, dont la forme la plus haute est l'amour de soi. Chez certaines personnes, l'entrée dans la maladie conduit à une ambivalence de l'esprit qui les en empêche, et ceci est source d'angoisse. Le médecin soigne : ce livre suggère qu'il ne s'agit pas seulement pour le médecin d'apporter un traitement, mais aussi d'aider le patient à mettre fin à cette ambivalence. Pour cela, il met en oeuvre vis-à-vis du patient dont il a le souci une forme d'amour compatible avec le respect de son autonomie.
Ainsi se construit pas à pas une théorie du soin dans laquelle les concepts d'empathie, de sympathie, d'autonomie, de respect, de confiance et, finalement, de personne humaine trouvent leur véritable place.