NIH Adherence Network Distinguished Speaker Series Webinar
Monday, March 11, 2013 from 3:00 PM to 4:00 PM (EDT)
Welcome to the NIH Adherence Network Distinguished Speaker Series
Patient-Centered Adherence is an Oxymoron: Self-Regulation of Medication in the Lived Experience of Chronic Illness
Bruce L. Lambert, PhD,
Professor, Department of Pharmacy Administration, University of Illinois at Chicago
To attend the webinar, please go to;
When we get sick, and self-care does not relieve our suffering, we often seek professional medical advice. Having received that advice, often at great cost in time, money and personal discomfort, most of us then proceed to ignore, or at the very least modify, the advice we were given. This is the notorious problem of patient ‘adherence’ to regimens. Despite tens of thousands of publications, adherence, when measured across a wide variety of regimens, is still quite poor, often hovering around 50%. What’s more, interventions to improve adherence have generally not been successful in bringing about sustainable, clinically significant improvements. One idea gaining support lately is that the solution lies in taking a more ‘patient-centered’ approach to adherence, but it is not at all clear what that might mean. I argue here that the very notion of patient-centered adherence is ill-formed, an oxymoron. To understand how patients make use of professional advice, we need to abandon the notion of adherence and all of its hyper-rational, biomedical connotations. Instead, we need (1) an accurate ethnographic account of what it is like to live with a chronic illness and (2) an accurate model of human motivation, cognition, choice and decision making. The best ethnographic accounts of chronic illness stem from the trajectory model of Anselm Strauss and Juliet Corbin. These accounts tell us that chronically ill people are primarily motivated to maintain a stable alignment between their bodies, their biographies and their conceptions of self (the so-called BBC Chain). To do this, chronically ill people engage in an ongoing process of self-regulation. Regimens of all types are integrated into this process of self-regulation only insofar as they help to maintain or restore a stable alignment between body, biography and conceptions of self. To understand the workings of this self-regulatory process, we must replace biomedicine’s implicit model of people as acutely ill members of the species homo economicus (Biomedical Man)—rational, logical, obedient—and see ourselves instead as chronically ill members of the species homo veritas (Reality Man)—driven by meaning, common sense, and emotion, limited in knowledge, memory and attention, often relying on heuristics and biases to make decisions. Taken together, our best ethnographic accounts of chronic illness, and our best psychological models of everyday cognition, have the potential to form the basis of a genuinely patient-centered understanding of how we integrate professional advice into our lives when we get sick.
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