MEDICAL MATTERS: Hands up anyone who has completed a full course of antibiotics without missing a tablet? Well done. You are in a minority. Probably in the region of 10 per cent of patients fully comply with treatment.
I know I have never completed a full course of tablets. From a typical five-day course of 15 tablets, I reckon the best I've managed is about 12 tablets. Why? You feel better; you are having a busy day, or you simply reach the end of the prescription period with a mysterious two or three tablets still in the bottle, unable to remember when exactly you missed a dose.
Yet most of us non-compliers get better anyway. What does this say about the treatment? It could be useless; the scientist who "proved" that one tablet three times a day for five days was the required dose was wrong; the placebo effect - in which patients improve when given a inert dummy pill for its psychological benefits - has come into play; or we have benefited from vis medicatrix naturae, the healing power of nature and the spontaneous return to health which would have happened anyway.
Medicine has traditionally focused on patients' "bad" behaviour as the reason for non-compliance with treatment. A study in a journal dedicated to the control of clinical trials found patients faked entries in medication logs, while other participants tried to beat electronic monitors.
Clinical diaries are central to trials of medication. Participants are asked to monitor their symptoms at meal times. However, in this "trial about trials", the researchers used diaries complete with light sensors and numerous electronic bugs to check if entries were being made en masse at the end of the trial, rather than regularly throughout.
The electronics indicated that actual compliance was only 11 per cent, even though respondents returned diary cards corresponding to a 90 per cent accuracy level.
Apart from the somewhat Orwellian nature of such scientific experimentation, surely it is so far removed from everyday reality as to make the results potentially meaningless? Indeed, it may well be time for physicians to examine their own practices.
Could the prescription have been written incorrectly? Was the doctor having a bad day, leading to a rushed consultation and a failure to adequately explain the treatment, its benefits and indeed its side-effects?
According to a recent editorial in the Lancet, "society may have expectations for physician and patients, but do people behave differently in their medical roles? People cut corners, although they know they ought not, especially if they see no direct harm to any specific individual or themselves."
So what to do? Education is not entirely effective. Audit is another option. But how many people are going to wear electronic monitors while on treatment? And should any doctor suggesting such a course of action not himself be audited (or worse)?
It's time for a shift in attitudes. An acceptance of peoples good intentions in a sea of fallibility. Mistakes are usually unintended and all of us take shortcuts. As the editorial writer put it, "we are all human physicians in corruptible institutions treating fallible patients. This is the ragged edge of medicine in the 21st century."
Readers who recall a previous column on the topic of private medical attendant reports for the insurance industry and the issue of informed consent may be interested in a follow-up. The Irish College of General Practitioners discussed the dilemma and possible solutions at a workshop at its AGM last month.
Amid real concerns that patients may be unaware of the depth of medical information being forwarded to insurance companies by their doctors after signing blanket consent, the family doctors had a full debate on the matter.
From the comments of the GPs who attended, it seems that many patients do not realise the full implication of signing forms to release their entire lifelong medical records. Participants questioned whether the financial consequences of previously-recorded illness were adequately spelt out by the insurance industry.
The College is now formulating a policy statement on the use of PMA's. Your opinions would be valued by the GP representative body.
Contact Dermot Folan, Assistant CEO, ICGP, Lincoln Place, Dublin 2, or e-mail your comments to this column and they will be passed on.
You can e-mail Dr Muiris Houston at mhouston@irish-times.ie. He regrets he cannot answer individual queries.