Medical compliance- are we true to it?

Posted by Rama Ravi on Wed, Jul 31, 2013  
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All of us know the meaning of the word ‘compliance’. When it comes to medical terms, compliance means ‘the accuracy with which a patient follows an agreed treatment plan. The treatment plan could be in various forms like medicines, diet, lifestyle changes, surgery, post operative care, etc. Let us think for a moment. How many of us really comply to the doctor’s advice? Now, most of us comply partly to what the doctor advises but many a time, our treatments are often unfinished and incomplete. Nevertheless, this is a dicey statement and it depends on the type of illness. When the symptoms are severe, and the disease is fatal or complicated, we often oblige the doctors completely. But the percentage of such scenarios in every day parlance is relatively less. We more often succumb to common illnesses which involve either infections like flu, malaria, dysentery, and in rare cases typhoid, dengue, etc or chronic diseases like diabetes, high blood pressure, high cholesterol, asthma, etc. In 60% of these scenarios, the treatment is either incomplete or irregular. Why do we do this? This is partly because we, as individuals, go only by the symptoms (the problems or inconveniences) we have and not by the disease status. So, when we actually start the treatment and find ourselves comfortable and devoid of the symptoms after a couple of days, we think the further continuation of the treatment is unnecessary. But in reality, the disease never gets completely cured before the completion of the course. Let us see why.


Firstly, let us see what happens in infectious diseases. As many of us know, infectious diseases are caused by micro-organisms like bacteria, virus, fungus, etc,. So, when we are infected with any of these organisms, our treatment is primarily directed at killing or inactivating those organisms. Therefore, when we start the treatment, within a couple of hours or days, around 50% of the organisms are killed. Hence we find a substantial cure in the symptoms. But, remember only 50% of the work is completed. At this stage, we are only symptom free and not disease free.  Therefore, when we abruptly discontinue the treatment, several of the following happen:


1. We still harbour the infection, and we are capable of getting sick again.


2. The organism is still present in the body, and therefore it can spread to others and cause illness in them


3. The organism changes its structure and becomes resistant to the usual treatment. This means that next time anyone gets infected with the same organism, stronger dose and longer duration of treatment might be required.


Next is the case of chronic diseases like diabetes, high blood pressure, etc. In these types of illnesses, we do not perceive any symptoms in the first place. Therefore, it is important to continue the treatment even when the values of the parameters are normal. It is essential to understand that the normal values are achieved only because of the drugs and not because of any magic. And there is no cure for these illnesses and life long medications is the only solution.


The other serious hazard with respect to drug compliance is the concept of self -medication. Self-medication, also called ‘over the counter’ drugging is a very dangerous way of treatment. This can lead to harmful side effects, drug resistance, etc. This is commonly seen with simple ailments like head ache, fever, etc,. Predominantly, the treatment given in the pharmacy often consists of ‘painkillers’ which can severely damage the kidneys, and/or antibiotics, which, when taken irregularly can lead to the above problems.


Hence let us observe the word ‘compliance’ completely and make the treatments of simple diseases simple for both the doctors and the patients.


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