La Traviata, by Giuseppe Verdi was performed by the Vancouver Opera last night at the Queen Elizabeth Theatre to a sold out audience. There are further shows May 10 and 12. The conductor was Jacques Lacombe and Director Jonathan Miller. It speaks to Jacques Lacombe's consumate skills that I found myself repeatedly listening to the Vancouver Opera Orchestra music as much as the voices. That speaks to Verdi to whose music is simply enchanting. . Erin Wall's performance of Violetta was rewarded by a standing ovation and literally a roar from the audience. Violetta's love, Alfredo, was played by David Pomeroy whose presence and tenors strength was most apparent in duets with the powerful soprano of Erin Hall. I most enjoyed baritone James Weston who played Alfredo's protective but misguided father, Georgio Germont. Sam Chung as Gastone, Barbara Towell as Flora, Benjamin Covey, as Barone, Giles Tomkins as the Doctor were all superb. Indeed it was a thoroughly masterful performance that made for a wholly enjoyable evening. I am thankful I already have tickets to next years opera. It will include another Verdi, this time Aida, West side Story, Barber of Seville and Romeo and Juliett.
The only disappointment of the night was trying again to get a taxi after the opera. It seems a recurrent theme in Vancouver with lack of queues and disrespect to the elderly. It's one of the reasons I enjoy convincing Laura to wear a short black dress so I can take the Harley, really the only way to attend an Opera in Vancouver.. .
Sunday, May 8, 2011
Saturday, May 7, 2011
Rude Weather
The weather is rude,
Dirty skies the colour of truck stop toilets
Where attendants on drugs refuse to mop.
This rain soils the earth so that no one objects when a man says, "It's pissing rain."
I miss the sun, the source of my soul's photosynthesis.
Great floods Noah the land and Job the human spirit.
There is no Cleopatra or Niling resurrection forecast.
I am not Mark Anthony and cannot caesar rain.
Were I to say "Et tu, Brute', I'd say it to the weather,
This season of quakes, tsunamis, floods and now just pissing rain,
Mixed metaphors, dangling propositions and even threats to oxymoron,
All drown a human dream of frollck
For surely no one can frollick in such pissing rain.
This rude weather defies prediction, denies manipulation.
Humbling even the best of us,
Poets,
Trying to make a tired living
Transmuting pissing modernity into something with heartfelt soulfulness
This presumptuous rain slyly slithers and seeps into underthings
Causing imagineless censors to demand passionless judges
Impale this rude rain on sex offender lists.
But this rain is as fecund as the Rape of the Sabines
And promises tomorrows rain forest jungle vegetation of dank crankiness,
Grist for the visual genius of Emily Carrs and Groups of Seven.
.
The dribbling tear drops of poets quickly become angry riffs and storms of metal musicians,
Who were it not for poets wouldn't even know of rain for they dare not leave their synthetic nighttime bunkers,
Fearing the natural elements might cause them to symphony.
This pissing rain could turn a heavy metal musician into a light organic folkie or worse a soul brother gospel singer.
This rain is that wet with irony.
In fact, It's all wet.
It's so wet and ill mannered,
I shant invite it to afternoon tea.
It bullied it's way into breakfast already.
And I can't go out and play again till it's left. Phooey!
Dirty skies the colour of truck stop toilets
Where attendants on drugs refuse to mop.
This rain soils the earth so that no one objects when a man says, "It's pissing rain."
I miss the sun, the source of my soul's photosynthesis.
Great floods Noah the land and Job the human spirit.
There is no Cleopatra or Niling resurrection forecast.
I am not Mark Anthony and cannot caesar rain.
Were I to say "Et tu, Brute', I'd say it to the weather,
This season of quakes, tsunamis, floods and now just pissing rain,
Mixed metaphors, dangling propositions and even threats to oxymoron,
All drown a human dream of frollck
For surely no one can frollick in such pissing rain.
This rude weather defies prediction, denies manipulation.
Humbling even the best of us,
Poets,
Trying to make a tired living
Transmuting pissing modernity into something with heartfelt soulfulness
This presumptuous rain slyly slithers and seeps into underthings
Causing imagineless censors to demand passionless judges
Impale this rude rain on sex offender lists.
But this rain is as fecund as the Rape of the Sabines
And promises tomorrows rain forest jungle vegetation of dank crankiness,
Grist for the visual genius of Emily Carrs and Groups of Seven.
.
The dribbling tear drops of poets quickly become angry riffs and storms of metal musicians,
Who were it not for poets wouldn't even know of rain for they dare not leave their synthetic nighttime bunkers,
Fearing the natural elements might cause them to symphony.
This pissing rain could turn a heavy metal musician into a light organic folkie or worse a soul brother gospel singer.
This rain is that wet with irony.
In fact, It's all wet.
It's so wet and ill mannered,
I shant invite it to afternoon tea.
It bullied it's way into breakfast already.
And I can't go out and play again till it's left. Phooey!
Thursday, May 5, 2011
Turning Point Recovery Society 4th Annual Gala Fundraiser
What a joyful occasion. This is truly the best recovery fund raising Gala event of the year. Turning Point Recovery Society, a licensed non-profit organization, has for 29 years provided long term abstinence based residential environment to people suffering from the disease of addiction. They have thereby improved the health and well being of the communities they serve. Thanks to so many volunteers and fundraising activities such as this, Turning Point Recovery Society is able to seek government funding less. That said the Society finds such support from private and public services to the extent that they were able to announce a new women only housing development tonight. It's a project that has been in the works for 5 years.Four Seasons Hotel is a truly elegant venue. The meal and service was the finest. We thoroughly enjoyed all aspects of the evening. Randene Neil of sponsor Global TV was a beautiful entertaining Emcee.. The President of the Society is Gary Schubak. Board Members and other notorieties including Richmond Liberal MLA were introduced. Brenda Plant, exceptional Executive Director gave a heart warming speech about the work the society does. A brief film showed the success stories.
Then Katey Sagel, quest speaker, held the audience in the palm of her hand with the inspiration and sincerity of her message of hope. Who would believe that this was "Peg Bundy" from "Married with Children". Yet sure enough she said "Al" in such a way as to establish her actress bonafides beyond a doubt. Her talk though was of her journey as a spiritual person, a woman and a mother in the era of rock stars and LA culture. When she stepped from the stage the whole audience lept to it's feet in standing ovation. Clearly as an actress and singer songwriter she had known her share of these . Tonight's audience celebrated her heart felt message and the humanity of her personhood.
Earlier I had the fun of skipping in and out to bid on opera tickets, symphony, and First Nations art. Westjet had offered for draw tickets for two to wherever they flew and this was a very busy lottery. (The winner eventually was escorted away in the protection of body guards.) Queen Charlotte Fishing Lodge tickets for two for 4 days all included excursion eventually were auctioned for $4000 as one of many big ticket items.
All round a marvellous evening of doing good by being there while decadently enjoying good food and fine company, listening to genius and bidding and acquiring more pleasures for future enjoyment. I can't wait till next year to suffer more on behalf of a very good cause.
Voltaren Emulgel Cream
http://en.wikipedia.org/wiki/Diclofenac
I've used this and I've recommended it. It's a non steroidal anti inflamatory (NSAID) cream that provides amazing pain relief and motion to areas of soft tissue injury. This includes things like whiplash injuries and old rotator cuff tears. It's marketted for strains. Non steroidal anti inflamatories are an alternative to salicilic acid or asa. The best known of the NSAID class is ibuprofen. The value of Voltaren is that it is a cream that can be applied several times a day , maximum 4 times. I suppose it can be used for extended periods. There are pages of 'medical disclaimer' information. Lawyers and Judged drink scotch and smoke cigars. They also drive cars. The risks of living in modern society make medicine safe by comparison. The fact is I sometimes get a 'crick in my neck'. The old 'liniments' of my grandfather's era dispite smelling grand and heating the skin don't do much. Voltaren goes on smooth and is undetectable. I don't use it regularly. I use it once in a while and I get a good night's sleep whereas the pain or old age and rheumatism might well disrupt my sleep. It's gets me over the hump. It's an alternative to ending up like Charlie Sheen perhaps. From my perspective as patient and physician it's a good drug. It's an addition to my life and it's an addition to my patients lives. It shouldn't be abused. It's probably can contribute marginally to strokes and heart attacks but so can marriage and divorce and working for certain corporations. I'm just thankful today that I thought, two nights I didn't sleep well because I got a draft on my neck and I used some voltaren last night and I slept just fine. My friend has a rotator cuff injury and he's not ready for surgery and medications upset his stomach. Voltaren Emulgel Cream is the best alternative. Eventually he'll probably need surgery. In the mean time he's doing whatever it takes to get through the day. Voltaren is a good thing to have in his tool box of solutions. This is what is called a testimonial. it's anecdotal evidence. There's excellent scientific support for NSAID. We've been using them for years safely and effectively. There was even an ASA cream that worked great on reducing the swelling and itch around mosquito bites. Voltaren might well work on that too. I've just used it on my neck. I didn't have a stroke or heart attack. It gave me relief. Great stuff. Thanks guys for making this.
I've used this and I've recommended it. It's a non steroidal anti inflamatory (NSAID) cream that provides amazing pain relief and motion to areas of soft tissue injury. This includes things like whiplash injuries and old rotator cuff tears. It's marketted for strains. Non steroidal anti inflamatories are an alternative to salicilic acid or asa. The best known of the NSAID class is ibuprofen. The value of Voltaren is that it is a cream that can be applied several times a day , maximum 4 times. I suppose it can be used for extended periods. There are pages of 'medical disclaimer' information. Lawyers and Judged drink scotch and smoke cigars. They also drive cars. The risks of living in modern society make medicine safe by comparison. The fact is I sometimes get a 'crick in my neck'. The old 'liniments' of my grandfather's era dispite smelling grand and heating the skin don't do much. Voltaren goes on smooth and is undetectable. I don't use it regularly. I use it once in a while and I get a good night's sleep whereas the pain or old age and rheumatism might well disrupt my sleep. It's gets me over the hump. It's an alternative to ending up like Charlie Sheen perhaps. From my perspective as patient and physician it's a good drug. It's an addition to my life and it's an addition to my patients lives. It shouldn't be abused. It's probably can contribute marginally to strokes and heart attacks but so can marriage and divorce and working for certain corporations. I'm just thankful today that I thought, two nights I didn't sleep well because I got a draft on my neck and I used some voltaren last night and I slept just fine. My friend has a rotator cuff injury and he's not ready for surgery and medications upset his stomach. Voltaren Emulgel Cream is the best alternative. Eventually he'll probably need surgery. In the mean time he's doing whatever it takes to get through the day. Voltaren is a good thing to have in his tool box of solutions. This is what is called a testimonial. it's anecdotal evidence. There's excellent scientific support for NSAID. We've been using them for years safely and effectively. There was even an ASA cream that worked great on reducing the swelling and itch around mosquito bites. Voltaren might well work on that too. I've just used it on my neck. I didn't have a stroke or heart attack. It gave me relief. Great stuff. Thanks guys for making this.
The Ascent of Money
The Ascent of Money, A Financial History of the World, by Niall Ferguson, Penguin Books, 2008 is a truly fascinating read that turns the intrigue of history into a fast paced thriller. It really is a who dunnit detective novel for the 2007 recession as well and answer the question why governments want us to buy houses and the Chinese in contrast to the South Americans insisted you build factories in their country rather than loan them the money to do it themselves.
Niall Ferguson could well be a Hollywood script writer the way this supposedl y 'dry' subject reads. I'm 340 pages into it with the remaining 23 pages to read. The last chapter is called the "Descent of Money". I'm not sure I'm ready to read that yet. I'm going to savour it as I've raced through other sections of this extraordinary plot of economics and politics.
I have learned about the family wealth of brother Rothschild and Baring, the building of companies and interest, the insurance and sharing of risk, banks and their growth and diversificaton. I've learned of war and Bretton Woods, the depression and more recently the recessions. At times it really does seem that the world banks, money and stocks and funds are just different black jack tables in the casino of the world. Yet here and there I understand the concepts of leverage and wealth creation by careful management. In the recent recessions millions were lost in days and though there were bail outs the very wealthy took huge cuts themselves.(See my own sad song written for those poor souls, called "I'm a millionaire but I used to be a billionaire' after the Economist disclosed dozens of billionaires were demoted in the financial crisis that put others out of houses into tents). I learned too that in most of the US you may lose your house but they can't get any of your other assets so buying a house with zero down makes for sweet cheap rent for years until the interest rises and the smart tenant (or money) moves on. Then there's Soros and Buffet and now China and the Cninese American "Chimerica'.
Niall Ferguson is Professor of History at Harvard and Fellow at Oxford and Fellow at Stanford. Most of all he's a brilliant story teller. And the Ascent of Money is a tremendous story. So where is the Hollywood movie with Brad Pitt and Jack Nicholson and Charley Chan. It's clear from reading it today that in China with it's 350,000 new millionaires there would be such a movie made immediately or at very least an HBO special like the Tudors or Borgias. Americans are still reading the sports pages while the Chinese have long realized the real 'contest' is in the business section. Beijing is winning the war in the marketplace and China is now the bank of America.
How to explain 2007, the beginning of the worst financial crisis since the depression of the 30's. Here are answers. Here is what is beyond partisan politics. Here is meaning of life in the world of 'banksterism' . It's not about white hat cowboys and black hat cowboys. Both Clinton and Bush declared that their bankers had misinformed them. In the world of economics with avarice and insurance in competition and tsunamis and Russian government crashes there are butterfly wings all over globalization. The arrogance of the nobel prize winning Black-Scholes model and the whimsy of the Quantum Fund begin to make sense when hedge funds and derivatives are explained. It's really more fashion than anything else and the Devil Wears Prada. I had to read that derivative part again and again hardly believing such silliness in asset management could exist as such a disconnect from reality. This is the financial world of 'deconstructionism'. This is Humpty Dumpty in Los Vegas. It's entertainment at the highest level as well.
Thanks to Niall Ferguson I can understand the 'sound bites' and propaganda, conspiracy theories and fear mongering that the media has thrown out. There's method in the madness but even that's a bit neurotic.. Investments really do go up on sunny days. And yes, I will be able to manage my own paltry sums of cash better thanks to Niall Ferguson. This is essential reading at it's finest.
Niall Ferguson could well be a Hollywood script writer the way this supposedl y 'dry' subject reads. I'm 340 pages into it with the remaining 23 pages to read. The last chapter is called the "Descent of Money". I'm not sure I'm ready to read that yet. I'm going to savour it as I've raced through other sections of this extraordinary plot of economics and politics.
I have learned about the family wealth of brother Rothschild and Baring, the building of companies and interest, the insurance and sharing of risk, banks and their growth and diversificaton. I've learned of war and Bretton Woods, the depression and more recently the recessions. At times it really does seem that the world banks, money and stocks and funds are just different black jack tables in the casino of the world. Yet here and there I understand the concepts of leverage and wealth creation by careful management. In the recent recessions millions were lost in days and though there were bail outs the very wealthy took huge cuts themselves.(See my own sad song written for those poor souls, called "I'm a millionaire but I used to be a billionaire' after the Economist disclosed dozens of billionaires were demoted in the financial crisis that put others out of houses into tents). I learned too that in most of the US you may lose your house but they can't get any of your other assets so buying a house with zero down makes for sweet cheap rent for years until the interest rises and the smart tenant (or money) moves on. Then there's Soros and Buffet and now China and the Cninese American "Chimerica'.
Niall Ferguson is Professor of History at Harvard and Fellow at Oxford and Fellow at Stanford. Most of all he's a brilliant story teller. And the Ascent of Money is a tremendous story. So where is the Hollywood movie with Brad Pitt and Jack Nicholson and Charley Chan. It's clear from reading it today that in China with it's 350,000 new millionaires there would be such a movie made immediately or at very least an HBO special like the Tudors or Borgias. Americans are still reading the sports pages while the Chinese have long realized the real 'contest' is in the business section. Beijing is winning the war in the marketplace and China is now the bank of America.
How to explain 2007, the beginning of the worst financial crisis since the depression of the 30's. Here are answers. Here is what is beyond partisan politics. Here is meaning of life in the world of 'banksterism' . It's not about white hat cowboys and black hat cowboys. Both Clinton and Bush declared that their bankers had misinformed them. In the world of economics with avarice and insurance in competition and tsunamis and Russian government crashes there are butterfly wings all over globalization. The arrogance of the nobel prize winning Black-Scholes model and the whimsy of the Quantum Fund begin to make sense when hedge funds and derivatives are explained. It's really more fashion than anything else and the Devil Wears Prada. I had to read that derivative part again and again hardly believing such silliness in asset management could exist as such a disconnect from reality. This is the financial world of 'deconstructionism'. This is Humpty Dumpty in Los Vegas. It's entertainment at the highest level as well.
Thanks to Niall Ferguson I can understand the 'sound bites' and propaganda, conspiracy theories and fear mongering that the media has thrown out. There's method in the madness but even that's a bit neurotic.. Investments really do go up on sunny days. And yes, I will be able to manage my own paltry sums of cash better thanks to Niall Ferguson. This is essential reading at it's finest.
Wednesday, May 4, 2011
Spiritual Cellphone on Vibrate
It's the end of another day,
And I haven't made my fortune,
I haven't invented the perfect machine
Found the safe one shot antiviral,
Come and gone to another galaxy,
Communicated with the dead in heaven.
I haven't been called upon by God,
Or if I was, I wasn't listening.
Not really, my spiritual cell phone on vibrate..
I've not found the cure for cancer,
Though I wasn't particularly looking.
I've certainly not cured insaniety, given the extent of world politics.
If I make a dint, it's like a dishwasher, without no job security,
In a 24 hour popular fast food place,
At the hub of the universe, ,offering porcelain rather than paper,.
To give the appearances of home cooked food to packaged alternatives.
,
I'm done in with waiting. Godot is getting old
In the slang jazz era expression..
Hoping for rapture in lieu of second coming,
Beam me up, Scotty, there's no intelligent life here.
Neither science or religion will save me from myself
We are all painful in our solitude.
Praying or plotting, reviving or conniving.
This moment is sacred and miraculous, enhanced with love.
We are not accidental humankind but creation..
We may still hoard shiny things and seek security in large powerful buildings and beaurocracies..
There are nuclear bombs, television, and internet.
Romance promised something more than sentimentality.
We all love kids as future in hope they'll make up for our failure..
I'm hanging in there
On call.
On call for God's invitation to do something
To be more than I am.
More than ordinary, more than mundane,
Special in a very common sort of way.
Like any child
Like a child of God..A playful God.
I am only asking that I be ready for my life to light up
As I praise the Lord
Singing songs of deliverance, halleluja and remembrance.
But I'm waiting, somewhat bored and fat with ennui
Because God doesn't come on my time
As I pay lip service to Thy Will Be done, Not my will.
I am bored with Martha and distant from Mary
Waiting sleep to dream a new day
I'll soil less and garden more.
But now to dream. Maybe tomorrow if only I can keep my lamp lit.
And I haven't made my fortune,
I haven't invented the perfect machine
Found the safe one shot antiviral,
Come and gone to another galaxy,
Communicated with the dead in heaven.
I haven't been called upon by God,
Or if I was, I wasn't listening.
Not really, my spiritual cell phone on vibrate..
I've not found the cure for cancer,
Though I wasn't particularly looking.
I've certainly not cured insaniety, given the extent of world politics.
If I make a dint, it's like a dishwasher, without no job security,
In a 24 hour popular fast food place,
At the hub of the universe, ,offering porcelain rather than paper,.
To give the appearances of home cooked food to packaged alternatives.
,
I'm done in with waiting. Godot is getting old
In the slang jazz era expression..
Hoping for rapture in lieu of second coming,
Beam me up, Scotty, there's no intelligent life here.
Neither science or religion will save me from myself
We are all painful in our solitude.
Praying or plotting, reviving or conniving.
This moment is sacred and miraculous, enhanced with love.
We are not accidental humankind but creation..
We may still hoard shiny things and seek security in large powerful buildings and beaurocracies..
There are nuclear bombs, television, and internet.
Romance promised something more than sentimentality.
We all love kids as future in hope they'll make up for our failure..
I'm hanging in there
On call.
On call for God's invitation to do something
To be more than I am.
More than ordinary, more than mundane,
Special in a very common sort of way.
Like any child
Like a child of God..A playful God.
I am only asking that I be ready for my life to light up
As I praise the Lord
Singing songs of deliverance, halleluja and remembrance.
But I'm waiting, somewhat bored and fat with ennui
Because God doesn't come on my time
As I pay lip service to Thy Will Be done, Not my will.
I am bored with Martha and distant from Mary
Waiting sleep to dream a new day
I'll soil less and garden more.
But now to dream. Maybe tomorrow if only I can keep my lamp lit.
Non Compliance and Non Adherence to Medical Regimen
Non Compliance and Non Adherence to Medical Regimen are terms which refer to the patient part of the physician patient contract. Historically, in the west, all doctors worked as consultants. Patients were free agents and acted independently. A patient was most compliant in the surgical sense once they consented to surgery. However compliance could affect surgery very importantly in the post surgical sense.
As a family physician I had many occasions to reset fractures and reapply casts because the patient, usually young men, didn't accept that they were injured and proceeded to continue as if nothing had happened. I have further had patients who post surgery pulled out sutures and re inflicted self inflicted wounds.
The principal area where compliance and non adherence to medical regimen occurs is in the following of recommendations. The most common is the difficulty people have with taking one antibiotic pill 4 times a day for the usual 10 days required. Many a pregnancy has occured because a young woman was 'on' the pill but not taking it.
Non compliance and non adherence to medical regimen increase with chronic illness and with mental illness. 30 % non compliance is not uncommon but increases to 50% non compliance with the complexity or longer requirements of the medical schedule. With mental illness non compliance has been registered as high as 80%. When a treatment which is voluntary has negative side effects compliance decreases.
Historically if a person didn't follow through with a medication they were accountable for the 'failure of treatment'. Today in our litiginous society where increasingly no one is accountable non compliance and non adherence to medical regimen is increasingly assumed to be the physicians responsibility. This goes with the increasing requirement to tell everything about a medication, all the remote but potentially negative side effects, the communication of which decreases compliance.
The shift of responsibility from individual and independent and freedom to state controlled and group consensus is interesting to watch as it plays out in a piecemeal way. Advertisements for medications on television increasingly tell patients that medications for relatively minor ailments can have lethal consequences. In contrast 'homeopathic' treatments and 'alternative' and 'complementary treatments' may have little negatives, such as massage therapy, but little validity for specific treatment of specific maladies. Yet massage therapy has been associated with sexual abuse.
In predicting the outcome of a treatment it's important to know what the treatment is, whether it was actually taken, and what is the efficacy of the treatment if it is taken as directed.
This becomes even more important in areas like Addiction Medicine where patients not uncommonly are seeking help because of negative consequences of their behaviour. Their "solution" would be to continue their "self medication'. Prochaska has developed "Motivation to Change" in this are. Pre contemplation, Contemplation, Determination and Action phases are identified. Patient's who are in pre contemplation and contemplation phases are at highest likelihood to be non compliant and not adhere to a medical regimen because they may not identify their problem as their addiction.
I believe the following paraphrase was attributed to Keith Richards, "I don't have a drug problem. I have a cop problem." In this regard the solution isn't to take antabuse, revia, attend a 12 step program, see a psychiatrist weekly or monthly but perhaps to see a really good lawyer or becoming actively involved politically to change the laws. Dr. Bob, the co founder, of Alcoholics Anonymous said, never deny an alcoholics the consequences of their addiction because they only change as a consequence of the consequences.
The more onerous and debilitating and acute a condition is the more likely a person is to comply with treatment. Gonorrhea is a sexually transmitted disease that can cause a man to feel "like I'm pissing razor blades." The treatment of choice for gonorrhea is an injection of penicillin. This kills the microorganism and relieves the pain. However Gonorrhea can go unnoticed and it is much harder to get a person to be 'tested' before being treated on 'speculation' that their unprotected sex with prostitutes might cause them to have an unnoticed infection.
Historically diseases were viewed more acutely and in a limitted fashion. The above example of gonorrhea would be considered a 'successful treatment' by all involved in the 1950's. In contrast today in the era of preventative medicine, wholistic medicine, and life style disease management, and wellness clinics, treatment with penicillin would be described as 'symptomatic treatment'. The potential underlying 'sexual addiction' would be a much harder condition to treat with much worse prognois for successful treatment. Abstinence from prostitutes in the latter scenario would be the 'successful treatment'.
This is seen too in the treatment of cardiovascular risk factors, specifically high cholesterol. Patients are asked to change their daily behaviour, take a medication for a condition that they don't 'feel'. Compliance and non adherence to medical regimen are similiarly more common when the condition being treated is asymptomatic.
The birth control pill is 99% effective treatment if taken daily for birth control. If the same birthcontrol pill is taken monthly it's clearly not nearly so effective, if at all.
Non compliance and non adherence to Medical Regimen are critical factors in assessing or understanding illness and wellness behaviour.
As a family physician I had many occasions to reset fractures and reapply casts because the patient, usually young men, didn't accept that they were injured and proceeded to continue as if nothing had happened. I have further had patients who post surgery pulled out sutures and re inflicted self inflicted wounds.
The principal area where compliance and non adherence to medical regimen occurs is in the following of recommendations. The most common is the difficulty people have with taking one antibiotic pill 4 times a day for the usual 10 days required. Many a pregnancy has occured because a young woman was 'on' the pill but not taking it.
Non compliance and non adherence to medical regimen increase with chronic illness and with mental illness. 30 % non compliance is not uncommon but increases to 50% non compliance with the complexity or longer requirements of the medical schedule. With mental illness non compliance has been registered as high as 80%. When a treatment which is voluntary has negative side effects compliance decreases.
Historically if a person didn't follow through with a medication they were accountable for the 'failure of treatment'. Today in our litiginous society where increasingly no one is accountable non compliance and non adherence to medical regimen is increasingly assumed to be the physicians responsibility. This goes with the increasing requirement to tell everything about a medication, all the remote but potentially negative side effects, the communication of which decreases compliance.
The shift of responsibility from individual and independent and freedom to state controlled and group consensus is interesting to watch as it plays out in a piecemeal way. Advertisements for medications on television increasingly tell patients that medications for relatively minor ailments can have lethal consequences. In contrast 'homeopathic' treatments and 'alternative' and 'complementary treatments' may have little negatives, such as massage therapy, but little validity for specific treatment of specific maladies. Yet massage therapy has been associated with sexual abuse.
In predicting the outcome of a treatment it's important to know what the treatment is, whether it was actually taken, and what is the efficacy of the treatment if it is taken as directed.
This becomes even more important in areas like Addiction Medicine where patients not uncommonly are seeking help because of negative consequences of their behaviour. Their "solution" would be to continue their "self medication'. Prochaska has developed "Motivation to Change" in this are. Pre contemplation, Contemplation, Determination and Action phases are identified. Patient's who are in pre contemplation and contemplation phases are at highest likelihood to be non compliant and not adhere to a medical regimen because they may not identify their problem as their addiction.
I believe the following paraphrase was attributed to Keith Richards, "I don't have a drug problem. I have a cop problem." In this regard the solution isn't to take antabuse, revia, attend a 12 step program, see a psychiatrist weekly or monthly but perhaps to see a really good lawyer or becoming actively involved politically to change the laws. Dr. Bob, the co founder, of Alcoholics Anonymous said, never deny an alcoholics the consequences of their addiction because they only change as a consequence of the consequences.
The more onerous and debilitating and acute a condition is the more likely a person is to comply with treatment. Gonorrhea is a sexually transmitted disease that can cause a man to feel "like I'm pissing razor blades." The treatment of choice for gonorrhea is an injection of penicillin. This kills the microorganism and relieves the pain. However Gonorrhea can go unnoticed and it is much harder to get a person to be 'tested' before being treated on 'speculation' that their unprotected sex with prostitutes might cause them to have an unnoticed infection.
Historically diseases were viewed more acutely and in a limitted fashion. The above example of gonorrhea would be considered a 'successful treatment' by all involved in the 1950's. In contrast today in the era of preventative medicine, wholistic medicine, and life style disease management, and wellness clinics, treatment with penicillin would be described as 'symptomatic treatment'. The potential underlying 'sexual addiction' would be a much harder condition to treat with much worse prognois for successful treatment. Abstinence from prostitutes in the latter scenario would be the 'successful treatment'.
This is seen too in the treatment of cardiovascular risk factors, specifically high cholesterol. Patients are asked to change their daily behaviour, take a medication for a condition that they don't 'feel'. Compliance and non adherence to medical regimen are similiarly more common when the condition being treated is asymptomatic.
The birth control pill is 99% effective treatment if taken daily for birth control. If the same birthcontrol pill is taken monthly it's clearly not nearly so effective, if at all.
Non compliance and non adherence to Medical Regimen are critical factors in assessing or understanding illness and wellness behaviour.
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