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Challenging non-compliance
  1. S Keszthelyi1,
  2. B Blasszauer2
  1. 1Faculty of Medicine, 1st Internal Clinic, University of Pecs, Pecs, Hungary
  2. 2Faculty of Medicine, Institute of Family Medicine, University of Pecs, Pecs, Hungary
  1. Correspondence to:
 Dr B Blasszauer, Institute of Family Medicine, University of Pecs, Ifjusag u. 15. 7624 Hungary; 

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One of the hardest tasks for a physician is to treat and take care of patients suffering from such chronic disease as diabetes. The difficulties arise mainly because the medical treatment and the necessary follow up demand that the physician interfere with, or at least influence, the whole lifestyle of the patient. The diabetic must pursue a distinct way of daily living: he must change his eating habits, go on a diet, create a healthy lifestyle and keep to it. Patients may know about the necessity of being on a diet, but a great number of them don’t have any understanding of such basic terms as “protein”, “carbohydrate”, “lipid”, or even “calorie”, which are essential to an understanding matters to do with diet.1 While it is obvious that scientific and technical terms should be translated into everyday language, and acknowledging that providing patients with information is an essential part of care, it is not possible, and not even necessary to give every piece of information to every patient.

Just as with any other chronic disease, a good outcome can only be achieved through a strong commitment to serving the interest of the patient. In order to accomplish this, physicians must be aware of the ethical implications raised by non-compliance. The authors are very much in agreement with the American sociologist, Peter Conrad, who stated that:

From a medical perspective, patients who do not comply with the doctor’s orders are usually seen as deviant, and deviance requires correction. But many chronically ill people view their behavior differently, as a matter of self regulation.

He is also right when he states that “compliance” looks very different when seen from the patient’s perspective. As an example, patients might adjust their medication to meet their everyday social needs rather than complying exactly with …

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