How can we accept that we ought to stop smoking, follow a diet, exercise, or take medications? The goal of this book is to describe the mechanisms of patientsâ adherence to long-term therapies, whose improvement, according to the World Health Organization (WHO), would be more beneficial than any biomedical progress. For example, approximately half of the patients do not regularly follow medical prescriptions, resulting in deleterious effects on peopleâs health and a strong impact on health expenditure. This book describes how our beliefs, desires, and emotions intervene in our choices concerning our health, by referring to concepts developed within the framework of the philosophy of mind. In particular, it tries to explain how we can choose between an immediate pleasure and a remote rewardâpreserving our health and our life. We postulate that such an âintertemporalâ choice can be directed by a âprinciple of foresightâ which leads us to give priority to the future. Just like patientsâ non-adherence to prescribed medications, doctors often donât always do what they should: They are non-adherent to good practice guidelines. We propose that what was recently de-scribed as âclinical inertiaâ could also represent a case of myopia: From time to time doctors fail to consider the long-term interests of their patient. Both patientsâ non-adherence and doctorsâ clinical inertia represent major barriers to the efficiency of care. However, it is also necessary to respect patientsâ autonomy. The analysis of relationship between mind and care which is provided in this book sheds new light on the nature of the therapeutic alliance between doctor and patient, solving the dilemma between the ethical principles of beneficence and autonomy.
