Intended for healthcare professionals


We need minimally disruptive medicine

BMJ 2009; 339 doi: (Published 11 August 2009) Cite this as: BMJ 2009;339:b2803
  1. Carl May, professor of medical sociology1,
  2. Victor M Montori, professor of medicine2,
  3. Frances S Mair, professor of primary care research3
  1. 1Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE2 4AA
  2. 2UK Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, MN, USA
  3. 3Section of General Practice and Primary Care, University of Glasgow, Glasgow
  1. Correspondence to: C R May c.r.may{at}
  • Accepted 18 June 2009

The burden of treatment for many people with complex, chronic, comorbidities reduces their capacity to collaborate in their care. Carl May, Victor Montori, and Frances Mair argue that to be effective, care must be less disruptive

Chronic disease is the great epidemic of our times, but the strategies we have developed to manage it have created a growing burden for patients. This treatment burden induces poor adherence, wasted resources, and poor outcomes. Against this background, we call for minimally disruptive medicine that seeks to tailor treatment regimens to the realities of the daily lives of patients. Such an approach could greatly improve the care and quality of life for patients.

Non-adherence, culpability, and susceptibility

Poor adherence to medical advice and drug regimens is a global problem with a long history. Non-adherence is important because many therapeutic interventions are effective only if used correctly, which requires continuous personal investment of time and effort from patients. The epidemiological transition from acute diseases, where the emphasis was on cure, to chronic illnesses that instead require management also means that patients take on a lifetime burden. Poor adherence can lead to complications in professional-patient relationships, additional ill health and expenditure for patients and their families, and the waste or misallocation of healthcare resources.1 2 3

The aetiology of non-adherence is complex, but individual culpability has been assumed to play an important part.4 5 People with chronic (and other) illnesses who do not adhere to treatment generally say that they know that they ought to do otherwise but that they lack the capacity, skills, and knowledge to do so. In one study, 45% of patients gave such reasons for intentionally not adhering to treatment for chronic illnesses.6 Recent research on adherence has focused, therefore, on interventions. The aim of these interventions is twofold: to improve …

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