Non-Adherence Is the Default Option

Non-adherence is the default option. So says Gérard Reach of the Sorbonne’s Education and Health Promotion Laboratory, who wants to know why patients sometimes will not do what their medical advisors have advised them to do for their own good.

What does default mean, exactly? A couple of things, but the applicable meaning here is, “a selection made usually automatically or without active consideration due to lack of a viable alternative.” Another dictionary puts it a different way: “What happens or appears if you do not make any other choice or change.”

Sadly, the default option for humans is usually to do nothing, rather than something. This is strangely true even when the person knows full well that she or he ought to be doing something.

Non-adherence is the same as non-compliance, and it happens a lot, increasing the severity of serious illnesses and the number of unnecessary deaths. Just like so many other factors, patient non-compliance needlessly bumps up healthcare costs.

So, what can bring about an increase in patient adherence? What can make it possible? As in so many cases of human behavior, it appears that studying the most successful performers would give some clues. This has been done,

[…] using concepts largely drawn from humanities, philosophy of mind, and behavioral economics and presents the findings of empirical studies supporting these hypotheses.

When someone brushes their teeth, they automatically rinse the toothpaste from their mouth. There is no need to consult the “to-do” list as a reminder. When a behavior is automatic, consciously remembering to do it is not a factor. Nor is it performed in order to dutifully check it off a list. Without reflection or debate, it just happens, as is the nature of a firmly ingrained habit.

How can that automatic quality be transferred to actions the doctor advises? Habit formation is crucial because it “allows adherence to become non-intentional, thereby sparing patients’ cognitive efforts.”

The author’s conclusions come from 20 years of observing patients with diabetes but, he says, “can be applied to all chronic diseases.” It seems that the relationship between the patient and the health professional is crucial. Two major factors are patient education, and shared medical decision-making.

The non-compliance problem was been officially recognized in academic literature for at least 40 years, although of course it is probably as old as time. It has been approached in various ways although, Reach says, “they fail to address its underlying mental mechanisms”:

Non-adherence may well be the default option, with only some patients managing, with considerable effort, to perform the unnatural action of practicing a treatment over the long term. The real question then becomes, how is patient adherence possible?

Your responses and feedback are welcome!

Source: “How is Patient Adherence Possible? A Novel Mechanistic Model of Adherence Based on Humanities,”, 07/18/23
Source: “Default,”, undated
Source: “Default,”, undated
Image by 807th Medical Command/CC BY 2.0

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Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
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Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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