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Diabetes Metab. 2008 Sep;34(4 Pt 1):382-5. doi: 10.1016/j.diabet.2008.02.008. Epub 2008 Aug 15.

Patient non-adherence and healthcare-provider inertia are clinical myopia.

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Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital, AP-HP and Laboratory of Pedagogy of Health, EA 3412, University Paris-13, CRNH-Idf, Bobigny, France.


The efficient implementation of healthcare is often jeopardized by the lack of patient adherence to medical recommendations and by inadequate healthcare-provider adherence to current guidelines, a phenomenon recently described as "clinical inertia". We propose here a theoretical model, based on concepts developed in the field of analytical philosophy of mind, that describes the mental mechanisms shared by the two phenomena, thus explaining their synergistically deleterious influence on the efficiency of care. We suggest that a failure to give preference to the long-term benefits of treatment intensification may represent a common mechanism underlying both patient non-adherence and physician clinical inertia. We dub such a failure as "clinical myopia". The model is explained in the context of clinical observations made in type 1 and 2 diabetic patients. However, it may also be relevant to other asymptomatic chronic diseases.

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