Medical Education and Compliance.

MUDr. Zuzana Miškovská, Ph.D., MUDr. Hana Válková- CMA J.E. Purkyne, Czech R.

Premises:
Treatment success is subject to many factors – the first factor is medicine and its technical and pharmaceutical possibilities; the second factor is the responsible professional approach of a physician, and last but not least, another important factor is also the patient´s personality –Empiric clinical experience indicates that both the patient and physician have totally different treatment priorities.

Aims:
The survey’s goal was to determine a rate of compliance between physician and patient diagnoses. After determination of the compliance/noncompliance, GPs have been offered to discuss the results.

Method:
The method was a questionnaire – an independent interviewer asked 10 randomly selected patients in each participating consulting room about, besides their demographic data, the life quality, disease severity and level of difficulty to adhere to the physician’s recommendations. Afterwards, GPs were asked by the interviewer to make a brief conclusion from the last preventive examinations.

Results:
The survey was positively accepted also by patients who evaluated discussions about their approach to health.
It is very obvious that patients’ education and compliance are in close relation.

1) What is the quality of life and health, what are the relations between them?

• quality of life more than 20% - 25% better than quality of health

• quality of life is directly proportional to the quality of health

• quality of life does not depend solely on the quality of health

• oncology patients report a medium level of their quality of life

• some of the teenagers from a small town evaluate their quality of life as 20% worse than their quality of health and 25% - 40% worse than adults!

2) Do patients know their health condition – their diseases?

• Knowledge of disease order and severity: Compliance of patients with their treating physician has been noticed in only 45% of the patients

• Maximum compliance between the physician and his/her patient has been observed in cardiac and metabolic, psychiatric, oncological (breast, endometrial, colorectal, prostate cancer) diseases

• Minimum compliance between the physician and patient has been observed in: leukaemia, ethylism, vertebrogenous algic syndrome without neurological complications

• men can understand their diseases better than women

• elderly people can understand their diseases better than the young and adults

3) What is the relation between the health and quality of life and knowledge of the patient’s own 

Compliance with the physician was 3.5 times more frequent than non-compliance with the physician in patients with excellent qualities of health and life 

Non-compliance with the physician was 1.5 times more frequent than compliance with the physician in patients with poor qualities of health and life

4) Observations from performance of the research 

Most elderly people have been surprised by the quality of life question, as nobody had ever asked them about it: “In doctor’s offices I used to be asked what they could do, what I had come with and for.” 
Elderly patients often do not know their diseases, referring the interviewers to their practitioners, because “He/she knows everything about me.” 
If the patients link the quality of life to their health, most of them evaluate the capability of individual mobility and independence to be the significant life quality indicator.

Conclusions: 
There is low awareness of the patient’s own health condition in the Czech environment. A passive approach and resignation prevail mostly in the older generation, presumably as a habit acquired during a period with a paternalistic health care system. 
Patients do not report diagnoses, but symptoms. 
Patients distinguish between two groups of disease types and severity: Those limiting their independence and those not limiting their independence. (There is no knowledge of and not even any willingness to learn the disease staging system according to professional companies or WHO.) 
Surprisingly good awareness of one’s own health condition and perception of life quality and health as excellent or good have been observed in oncological and psychiatric patients. 
The negativity of young people from small cities is alarming.

Challenge for health care professionals:
Medical campaigns for preventive programmes can be successful only if people are well aware of the diseases which “are not painful, but may kill”.