1. It is incumbent on medical providers that they are asking patients
to - here to regimens with demonstrated eficacy, Providers need to
remind themselves of the Hippocratic oath: "I will follow that system of
regimen which, according to my ability and judgment, I consider for the
benefit ofmy patients, and abstain from whatever is deleterious and
mischievous" (as cited in Cassell, 199 1, p. 145). 2. Providers need to
abandon the "blame and shame" approach to dealing with medical adherence
problems. It is tempting to blame patients for adherence failures and
shame them into changing their behavior. Providers need to share the
blame (or better yet omit blame) and look at their own attitudes and
behaviors that impact adherence. For example, failing to simplify
regimens or minimize negative side effects can adversely impact patient
adherence. 3. Patients and their families are no longer (or maybe were
never) satisfied with apassive role in their health care. In fact, the
tern compliance lost favor in the literature because it implied for some
an authoritarian approach to health care that required unquestioned
obedience by patients to provider recommendations (DiMatteo & DiNicola,
1982). Comprehensive and effective health care requires a cooperative
relationship between providers and patients and their families. It also
acknowledges the following realities, particularly for treating persons
with chronic illness: "Doctors do not treat chronic illnesses. The
chronically ill treat themselves with the help of their physicians; the
physician is part of the treatment.
