By R. Hanson. California Lutheran University. 2018.
Surgery is an art discount 1 mg finasteride with visa, and the best way to teach an art Quoted in the Hunterian Museum finasteride 1mg cheap, Royal College of is an apprenticeship system buy 1mg finasteride visa. Quoted in the Hunterian Museum, Royal College of Sir George Murray Humphry – Surgeons of England English professor of surgery The last part of surgery, namely operations, is a In surgery, eyes ﬁrst and most; ﬁngers next and reﬂection of the healing art; it is a tacit little; tongue last and least. Attributed Baghdad physician I have already told the Ruler of the Faithful that my art must be used only for the good of the William Hunter – people. British surgeon, anatomist, and religious philosopher The Illustrated History of Surgery Knut Haeger () Were I to place a man of proper talents, in the Geoffrey Hunt most direct road for becoming truly great in his Contemporary British ethicist profession, I would choose a good practical Anatomist and put him into a large hospital to Health care professionals who always took the attend the sick and dissect the dead. Edward Arnold, London () Attributed James Henry Leigh Hunt – English poet and essayist Sir Robert Hutchison – The ground-work of all happiness is health. Address to the American Fracture Association, October It is always well, before handing the cup of () knowledge to the young, to wait until the froth has settled. John Hunter – British Medical Journal : () British surgeon and scientist It is unnecessary—perhaps dangerous—in I believe your solution is right, but why believe? Lancet : () Letter to Edward Jenner about his new vaccine for smallpox The scientiﬁc truth may be put quite brieﬂy; eat The stomach is the distinguishing part between an moderately, having an ordinary mixed diet, and animal and a vegetable; for we do not know any don’t worry. V From inability to let well alone; from too much zeal for the new and contempt for what is The operation is a silent confession of the old; from putting knowledge before wisdom, surgeon’s inadequacy. Without this knowledge a man than the endurance of the same, Good Lord, cannot be a surgeon. Attributed British Medical Journal : () · Sir Julian Huxley – Healthy people need no bureaucratic interference British biologist and author to mate, give birth, share the human condition and die. Medical Nemesis Attributed To give the lower class greater access to health Evolution is the most powerful and the most care would only equalize the delivery of comprehensive idea that has ever arisen on Earth. British biologist Limits to Medicine () I asserted – and I repeat – that a man has no reason to be ashamed of having an ape for his Indian proverbs grandfather. Speech, June () replying to Bishop Samuel Physicians live by rich patients, ofﬁcials by Wilberforce at the Association for the Advancement of Science in Oxford, June () unlucky princes, princes by litigants, and clever men by fools. It is an error to imagine that evolution signiﬁes a constant tendency to increased perfection. Indian (Kashmiri) proverb Social Diseases and Worse Remedies ‘The Struggle for Existence in Human Society’ Until a physician has killed one or two he is not a physician. If he is to allowed to let his children go unvaccinated, he might as well be allowed to leave Indian (Tamil) proverbs strychnine lozenges about in the way of mine. Method and Results ‘Administrative Nihilism’ Domestic medicine is preferable to that of a physician. Hospitality and medicine must be conﬁned to Darwiniana ‘The Coming of Age of the Origin of Species’ three days. Many people think they have religion when they Ariel ‘The Fabric and Creation of a Dream’ are troubled with dyspepsia. Ingle – Norwegian playwright Science cannot be equated to measurement, Oh, one soon makes friends with invalids; and I although many contemporary scientists behave need so much to have someone to live for. Austrian-born social philosopher and activist Principles of Research in Biology and Medicine Ch. Werner Jaeger – The silliest charm gives more comfort to German classical scholar thousands in sorrow and pain In classical times, more than at any other period Than they will ever get from the knowledge that until a few decades ago, the doctor was more proves it foolish and vain. Isidore of Seville – A custom loathsome to the eye, hateful to the Spanish ecclesiastic nose, harmful to the brain, dangerous to the lungs. A Counterblast to Tobacco The physician ought to know literature, to be able to understand or to explain what he reads. Pierre Marie Janet – If the patient dies, it is the doctor who has killed French professor of psychology, Sorbonne, Paris him, and if he gets well, it is the saints who have If a patient is poor he is committed to a public cured him. Japanese proverbs Boston Medical Quarterly : () Better go without medicine than call in an In teaching the medical student the primary unskilful physician. First the man takes a drink, then the drink takes a drink, then the drink takes the man. Third book of Criticism Mary Corinna Puttnam Jacobi – DeForest Clinton Jarvis –? Garrison, Bulletin of the New York Academy of Medicine October, – () Karl Jaspers – German philosopher The magnetic needle of professional rectitude should, in spite of occasional deviations, always The anxiety affects the body. Academy of Medicine October, – () Die geistige Situation der Zeit Pt , Ch. Letter to Philip Turpin, July () Sir William Jenner – If the body be feeble, the mind will not be English physician and pathologist strong. British humorist Letter to Maria Cosway, October () We drink one another’s health and spoil our own. Idleness begets ennui, ennui the hypochondriac, Idle Thoughts of an Idle Fellow, ‘On Eating and Drinking’ and that a diseased body. No laborious person was Love is like the measles, we all have to go ever yet hysterical. Letter to Martha Jefferson, March () Idle Thoughts of an Idle Fellow, ‘On Being in Love’ The most uninformed mind with a healthy body, I never read a patent medicine advertisement is happier than the wisest valetudinarian. Randolph Jr, July () I am suffering from the particular disease Health is the ﬁrst requisite after morality. Future William Stanley Jevons – nations will know by history only that the English economist and logician loathsome smallpox has existed and by you has So-called original research is now regarded as a been extirpated. God could not be everywhere and therefore he Letter to Dr Caspar Wistar, June () made mothers. John of Arderne – Letter to Dr Caspar Wistar, June () English surgeon and father of colorectal surgery The adventurous physician goes on, and A bubo is a tumour developing within the substitutes presumption for knowledge. I wish to see this beverage (beer) become common Treatises of Fistula-in-ano D’Arcy Power. Oxford University instead of the whiskey which kills one-third of our Press () citizens and ruins their families. Bodily decay is gloomy in prospect, but of all Treatises of Fistula-in-ano D’Arcy Power. Oxford University human contemplations the most abhorrent is Press, Oxford () body without mind. Letter to John Adams, August () Sir Elton John – We never repent of having eaten too little. British rock singer Letter to Thomas Jefferson Smith, February () There’s nothing wrong with going to bed with somebody of your own sex. People should be very Edward Jenner – free with sex – they should draw the line at goats. English country physician Attributed The deviation of man from the state in which he Samuel Johnson – was originally placed by nature seems to have English lexicographer and writer proved to him a proliﬁc source of disease. An Inquiry into the Causes and Effects of the Variolae Vaccinae, We palliate what we cannot cure. Jung – has been made by which a single malady is more Austrian psychoanalyst easily cured.
The reflection on experiences code encompasses basic learning principles cheap finasteride 5mg online, such that consumers may base adherence decisions on past experiences of adherence or non-adherence 5mg finasteride otc, or by making comparisons between presentations prior to and after medication treatment discount finasteride 5mg. Commonly, for example, interviewees attributed their adherence to learning from past, 112 negative experiences of non-adherence such as relapse. Interviewees also occasionally posited that their observations of other mentally ill consumers when adherent or non-adherent influenced their own adherence. These findings could be seen to somewhat contrast quantitative research, which has reported associations between recent, past non-adherence and poorer adherence outcomes at six months follow-up (i. Similarly, another study has found that the strongest predictor of adherence at six months follow-up was good adherence in the month prior to baseline (Novick et al. In the analysis presented below, adherence is typically constructed as a behaviour which is learned and is shaped according to individual experiences. Experiences of non-adherence are frequently framed as important learning curves for consumers to reflect on, despite associations with relapse. Individualism is stressed, as is the importance of consumers’ agency in relation to adherence choices, especially in the extracts that discuss interventions. Four different types of experiences that consumers reflected on and associated with their adherence will be discussed: (1) experiences of illness prior to medication treatment; (2) experiences of consequences of non-adherence; (3) experiences of the benefits of adherence; and (4) observations of other consumers. A section on interventions is also included, as when asked about how adherence could be addressed, consumers often emphasized the benefits of reflecting on and, thus, learning from, personal experiences, therefore potentially rendering ineffective interventions which aim to prevent non-adherence or entail external force to promote adherence. When asked about their reasons for remaining adherent, interviewees occasionally referred back to a pre-diagnosis period of time and emphasized the difficulty of experiencing symptoms of schizophrenia untreated. Below, interviewees can be seen to indicate that reflecting on early illness experiences and comparing pre-treatment experiences to experiences when treated with medication provide incentive for maintaining adherence: Ryan, 26/09/2008 R: What I do is think back, yeah, I was like this when I was unwell: Paranoid, delusional, hallucinations, um thoughts were just all over the place, couldn’t function, couldn’t do anything, insane basically and like, not much (inaudible) as far as sanity goes. So uh, what I do is I look back and think how bad I was, how bad my mental health was prior to getting treatment and then getting the treatment and then looking at how I was before and how I am now. Looking back, how difficult life had been from 1965 um, I mean, it was the same when you ask my doctor then how I presented, he’d tell you, mad. L: So it’s like making that comparison between how hard it was for you without the medication and with. In the above extracts, Ryan and Thomas compare their lives before receiving effective medication treatment, in the early stages of their illnesses, with their current lives, as stable, adherent consumers. Thomas’ contrasting of his former, pre-medication time of life (“difficult”, “very, very hard”) with his adherent years (“a piece of cake”) functions to emphasise the positive impact that medication treatment and adherence have had on his life. Ryan also emphasizes how difficult his life was before medication treatment by emphasizing his inability to function and describing himself as “insane”. Ryan and Thomas attribute their current adherence to learning from their experiences pre-treatment and post-treatment. Specifically, in the context of being asked what motivates him to remain adherent currently, Ryan explicitly states that he “look(s) back and think(s) how bad (he) was, how bad (his) mental health was prior to getting treatment and then getting the treatment and then looking at how (he) was before and how (he is) now”. Thomas’ past experiences are constructed as influencing his current adherence through the statement that he “wouldn’t be prepared to take the chance” to return to a pre-medication state, implying that he does not want to become non-adherent due to the associated risk of experiencing instability of his mental health and debilitating illness symptoms that he experienced in the past. Although not dissimilar to the idea of being influenced by pre- medication treatment experiences, this sub-code varies slightly from the previous one in that consumers referred to more recent, post-diagnosis experiences of non-adherence which typically followed periods of adherence and stability. Many interviewees stated that their experiences of becoming non-adherent and then relapsing provided incentive for them to remain adherent, as they had learned the association between non-adherence and symptom relapse and gained insight into the need for ongoing medication treatment. Indeed, many interviewees who described having learned from experiences of non-adherence had become advocates for adherence amongst other consumers. In the following extracts, interviewees attribute their adherence to learning that maintenance medication is necessary for their stability from a past episode of non-adherence, whereby their symptoms flared up. Gary, 31/07/2008 L: So, what would you say motivates you to stay on your medication then now, because you’ve been…I know you’ve had a couple of times when you’ve stopped, but why do you keep taking your medication now? G: Ya know, not better, so I might as well stay on the medication and be better all the time 116 Ryan L: And so that’s what motivates you to keep going then? R: Well, I did like, I guess I never were a guy for medication in ‘94, ‘95 and so on, but I kept saying that when I did try Abilify, and I went off clozapine in 2004, um, I just got unwell in a quick space of time and realised that hey, you know, the illness is, it just occurred to me after nine years of being well that uh, the illness is still there, so you just need to take them. Travis, 19/02/2009 T: Um, but I think you know, with my progress, it’s been a lot of years and a lot of bad experiences that have pushed me through, you know. In the first extract, Gary directly posits his “past history” as his reason for taking his medication, elaborating that he has learned that when he discontinues his medication, his symptoms exacerbate. Reflection on this negative experience for Gary enabled him to also learn of the relative benefits of remaining adherent (“so I might as well stay on the medication and be better all the time”). He relays, however, that an experience of non- adherence - which lead to a relapse after nine years of stability whilst adherent - led to a gain in insight about the chronicity of his mental illness and, thus, influenced his current beliefs about the need for medication 117 (“realised that hey, you know, the illness is, it just occurred to me after nine years of being well that uh, the illness is still there, so you just need to take them. Consistently, Travis, a peer worker who was adherent and stable at the time of interview, attributes his “progress” to time and “a lot of bad experiences”. Travis concurs that he learned from negative experiences, which “pushed him through”, despite acknowledging that they were “never nice”. In line with the above extracts, below Steve and Thomas explicitly state that they have learned not to stop taking their medication as a result of the experiences of the consequences of non-adherence. The experiences described in the following extracts represent secondary consequences of symptom relapse for these interviewees; hospitalization and imprisonment: Steve, 4/02/2009 L: Yep. Is that sort of a disincentive, does that sort of make you want to stop taking it? S: Um, nah I’ve stopped taking my medications in the past, I have, but as soon-, I ended up back in hospital and learned my lesson not to get off ‘em. Because that was my huge mistake in my 20s when I had my first bad episode, terrible. After being put in jail, I knew then that if I didn’t follow what the doctors said and take my pills then I would have very little life to call my own. In the first extract, even when being asked a leading question as to whether the side effect of weight gain influences Steve’s adherence, he declines and justifies his adherence in spite of this side effect by associating past non-adherence with hospitalisation. It is implied that the disadvantage of adherence - namely, weight gain - is overtaken by the negative consequences of non-adherence - specifically, hospitalization. Steve then directly reinforces his current position on adherence in spite of side effects and eludes to the trial and error process involved in adherence by stating that he “learned (his) lesson not to get off ‘em” from this past experience of hospitalisation. In the second extract, Thomas explicitly constructs non- adherence early in his illness as a “huge mistake” and his experience of going to jail after a bout of non-adherence as a learning curve in his life by labelling it a “turning point”. Thomas constructs his experience of being jailed as teaching him of the serious life impact that non-adherence can exert and thus influencing his present adherence. In both of the above extracts, adherence is implicitly framed as a means of avoiding the negative consequences of non- adherence that can result from relapse. In the below extract, Thomas more explicitly frames adherence as a means of avoiding risks associated with non- adherence: Thomas, 19/02/2009 119 L: So um, we’ve talked about your experiences then with antipsychotic medications. Um, what would be your beliefs generally about antipsychotic medications and taking them? T: Oh well, whoa, I mean you asked me when I was in Canberra what I thought about it then… I knew it had to be. Such a long way to get back after the first time and then it’s a long way to get back on the second one and then that’s a catastrophe.
But it has this in its favor discount 1mg finasteride otc, that it brings out all we know of medicine purchase finasteride 1 mg mastercard, and enables us to classify our own knowledge and that of the books generic 5mg finasteride free shipping, so as to make them useful. When we study local remedies we find that they may be classified in a similar manner, some of them readily, others with difficulty. We have remedies that influence the respiratory organs, the digestive apparatus, the urinary apparatus, the excretory apparatus - skin, kidneys, bowels - the brain, etc. We find also that some remedies may be classified as they influence special tissues - mucous membranes, serous membranes, connective tissue, bones, etc. Let us call this the first study of remedies, a study that recalls and fixes that which we know, and that gathers from books the essential facts, or what seems to us essential facts of drug action. It is work, but I will guarantee that the physician comes out of it stronger in mind, and very much better able to prescribe for disease. There are some things which can only be learned by experiment, and I would urge every one to some effort in this direction. You have your own bodies, and though you may value them highly, it will do little harm to test some medicines upon your own person. There is nothing in medicine that I would not test on my own person, if I was engaged in studying its action. Very certainly if the physician has occasion to take medicine for any disease, he should carefully note its effects from hour to hour. Let us call this the second method of studying remedies, it is the Homœopathic method, though employed to some extent by all classes of physicians. It gives most excellent and reliable results, and we can not afford to dispense with it. The third method is by carefully studying the effects of remedies administered for disease. This study can only be made to advantage where notes are kept, when care is used in the diagnosis, and when single remedies, or remedies that act in the same way, are employed, It is true that we can carry something in our memories, and by repeated observations facts will become familiar, but it is not a good plan to trust the memory too far. There are two things we want to know - the expression of disease, and the action of remedies - and in so far as we can, we want to associate them together. We may keep a record of cases with but little writing, if we have a plan to commence with. One word will sometimes express the condition of disease, it will rarely require more than a line. Now when giving remedies we may note nearly as briefly the reason why we have selected the remedy. Pulse small, frequent - Aconite; pulse frequent, sharp - Rhus; veins full - Podophyllum; tissues full, œdematous - Apocynum; muscular pain - Macrotys; nervous, free from fever - Pulsatilla; periodicity - Quinine; dull, stupid, sleepy - Belladonna; pain of serous membranes - Bryonia; dusky coloration of surface or mucous membranes - Baptisia; mucous membranes deep red - Acids; mucous membranes pale - Alkalies; feeble heart - beef-tea; strong circulation, high temperature - boiled milk. I give examples as my memory recalls them, but I think that the majority can have a record in about as many words. We do not want to write a book for other persons, but to make such notes as will enable us to recall the entire history of the disease, with its expressions that have suggested the use of the remedies employed. The reader will see that the record of the effect of the medicine can be easily kept. A 0 will tell the story of no effect, and a group of half a dozen adjectives will note the more important influences that we wish to record. In making a study of our working materia medica, it is well to note the advantages of carrying remedies, and of extemporaneous prescription at the bedside. The advantages are threefold - to the physician, to the patient, and to the friends. To the physician in that he learns his remedies better, and prescribes with greater certainty. To the patient, that the remedies are given in less doses, are promptly administered, and are not admixed with unpleasant vehicles, and are of more certain value and action. I have no special love for retail druggists, and many unpleasant experiences have shown me that it is quite possible to procure the poorest drugs in the market from them, and that it is quite uncertain what you will get in any given case. Of course there are many exceptions, but this is applicable to the druggist in ordinary, who makes it a rule to buy cheap, and sell dear. I need not say that a contract between physician and druggist, by which the former receives a percentage on prescriptions, is a very small species of swindling, and unworthy the profession. Patients will soon recognize the advantage that comes from a well filled medicine case, and will pay their bills more promptly if they are not bled by the druggist. Talking about bleeding, I have seen, time and again, a poor family saddled with an expense of from thirty cents to a dollar and a half a day for weeks, and for drugs that were useless, or in quantities much larger than were necessary. Recently I counted on the mantel of a patient, seven four-ounce, two six-ounce, and three two-ounce bottles, with three boxes of powders, all of which had been procured in seven days for a child four months old. As regards the form in which medicines are dispensed, I greatly prefer fluids, as they are easily measured, miscible with water, which is the best vehicle, are readily absorbed by the stomach, and hence of quicker and more certain action. The physician carrying his medicine in fluid form will soon learn that the small dose is not only as good but better than the old doses, and that with the majority of drugs given for direct action, the standard gtt. Prescribed in water in this way, medicines are not unpleasant, and the child will take them without objection. In dispensing, we have them bring one or two glasses half full of water, and a teaspoon, and prepare the remedy before the patient. The child takes its medicine without trouble, and indeed I do not recollect when I have had a case where the child required to be forced to take it. Using but small quantities of the stronger tinctures, an ordinary pocket case will carry enough for a very large practice. The pocket case I am using contains twenty-four four-drachm vials, and sixteen two-drachm vials, is of Eastern manufacture, and cost $3. It can be carried in the overcoat pocket, is sufficiently thick to sit upright in the buggy or on the table, corks all up - no unimportant matter in carrying fluids. The first row of twelve vials contains the essentials of practice - the remedies in common use - Veratrum, Aconite Gelseminum, Lobelia, Belladonna, Rhus, Bryonia, Nux, Ipecac, Phytolacca, Asclepias, Macrotys, and we will give these a first consideration. This remedy is employed to slow the pulse, and is especially indicated when it is full and strong, the large pulse being the prominent feature. The deep red stripe down the center of the tongue - marked - is a characteristic symptom, and calls for Veratrum. Fullness of tissue - not contraction - is found in cases where Veratrum gives its best results. It is a remedy in erysipelas with full tissue and bright color, both locally and internally, and in chronic disease with full pulse and increased temperature. This remedy is employed to slow the pulse and is especially indicated when it is small. It is the child’s sedative, and is employed in the entire range of fevers and inflammations. It exerts a special influence on the throat and larynx, and is thus used in the treatment of quinsy and croup, being the most certain remedy for the latter we possess. It exerts its most marked influence on mucous membranes, and is thus used in acute disease of bronchial tubes or intestinal canal.
For some generic finasteride 5 mg with amex, medications successfully managed their symptoms whilst others reported ongoing efforts to find the right medication discount finasteride 1mg otc, or combination of medications buy discount finasteride 1mg on-line, to manage symptoms and minimise side effects. Most described changes over time, with periods of stability marred by either medication resistance or side effects that required a change in dose or type. The results of the study indicated that participants negotiated their need for medication internally (including struggles over self identity) and externally (through negotiations with health care providers). Interview data indicated that medication taking may prompt consumers to re-negotiate their self-identities as formerly well persons (Carder et al. When symptoms are under control, they may question whether they are cured, in remission, or if the medication is treating symptoms. Some participants resisted taking medication because it conflicted with their identities as a healthy person or someone who normally did not take medication. Some participants stated that they reduced their intake of medication to curtail side effects or discover the dosage that best met their personal threshold for 56 symptom management. Regarding external negotiations, participants described both battling and working with their physicians over medications, including decisions regarding whether to take medication, type of medication, how much and by what route. Many of the participants had taken medication for years and, thus, knew what worked and did not work for them. One source of resistance derived from participants’ dissatisfaction with physicians who simply prescribe medications whenever the individual has new or additional symptoms, leading to complex medication regimens. In addition to the physical effects of taking medication for an extended period of time, some participants reported an emotional toll associated with the trial and error involved in finding the right medication regimen (Carder et al. Indeed, two participants with schizophrenia reported feeling like a “human experiment” as a result of the long process of finding the right medication or combination of medications (Carder et al. More recently, Shoemaker and Ramahlo de Oliveira (2008) conducted a study focussing on the meaning of medication for 41 consumers, which included participants with diagnoses of schizophrenia (as with the previous study, the number of participants with schizophrenia was, unfortunately, not reported). A meta-synthesis of three different but complementary qualitative studies was conducted by researchers, which included unstructured and in- depth interviews as parts of phenomenological and ethnographic studies. The authors defined the medication experience as an individual’s subjective experience of taking medication in their daily life. The meaning of medication was captured by four codes of the medication experience: a meaningful encounter; bodily effects; unremitting nature; and exerting control, which the authors considered reflected stages of the medication experience. The meaningful encounter can be revealed as a sense of losing control, a sign of ageing or a signifier of illness, and often causes questioning and a meeting with stigma. Whilst questioning the need for medication upon diagnosis is typically interpreted as resistance by health care professionals, the authors propose that for participants, it can represent a means of regaining a degree of control. Participants sensed that their individual autonomy was undermined when taking chronic medications until the point that they questioned the taken-for-granted notion that medications are the right option. The first reactions to initiating a medication regime can also be shaped by the social views of the medical condition, including stigma. The bodily effects of medications code was revealed as the experience of a “magic elixir” or trade-offs. Some participants indicated that medication could “normalise” them, whereas others indicated that medication alleviated them from incapacitation and, thus, enabled them to function. Participants who experienced side effects were willing to accept them as a trade-off if the benefit experienced by medication was sufficiently good. The unremitting nature of a chronic medication is considered a burden and participants often recalled that they responded angrily to this realisation. The expectation of taking medication regularly positions the patient as a passive agent and the medication as a symbol of dependence. The last code of the medication experience was revealed as consumers exerting control over their medication. After encountering the meaning of a medication, questioning it, realising the bodily effects and the continuous nature of medications, participants experimented with becoming the managers of their treatment regimens. They discovered creative ways to manage their medications and exert control over them; in part because they were now knowledgeable (Shoemaker & Ramahlo de Oliveira, 2008, 2008). The views of consumers, carers and professionals from four different countries (England, Germany, Italy and the Netherlands) were combined in a study by Kikkert et al. The sample comprised of 27 people with schizophrenia, 29 carers and 28 professionals involved in the treatment of consumers. Participants were allocated selectively to groups which were comprised of members of each stakeholder group. The concept mapping procedure involved group discussions about factors that influence medication adherence. Brainstorming of factors related to adherence was conducted amongst groups and participants were asked to generate statements about influences on adherence. These statements were then reviewed by researchers and reduced to a manageable number via the combination of similar statements and deletion of statements regarded as least relevant. Individual group members then conducted clustering; the process of determining which factors emerged from the data and to what extent factors related to each other. This was followed by prioritising, or ordering of the data in terms of importance in relation to medication adherence. Ultimately, five clinically relevant codes were identified as affecting adherence: medication efficacy, external factors (such as patient support and therapeutic alliance), insight, side effects and attitudes towards medication. Interestingly, the importance of each of these factors differed 59 significantly between consumers, carers and professionals, indicating that these stakeholder groups do not have a shared understanding of what influences medication adherence behaviour. The greatest disparity in prioritising was observed between consumers and professionals (Kikkert et al. In the latter case, non-adherence is viewed as an illness symptom and, thus, negative attitudes to medication are seen as irrational and a direct consequence of the underlying psychoses. Despite the different study populations and research designs, some consistencies emerged across qualitative research related to adherence amongst people with schizophrenia. For example, all of the studies used qualitative interviews as the means of data collection. Adherence was frequently associated with the benefits of medication in terms of symptom control and the costs associated with non-adherence (such as relapse and rehospitalisation) (Rogers et al. Consumers generally talked about the effectiveness of medication in treating symptoms and the side effects associated with medication collectively and weighed the two against each other to determine their attitudes towards medication (Shoemaker & Ramahlo de Oliveira, 2008, 2008). Functioning and appearance to the 60 outside world were important considerations for consumers when discussing the benefits and costs of medication (Carrick et al. Once consumers acquired knowledge about their illnesses and medication, which typically occurred with time and experience, they reported to engage in more practices akin to self-medication, such as reducing their dosage of their own accord (Shoemaker & Ramahlo de Oliveira, 2008, 2008). Thus, in some instances, non-adherence can represent a means of expressing control over their treatment. Healthcare providers were generally viewed as exerting a significant amount of control over consumers’ treatment and a lack of involvement of consumers and family members in managing treatment was reported. Additionally, there were significant disparities between the views of consumers and healthcare providers regarding the relative impact of influences on adherence (Kikkert et al. A limitation of two of the studies discussed was that they synthesised the findings from studies that explored the medication experience across multiple chronic conditions including schizophrenia, rendering it difficult to discern the aspects of participants’ experiences related to the unique illness experience of schizophrenia.
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