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Reasons to be non-adherent

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Following an earlier piece on the relative lack of adherence to medication among women compared with that of men (PJ 2012;288:572), I began to wonder about the possible reasons why women do not always take their medicines.

Although I do not have an evidence-based answer, my thinking took me back to my mother, who (to put what follows into context) was born in 1912 and died in 1999. She suffered from angina, probably from the age of about 55, although it was not until she was 76 that she consulted her GP — and then only because the chest pain was severe enough to scare her.

She was prescribed nifedipine and glyceryl trinitrate, but hated taking them. Indeed, she was not compliant and tended to take the nifedipine only on alternate days. She preferred instead to rely on the glyceryl trinitrate whenever she had to walk up a slope. As a pharmacist, I found this decision difficult, but over the years I learnt to say little.

In this context, I was much interested in the discussion about waste of prescribed medicines in a PJ Online blog by Lin-Nam Wang on 10 January this year, and the idea that telling people how much their medicines cost might reduce the waste.

In my mother’s case, I used to suggest to her that, to avoid wasting her unused angina products, she should tell the doctor she did not want to take all her medicines. But my mother was reluctant to do so because she believed that that would seem rude and ungrateful.

To be polite she would rather go to the surgery ­and collect her prescription. She also wanted to attend the surgery regularly to save me the angst of a post-mortem when she died.

In the end, so far as I remember, and because she had always hated waste, she got round her problem by collecting her prescriptions from the surgery but not always taking them into the pharmacy to be dispensed.

When she died, a few tablets were left, but not the bagfuls we sometimes hear about.

Today, a pharmacist might have called her to ask why she was not having her prescriptions dispensed — something I would do as a pharmacist. But I guess then she would have collected her medicines, to be polite (in her mind), but not taken them, in which case they really would have been wasted.

My mother lived to be 87. She was a qualified optician and her sister was a nurse. Their parents had migrated from the countryside to Manchester in 1908 and I often think that both my mother and my aunt retained rural beliefs and had not become fully urbanised mentally.

Also, my aunt expressed the view that, among all the doctors she had worked with as a nurse, the “medical men were less useful than the surgeons”. So I guess that some negative feeling about medication ran in my mother’s family.

Perhaps, as some research has shown, some people believe in medication while others do not.

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From: Beyond pharmacy blog

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