Taking Lessons from Infectious Disease

About a year and a half ago, I began a rather short-lived stint as the TB Program Coordinator in my state. I had focused on tuberculosis (TB) as part of my master's thesis, and then took a job in that area. Part of my job was developing programming to "encourage" TB patients to take the full course of their antibiotics. And if they did not go gently into that good night night, then I had the authority to sign a court order to hospitalize them against their will. Which I did, several times.

Many of the people diagnosed with TB (at least in the city where I was) were addicted to drugs, typically crack cocaine. In an addict's eyes, crack is much more fun to take than isoniazid or rifampin, the two major first-line drugs against TB. Also, at a course of treatment of 6 to 9 months, it's hard to obtain compliance from anyone, let alone someone who abuses drugs or alcohol.

However, there is a treatment called Directly Observed Therapy (DOT), where a public health nurse goes to your house (hotel, crack den...they're usually not very picky), meds in tow, gives them to you, and watches you take them. Pat on the back, see ya tomorrow. Often times, incentives are used. Such as, "Meet me at Dunkin' Donuts to take your meds, and I'll buy you a coffee and doughnut." To a homeless guy, that's a treat, and you'd be surprised at the levels of compliance little things like that can bring.

Though DOT does try to educate the patient about the importance of taking antibiotics regularly, it does not need that in order for the program to succeed- that is, for the patient to continue to take their meds, as prescribed, until it is determined that treatment is finished. One of my nurses told me "I'd tell them they were dropping acid if I thought it would get them to take their pills." This is also the woman who called me "toots" and "babe" on the phone and wore a purple velvet cowboy hat, so go figure.

The similarities to the Maudsley Approach for treating anorexia are almost too similar to ignore. The point with DOT- and with Maudsley- is for the sufferer to take their medicine, whether it's antibiotics or food. They don't have to like it, they don't have to agree with it, they don't even have to think it's necessary, but all measures will be taken to see that they do. Another interesting aspect of DOT is that all responsibility for treatment compliance is on the shoulders of the health department, NOT the patient. It's rather similar in Maudsley- it's up to the parents or carers to see that the sufferer eat, NOT the sufferer to rely on their own devices. And, there are firm backups in place. If you continually refuse your medication (typically by not showing up), we'll put you in the hospital. Ditto for Maudsley.

You have to take your meds. Period. You do not negotiate.

Certainly, the public health nurses will negotiate if they want Dunkin' Donuts, Tim Horton's or Mickey D's coffee, where and when they want to take their meds...but you have to take your meds. Maudsley is the same. You can have fried chicken, hamburgers, french fries, ice cream, and carrot sticks. But you still take your medicine.

Now if only bribing someone with anorexia to a trip to Dunkin' Donuts would work...

posted under , , |


samsi77 said...

so did you take your medicine today? Amazing comparison.... very accurate and true!

samsi77 said...

so did you take your medicine today? Amazing comparison.... very accurate and true!

mary said...

Yes, keep taking your medicine! It won't always be this hard. dunkin donuts...mmmmm, what a lovely cure.


Actually, yeah, Dunkin Donuts doesn't carry the risk of liver damage, either, unlike some of the TB meds.

I did take my medicine. PB&J. :)

Sam- 2 am? Girl, get to bed!

Allan Showalter, MD said...

Outstanding post. Your insightful comparison between DOT and the Maudsley Approach is useful in thinking about noncompliance in general and especially in situations in which the clinician (or at least someone other than the patient) has to take responsibility for adherence to treatment. I featured this post on my own blog, dealing with noncompliance, today at You have to take your meds. Period. You do not negotiate.

Post a Comment

Newer Post Older Post Home

ED Bites on Facebook!

ED Bites is on Twitter!

Search ED Bites

About Me

My photo
I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

Drop me a line!

Have any questions or comments about this blog? Feel free to email me at carrie@edbites.com

nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


Popular Posts


Recent Comments