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本篇文章截止时间为：2019年1月4日前译回
During my psychiatry residency, in an outpatient internal medicine clinic, I worked with a patient with hypertension and diabetes who was often non-adherent with treatment. When I asked why he did not take his medications, he just said, “Okay doc, I will take them.” He didn’t offer any reasons for his non-adherence. At subsequent appointments he would tell me that he had not taken his medications. We had repeated conversations about the importance of adherence. He had the financial resources and social support network to come to his appointments and purchase his medications. He denied side effects. Eventually, my rotation in the clinic ended, and I had made no progress with him.
I often thought back to that patient. As I progressed through training, I realised that he may have displayed resistance. Resistance is a process, usually unconscious, that interferes with treatment objectives. It can be conceptualised as psychological friction, working in the opposite direction of what we want for our patients. Resistance develops from our inner defences, which form our personalities.
Resistance can manifest in different ways such as arguing, missing appointments, and non-adherence with treatment. Patients are often unaware of the impact of their feelings, thoughts, and behaviours on their illness or treatment. If we are not attuned to the existence of resistance, we could react in a detrimental manner and give up on patients or resent providing further care.
Resistance is not limited to psychiatry; it is found in all medical specialties. Being aware of resistance can help avoid inappropriate reactions to our patients and may assist in improving adherence and response to treatment.
Kaustubh G Joshi, associate professor of clinical psychiatry.
University of South Carolina School of Medicine, Department of Neuropsychiatry and Behavioral Science, Columbia, South Carolina, USA
Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.
BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.i6781
