Doctors' orders and patients' self-interest: two views of medication usage?

This community-based study of epilepsy in Rochester, Minnesota found that almost 60% of 127 adults aged 18-59 said they had altered their anticonvulsant medications in one of the following 3 ways: stopped taking them for at least 3 days, discontinued them completely, or changed the dosage for more than 2 weeks. Twenty percent said they had followed an altered regimen in the week before the interview. Medical records for 10 years for the entire group of 199 prevalence cases in this age range showed that 28% had discontinued medications for more than 3 days, and 14% had changed the dosage for more than 2 weeks. Comparing interview statements with information in the medical record, 70% of interviewees had changed their medications in one of these ways. There is a basic difference between changing and stopping the dose: changing involves evaluating the regimen; stopping involves evaluating the illness itself. Such testing is a common part of managing epilepsy over time. These strategies can be called forms of self-regulation of medical regimens. The concept of self-regulation challenges the traditional patient-doctor relationship because it grants more autonomy and control to the patient and requires basic re-examinations of clinical expectations and patient responsibilities.