According to WHO forecasts, 60% of the worlds population (3.3 billion people) may be overweight (2.2 billion people) and obese (1.1 billion people) by 2030. Increased body weight and atherogenic dyslipidemia are independent risk factors for chronic non-infectious diseases, which, in turn, lead to premature mortality of the working population. Management of patients with increased body weight requires a complex change in their lifestyle and their consistent and sustained efforts. Taking into account the latest data on the contribution of abdominal obesity, dyslipidemia, fatty hepatosis to the risks for development of cardiovascular diseases, these patients are indicated the earliest therapeutic and preventive outpatient intervention. The success of treatment depends on the degree of motivation, the level of compliance of the patient and regular control throughout life. However, when a patient considers himself healthy, he hopes to solve the arising problems quickly and easily, which is often impossible for objective reasons. In this case, the fundamental attitude of the patient may be crucial in the success of treatment. In the article, a typical clinical case of overweight and of other risk factors for chronic non-infectious diseases at the stage of early clinical manifestations associated with increased risks of multiple comorbidities, is described. But the patient, considering himself quite healthy and the first clinical manifestations insignificant, faced with the necessity of regular medical monitoring and complex life-long intervention, partially follows doctors recommendations and eventually is shying away from solving problems. By focusing on a paternalistic or engineering model of relationships with the doctor, the patient significantly reduces the effectiveness of the earliest control of risk factors for chronic non-infectious diseases. Analyzing the presented clinical case, it is possible to draw attention of specialists to the necessity of rationalization of diagnostic and treatment programs in real outpatient practice.
More than 40% of adult Russians periodically feel heartburn. Progression of the disease leads to a number of complications shortening patients life. However, patients try to cope with problems by themselves, without receiving adequate early treatment. Only when the life quality worsens, which evidences progression of the disease, they turn to a doctor. Success of treatment depends on the level of the patients compliance, life-long complete and regular adherence to treatment recommended by the doctor. With this, an outpatient with a chronic disease should provide the most part of the required medical service by himself. However, patients often change the therapeutic measures on their own impairing the result of treatment. The given below clinical case of patient Zh., 38 years old, with heartburn and existing risk factors of other non-infectious diseases is a typical illustration of the interaction of a general practitioner and an outpatient practicing self-treatment. Facing the situation of necessary regular medical monitoring and life-long complex intervention, the patient uses only easy-to-follow doctors recommendations and understandable for him treatment methods. Conclusion. On an example of this clinical case, a possible necessary and sufficient plan o f informing outpatient is presented containing information of the tactics of his behavior for full realization of medical recommendations. For successful adaptation of an outpatient with chronic health problems and harmonic attitude to the disease, the doctor should be maximally specific about necessary and adequate measures for correction of the patients behavior for the fullest realization of therapeutic recommendations. Recommendations should contain understandable information of basic medicinal and non-medicinal therapy in remission (the essential vital stereotypes work-rest regime, type and regime of nutrition, physical activity and principles of monitoring the condition), of signs of exacerbation and methods of therapy on demand and also information of symptoms requiring urgent assistance, of risks of self-treatment, of visiting the doctor in case new or vivid symptoms appear, of the dates of planned examinations by the doctor. These recommendations are not applicable to patients with severe and manifest course of the disease, with disharmonic attitude to the disease, and in case of inadequate organization capacities and low compliance of the patient.
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