Patient non-compliance: Deviance or reasoned decision-making?

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Abstract

A large quantity of research concerning issues of patient compliance with medications has been produced in recent years. The assumption in much of this work is that patients have little option but to comply with the advice and instructions they receive. Studies have shown, however, that between one third and one half of all patients are non-compliant, but different authors cite different reasons for this high level of non-compliance. In this paper, the concept of compliance is questioned. It is shown to be largely irrelevant to patients who carry out a ‘cost-benefit’ analysis of each treatment, weighing up the cost/risks of each treatment against the benefits as they perceive them. Their perceptions and the personal and social circumstances within which they live are shown to be crucial to their decision-making. Thus an apparently irrational act of non-compliance (from the doctor's point of view) may be a very rational action when seen from the patient's point of view. The solution to the waste of resources inherent in non-compliance lies not in attempting to increase patient compliance per se, but in the development of more open, co-operative doctor-patient relationships.

References (40)

  • R.W. Squier

    A model of emphatic understanding and adherence to treatment regimens in practitioner-patient relationships

    Soc. Sci. Med.

    (1990)
  • A.L. Wright et al.

    On the creation of problem patients

    Soc. Sci. Med.

    (1990)
  • K. Charmaz

    Discovering chronic illness: using grounded theory

    Soc. Sci. Med.

    (1990)
  • I.K. Zola

    Structural constraints in the doctor-patient relationship: the case of non-compliance

  • P. Ley et al.

    Communicating with the Patient

    (1967)
  • M.R. DiMatteo et al.

    Achieving Patient Compliance

    (1982)
  • D. Hughes

    Control in the medical consultation

    Sociology

    (1982)
  • B. Svarstad

    The doctor-patient encounter: an observational study of communication and outcome

    (1974)
  • H.R. Geersten et al.

    Patient non-compliance within the context of seeking medical care for arthritis

    J. Chron. Dis.

    (1973)
  • E. Freidson

    Professional Dominance

    (1970)
  • Cited by (0)

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