Patients usually have reasons for being noncompliant

Commentary. By Charles Atkins, MD, AMNews contributor. April 9, 2001.

COMMENTARY

Observations on the state of medical practice and medical life

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I recently listened to myself describing potential side effects of a medication to a patient.

"Well, you could gain weight, might experience some hair loss, and there's a chance that your thinking won't feel as crisp." Sounded like a winner to me.

As I approach my 40s, I can just imagine what my response would be to a physician trying to push a drug that would make me fat, bald and stupid. Yet if I were to be recommended such a pill, in this case for manic depression, and then neglected to take it, I would be branded as noncompliant.

In my current position, where I oversee systems of care, I spend a great deal of time reviewing medical records for individuals who have severe and prolonged mental illness. Repeatedly I come up against the term noncompliance. The more I see it, the less I like it.

So I start with Stedman's Medical Dictionary to ascertain whether this is even a word. I find compliance: "The consistency and accuracy with which a patient follows the regimen prescribed by a physician or other health professional. Adherence."

Still, I don't care for the sound of noncompliance -- as if not following the doctor's advice is a sign of moral turpitude. The term hides a bigger issue: Why is this person not doing what the doctor said?

It's not because they're being naughty. This is why the term makes me see red.

If we dig below the surface of noncompliance, we get to elements of real meaning, such as, the person can't afford the medication or tolerate the side effects or deal with the illness for which the medication is prescribed. [...]