Patient Compliance and the Role of the Expert

Abstract

The failure of patients to follow recommendations made to them by health experts usually represents a hazard to the patient's health, a waste of health resources, and a source of frustration to the health expert. Many studies of such failure lead to the conclusion that every patient should be considered as potentially “non‐compliant.” The most promising site for intervention is in the expert‐patient interaction. Viewing compliance as a property of the transaction between expert and client, it is appropriate to see the responsibility for establishing compliance as shared between expert and client. From this viewpoint, several models of the expert‐client relationship are reviewed. Three areas of responsibility can be assigned to experts—exploring the individual patient's situation fully; anticipating the patient's difficulties in following recommendations; and communicating information in a way that will maximize its effectiveness. Recognition of these responsibilities will have numerous consequences for those who teach health professionals and for psychologists engaged in the study of communication processes.

Observância da orientação médica pelo usuário de lentes de contato

“…Este estudo sugere que a orientação não foi suficiente para assegurar a observân-cia das recomendações e a prevenção das complicações. A compreensão pode ser influenciada pela clareza ou complexidade das informações, pela relação do médico e da auxiliar de consultório com o paciente (18)(19) e pela capacidade de entendimento do usuário. Os pacientes esquecem dentro de minutos, de um terço a metade do que lhes foi dito na consulta, especialmente instruções e recomendações e que o mais importan-…”

Treatment Compliance in End-Stage Renal Disease Patients on Dialysis

“…demographic characteristics of the patients, and the physician-patient interaction. Theoretical models of compliance behavior have included personality trait, psy chodynamic, sociocultural, learning theory, cognitive theory, health belief, and health transactions [26] (ta ble II). The personality trait model posits that com pliance behavior is related to enduring, and presumably unchanging, personality characteristics (e.g., immature, impulsive, uncooperative), while the psychodynamic model emphasizes the psychological meaning of the ill ness and treatment situation to the patient and the con scious or unconscious fears, anxieties, and psychological conflicts that may be aroused by compliance.…”

Clinical problem solving and therapeutic noncompliance: A heuristic for enhancing the clinician's generation of alternatives

“…While there is considerable diversity in conceptions of the etiology of therapeutic noncompliance (Christensen, 1978;Haynes, 1976;Kirscht & Rosenstock, 1979;Stone, 1979), numerous authors agree that noncompliance occurs fundamentally in a context of social influence (Corrigan, Dell, Lewis, & Schmidt, 1980;Friedman & DiMatteo, 1979;Rodin & Janis, 1979;Stone, 1979;Strong, 1978). From this vantage, noncompliance occurs when the desired process of social influence in the health transaction breaks down-when a clinician's request is made and received, but not carried out.…”