Brought to you by the students of the University of Cincinnati College of Medicine
Patient compliance is well-regarded in medicine. Compliant patients are “good patients” who consistently adhere to their medical regimens, participate in timely preventative health screenings, and raise appropriate concerns and questions that physicians can readily handle. Non-compliant patients, conversely, are patients who are not content to be docile cogs in the healthcare system wheel. Instead, they are the wrenches thrust into the wheel, perturbing its rhythmic pace (at best) or erratically destabilizing it (at worst). And while it may seem like a no-brainer that non-compliant patients should be quickly extricated from the system, there is a contrarian argument for their integral place in it.
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Before the latter part of the 20th century, physicians were accustomed to having a monopoly over the knowledge of their patient’s bodies. The belief that patients should “comply” to the ones with superior education and judgment has gone relatively unfettered for centuries (even in today’s age of open access information). Alongside these established notions of medical paternalism and authoritarianism is the fact that compliant patients require less time and attention to treat, especially in the current era of crushing time pressures. Inarguably, noncompliant patients siphon off valuable time and energy from the beleaguered physician.
Yet despite their alleged burden on the system, noncompliant patients are met with a variety of responses. Some physicians apply compassion and thoughtfulness to their patient’s frustrations, while others blithely neglect them, allowing patients to tumble aimlessly through the system. Still, other healthcare workers will indiscriminately pander to their patient’s demands, deftly playing the defensive medicine card and carelessly introducing more inefficiencies and inequalities into the system. Indeed, some physicians may even become blatantly hostile to noncompliant patients, seeking to tame their disobedient behavior or entirely dismiss them.
But while noncompliant patients can be a tremendous strain on the system, the best approach is not to neglect, discard, or condescendingly confront them. In the grand scheme, disgruntled patients should be taken seriously. Noncompliant patients are ultimately an indication of something greater: emotionally conflicted and existentially anxious individuals; people affronted by a tragic transformation of their physical bodies and/or a radical upending of their lifestyles; or even persons caught in the throes of financial uncertainty, familial abandonment, or an inherently unfair healthcare system. When patients express or act on their dissatisfactions and resentment—or display subtle defiance—they are sounding a clarion cry for help or pointing out a systemic incongruity. Hence, their noncompliance should be met with creative insight; guidance toward supplementary resources; and deep humanistic concern. Additionally, patient disobedience can be utilized as an opportunity to reflect and revamp one’s practice, healthcare policies, or areas of neglected patient research.
Ultimately, the noncompliant patient will continually elicit groans and raised eyebrows from clinicians. However, exquisitely perceptive and devoted clinicians will see through the smokescreen and past their own limited experiences to the startling truth: patient noncompliance has the potential to stimulate ideas for greater patient care, or even catalyze paradigm shifts in how patient concerns are resolved.
About the Author:
Candice Danielle Carpenter is a second year medical student. Her passions include idea-mongering, radical and contemporary museum exhibitions, and intellectual jousting and pontificating at two in the morning.
About the artwork:
Gene Novikov is a second year medical student at UCCOM. "Checking Reflexes" is a pencil and paper cartoon inspired by his experiences in the Clinical Skills course.
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