#9. Once You’ve Seen One Noncompliant Patient,
You’ve Seen One Noncompliant Patient

The extent to and manner in which Patient X, in a specific set of circumstances,¹ adheres to a prescribed treatment can be extrapolated and generalized to accurately characterize — the extent to and manner in which Patient X, in that specific set of circumstances, adheres to that prescribed treatment.

Compliance is the result of a complex collection of cognitive, emotional, physiological, and cultural factors, some of which are obvious, others which are subtle, and many of which may be in conflict. Compliance not only varies from patient to patient but the same patient may respond differently to the demands of different treatment regimens and in response to various disorders. Further, Patient X’s compliance behavior vis-à-vis the same disorder and treatment may vary under different circumstances; patient X’s adherence to the same treatment for the same disorder may, for example, be different at ages 5, 15, 35, 55, and 85.

Past compliance behavior for a specific patient may be somewhat predictive of that patient’s future compliance, but the power and reliability of such predictions are not impressive even if the circumstances are similar. Generalizing beyond a specific patient to a group of patients has proven a sucker’s bet for clinicians.


Footnotes

1. E.g., the severity of Patient A’s disorder, the side-effects of any medication, the doctor’s empathy, etc. [back]

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