The Top Ten Patient Compliance Points: #5
#5. “Complianceadherenceconcordance” just doesn’t scan;
Let’s call it compliance until something better comes along
Now look, Colonel Bat Guano – If that is really your name
~ from Dr. Strangelove
They certainly give very strange names to diseases
~ Plato
And to compliance
~ Showalter
Even though I’m a doctor, I just can’t go along with “medical compliance” as an ideal term for whatever it is we’re talking about. I’ve also had it with “patient compliance.” “Cooperation” doesn’t quite work with me. And while “adherence” has its adherents, it does not seem something I could stick with. As for “concordance,” which carries the official sanction of the Royal Pharmaceutical Society of Great Britain, it just doesn’t lend itself to puns.
Pragmatically, whatever distinctions once may have existed between the connotations of “compliance” and “adherence” have likely been washed out by the pervasive use of these and their congeners as synonyms in the preponderance of the medical literature. The argument can legitimately be made that such semantic quibbles may now produce more distraction than insight into the clinician-patient relationship. Lacking compelling advantages favoring the use of any of the suggested terms and the institutionalized encoding of “medical compliance,” “patient compliance,” and “medication compliance” into the medical literature and databases, it makes sense — until something better comes along — to continue using this familiar phrase to designate the healthcare behaviors of individuals responding to medical recommendations and, unless specified otherwise, assume that “adherence,” “compliance,” and “concordance” refer to the same phenomenon.
My own hunch is that eventually, the issue of compliance/adherence will be properly subsumed by a focus on treatment implementation and execution.
For what it’s worth, my preference is to get behind “alignment” under the premise is that we are striving not so much to persuade, coerce, or trick patients into doing what their doctors prescribe as to align clinicians, patients, payers, and anyone else involved in healthcare so that everyone is working in concert. An easy example of alignment’s advantages is the case in which a patient does not adhere to the prescribed treatment plan but does communicate that decision and his or her reasons to the clinicians. That is not “compliance” (at least by a strict definition), but it seems different from and exponentially preferable to the case in which the patient not only does not follow the treatment plan but also misleads the clinician into thinking he or she is doing so. Assuming the patient was not just perversely turning down all options, he or she and the clinicians could be in “alignment” although the patient is not in “compliance.” The other important connotation is that “alignment” obviates the assumption, essential to “compliance,” that patients are either obedient or disobedient to the dictates of the clinician; rather, “alignment” allows for a less one-sided involvement of the clinicians and patients. Nonetheless, “alignment,” used in this sense, would not be recognized by the medical community.
For more on the issue of nomenclature, see:
Running Patient Compliance Up The Flagpole
The New, Improved Patient Compliance
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