Medical compliance as an ideology

Medical compliance researchers have produced more than 4000 scientific papers in the past two decades, but their research into determinants of non-compliance has been inconclusive. This paper argues that the popularity of compliance and the uncertainty over its determinants can be understood if compliance is analyzed as an ideology that assumes and justifies physician authority. I explore compliance as a problematic concept, looking at its assumptions and its influences on clinical practice. The concept of patient compliance has a social history linked to the struggle to create and maintain physician control over infant feeding technology earlier in this century. But while physicians were successful in that struggle, they have never exercised complete control over health care products. Compliance must be reconceptualized and its research reoriented if it is accurately to portray medication usage and related health behaviors outside the clinic.