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From careless consumptives to recalcitrant patients: The historical construction of noncompliance

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  • Lerner, Barron H.

Abstract

Thousands of articles on "noncompliance" have appeared since 1975. Yet the term has been criticized as paternalistic--as wrongly implying that patients should necessarily follow doctors' orders. This paper, which reviews how noncompliance has been constructed historically, argues that the problem with noncompliance is more than just one of terminology. Changing social and cultural factors during the 20th century have influenced the way in which uncooperative patients have been described. For example, resentment of poor immigrants in the early 1900s led doctors to describe tuberculosis patients who did not follow advice as "ignorant" and "vicious." Following World War II, patients who balked at taking new curative antibiotics for tuberculosis were called "recalcitrant." The term "noncompliance," popularized by Sackett and Haynes in the 1970s, reflected their early role in the field of research now termed "evidence-based medicine." While Sackett and Haynes had hoped that the new term would eschew earlier value judgments, noncompliance, through its association with the positivistic ethos of evidence-based medicine, has been conceptualized as a "tragic" problem potentially solvable by clinical research. Hence, noncompliant patients are still seen as deviant. With the growth of managed care in the United States, there is increasing pressure to get patients to follow medical recommendations. History suggests that labels such as "noncompliant" are invariably judgmental. Rather than seeing the provider's role as trying to get noncompliant patients to comply, we should emphasize the importance of negotiation and accommodation within the provider-patient relationship.

Suggested Citation

  • Lerner, Barron H., 1997. "From careless consumptives to recalcitrant patients: The historical construction of noncompliance," Social Science & Medicine, Elsevier, vol. 45(9), pages 1423-1431, November.
  • Handle: RePEc:eee:socmed:v:45:y:1997:i:9:p:1423-1431
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    Cited by:

    1. Shrier Ian & Kaufman Jay S. & Platt Robert W. & Steele Russell J., 2013. "Principal Stratification: A Broader Vision," The International Journal of Biostatistics, De Gruyter, vol. 9(2), pages 307-313, November.
    2. Jessica D. Bellinger & Rahnuma M. Hassan & Patrick A. Rivers & Qiang Cheng & Edith Williams & Saundra H. Glover, 2010. "Specialty Care Use in US Patients with Chronic Diseases," IJERPH, MDPI, vol. 7(3), pages 1-16, March.
    3. Laurier, Catherine & Lafortune, Denis & Collin, Johanne, 2010. "Compliance with psychotropic medication treatment among adolescents living in youth care centres," Children and Youth Services Review, Elsevier, vol. 32(1), pages 67-73, January.
    4. Bengtsson, Staffan & Bülow, Pia H., 2016. "The myth of the total institution: Written narratives of patients' views of sanatorium care 1908–1959," Social Science & Medicine, Elsevier, vol. 153(C), pages 54-61.

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