Patient compliance with therapeutic advice: a modern view

Considering all the hurdles between the advice to take medication and the taking of it, that patients comply as well as they do is remarkable. It is all the more remarkable when physicians ask patients who are well to take costly and unpleasant medications or diets (for example, for hypertension or hyperlipidemia), day after day, to prevent low-probability events many years in the future. The problem of noncompliance will remain with us; it is, after all, part of the human condition. It will not be, and probably should not be, conquered altogether. Because many prescribed medications are not powerful over and above their placebo effects, noncompliance often does no harm. When patients refuse to do what physicians advise, as expressions of their own informed free will, it is also unclear that harm has been done. What we, as a health-care community, should be most concerned about is the noncompliance that arises for other, less ambiguous reasons: failure of communication or lack of opportunity. The main issue, as I see it, is to find ways to reduce unnecessary and harmful noncompliance--that is, noncompliance that occurs because of misunderstanding about what has been suggested and what is at stake, or because of poverty and other logistic problems. Therefore, I have emphasized those aspects of compliance in this review. Compliance with medical advice is far too complex, especially these days, to reduce to a simple yes-no dichotomy. A great deal of wisdom is called for, both on the patient's and on the physician's side, when medical advice is given.