Chronic illness behavior and noncompliance with treatment: pathways to an interactional approach

The increasing cost of medical overconsumption is partially due to the physicians' neglect in everyday clinical practice of the intrinsic gratification of the sick role in our society. Many health care providers do not seem to realize that their intervention as experts in the patient's personal life inevitably implies they are becoming part of the ongoing learning history of that individual. Chronic somatic complaining and partial or complete refusal to follow therapeutic advice have to be viewed, first and foremost, as a symptom of a dysfunctional interaction between the patient and his/her immediate environment of which the clinician became a significant member. Management of chronic illness behavior and non-compliance with treatment requires both a functional analysis and a strategy inspired by an interactional perspective on the attitudes and behaviors of at least three parties involved in health care: doctor, patient, and family.