Culturally competent professionals in therapeutic alliances enhance patient compliance

Medical training has traditionally focused on diagnosis and treatment of disease, with the notion that if these two factors are satisfactorily managed, the desired outcome will inevitably follow. When it does not, failure is often blamed on patient noncompliance. Failure of patients to return for follow-up visits or comply with medication regimens has been shown to be a major barrier to the delivery of effective medical care. However, effective clinical decision making requires that physicians skillfully address not only the biomedical aspects of diseases and their management, but also the sociobehavorial characteristics of patients. The authors maintain that patient participation is necessary for compliance and that a naturally occurring therapeutic alliance between physician and patient incorporates factors such as lifestyle, family, and living circumstances and an awareness of the culturally unique needs of minority patients. Integration of these factors into professional decision making and practical management plans will enhance patient compliance.