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The "non-compliant" patient

It used to strike me as odd that physicians used somewhat hostile language to describe patient behavior – “the patient is non-compliant,” “the patient refused [this-or-that drug or procedure],” “the patient denies [insert symptom here].”

After many years of using these words, I forgot just how inflammatory they are. They became part of my language, and I used them every day to describe people. I’m not really sure how this phraseology became common parlance, but it is a tad adversarial when you think of it. It sets up a kind of us versus them environment. And really, medicine is all about us in partnership with them.

I was reminded of this fact as a friend of mine described a recent “non-compliance” episode. She had been complaining of shortness of breath, and had some sort of suspicious finding on her chest CT. The pulmonary specialist (called a ‘respirologist’ in Canada) recommended a bronchoscopy. Here’s what she says,

I wish I had the chance to explain to my respirologist why I was non-compliant about the bronchoscopy. I got the impression that she thought I was being “difficult” for no good reason, and that I was wasting her time. But the truth is, all my life I’ve had this vague sense that anything big going down my throat was particularly scary to me. I knew I had trouble gagging down pills, but it never occurred to me to mention that. I also chew my food to death in order to swallow it comfortably, but I never thought about that very consciously, either. It wasn’t until months later when I had to undergo surgery for my gallbladder that my anesthesiologist (who had to intubate me) discovered that I had an internal throat deformity.

So my point is that it might be valuable for the respirologist to know that when a patient is very scared of something (especially when she is usually never scared of tests, needles, etc), it could be an important clue. I know now that bronchoscopies are not without risk. A bronchoscopy technician might not have handled the situation nearly as well as that highly-trained, very experienced anaesthesiologist did.

What I learned is this: patients don’t know how to explain things that they haven’t thought much about before, especially when they know that their doc is understandably pressured to get through her scheduled appointments on time. All they know is that they’re scared and that they want to run away. They’re not primarily out to exasperate their docs with their noncompliant attitude. Still, it isn’t easy being a doc. I’m sure noncompliant patients are indeed very irritating. But it isn’t easy being a patient, either. Being looked down upon is irritating too. Not only that, but the patient has a lot more to lose if a mistake is made. But what can you do? Everybody is under a lot of pressure when it comes to medical issues. We all just have to try to be understanding and do our best to work together for a good outcome. It’s in the best interest of both parties, so it shouldn’t have to be a battle!

Have you been a “non-compliant” patient for a good reason? Do share.

This post originally appeared on Dr. Val’s blog at

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One Response to “The "non-compliant" patient”

  1. Anonymous says:

    I was “noncompliant” with a recommendation for shoulder surgery for rotator cuff impingement. Surgeon #1 gave me a cortisone injection which had no effect, said the only remaining helpful course was surgery. Surgeon #2, also recommended surgery, but was willing to try another cortisone injection, in a different part of my shoulder, which eased the pain considerably. My PCP also recommended surgery. What stopped me from surgery was fear of surgery, not a great reason. I exercised and stretched and rehabbed for a year, and did well. I still do rotator cuff rehab exercises 3 times a week. I have excellent range of motion and strength, but I honestly don’t know whether my noncompliance was a good idea or not–I guess time will tell.

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