Posted by on Jun 11, 2015 in Blog | 9 comments

Any Trekkie (Star Trek Fan) would know this greeting of the Borg that ends with “Resistance Is Futile.”

What Does Compliance Mean?

According to the Merriam-Webster Dictionary, compliance is “the act or process of doing what you have been asked or ordered to do.”

Language of Medication TakingThis word is part of the legal, militaristic language of quarantine. In the US, Congress enacted legislation in 1878, 1890, 1893, and 1906 that established the Public Health Service to “prevent introduction of epidemic diseases” into the US and “prevent the interstate spread of communicable diseases.” The Public Health Service was organized in 1889 along military lines with commissioned officers.

Perhaps the birth of the pejorative terminology of “compliance” comes from the efforts to control outbreaks of diseases like tuberculosis. People who did not comply were termed “ignorant, vicious, recalcitrant, or defaulters.” Even research on medication taking conducted before 1960 describes people who didn’t take their medicines as prescribed as “untrustworthy.”

From Compliance To Adherence

The language of medication taking has moved away from “compliance” to “adherence” but many would say this is not much of a change.
What does adherence mean? Adherence is “the act of doing what is required by a rule, belief,The Language of Medication Taking etc.” One article written in 1999 suggested that, while “The term “compliance” suggests a restricted medical-centered model of behavior…the alternative, “adherence” implies that patients have more autonomy in defining and following their medical treatments.”

When studying medication taking, these words create problems. For example, these words imply a dichotomy: either you are adherent or you are non-adherent. What if you forget to take your medication once or twice, but otherwise stay on track with the treatment? You would be classified as non-adherent. What if you take your medication consistently but it is at a lower dose? You are adherent:  but there are different behaviors going on beyond yes, you take your medicines and no, you don’t.

Furthermore, these words stigmatize people who may not have taken every pill at the desired time and, in turn, can interfere with relationships between those people and future providers.

How Do People With Chronic Conditions Feel About These Words?

During a tweetchat held in March 2015, a variety of people with chronic conditions (and their caregivers) shared their feelings about the words “Compliance” and “Adherence.” Their conditions varied from gastroparesis and diabetes to migraine, stroke and chronic pain.  There is more from this discussion in the follow up post.

These patients have strong negative feelings about the words of medication taking that are part of the lexicon of the pharmaceutical industry, medicine and the healthcare system.

Rethinking “Compliance” and “Adherence”

Should the language of medication taking change? What are reasons behind not taking medication as prescribed? This is the first post on this important topic. Please feel free to join the conversation (in the comments section) as we explore medication taking.

Tweets from the HCHLITSS Tweetchat March 27, 2015.