July 1990

On White-Coat Effects and the Electronic Monitoring of Compliance

Author Affiliations

Clinical Epidemiology Unit Yale University School of Medicine New Haven, CT 06510

Arch Intern Med. 1990;150(7):1377-1378. doi:10.1001/archinte.1990.00390190043003

Compliance was "discovered" and christened about 20 years ago.1 Because thoughtful physicians have always known that patients may not take medication in the recommended schedule, the "discovery" of noncompliance was not new. What made it important was its formal identification as an important constituent of quantified analyses of therapy. Inadequate compliance could lead to gross distortions in therapeutic evaluation if an efficacious medication was falsely regarded as useless in a patient who had failed to take it.

See also p 1509.

The name produced by the christening process did not receive universal acclaim. The word compliance may imply obeisance or servility that is an unwelcome concept in an era of heightened concern for increased patient autonomy and reduced physician paternalism. No other single word, however, has been available as a preferred substitute for compliance. Adherence seems too sticky; fidelity has too many other connotations; and maintenance suggests a repair

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