Compliance vs accessible care- time to change concepts

A while ago I wrote a paper about high compliance when using online neuropediatric clinic (to be published soon). After the paper was accepted the topic was presented at conference. Once I attended the conference I realized that I used the wrong concepts.

Adherence and compliance.

Much has been written about non- compliance. One of the main reasons that people stop taking medications are side effects. This is obvious: if you have severe side effects sometimes it’s not worth taking the medication even when beneficial. However before making this decision it is expected that the patient will return to the doctor to discuss other options. The papers I read (non-compliance to ADHD medication) did not take into account clinical accessibility. This reflects our assumption as doctors: we recommend medication and patients comply. If they don’t that’s non- compliance.

There is something for paternalistic about “compliance” it disregards mutual communication.

Non-compliance maybe also perceived from the doctors’ side- that cannot address his patients’ issues in a timely manner. This is especially relevant when a patient has adverse effects. These are not urgent and can wait for the next available appointment (that for neurology means months). Practically the delay in follow up makes it less relevant.


Using positive language- moving from compliance to accessible care.

Use the concept compliance only when clinical care is available. When follow-up appointment is not available this concept is judgmental and paternalistic. To reach true compliance we have to enhance availability from the doctor’s side and enable timely communication. This communication has to be incorporated into the system. Online clinics enable high accessibility and is especially useful in addressing adverse effects.

Once I understood that the paper was about accessibility to online clinics and communication abilities, I changed the title accordingly.


Points for thought:

Doctor: When you see non-compliance ask yourself why was it a problem of accessibility? Communication?
Patient: Issues with the medication? How can you address the problem in a timely manner? Is this time scale for follow-up acceptable?
Service providers: If the standard follow-up are ineffective are there ways such as online clinic that can address the problem in a