In the late 1990’s nurses o know did a study where they personally administered a questionnaire to people with ESRD. The study structure was weak and loose and the data hung around for years, but in about 2003, we had an intern organize it and annotate other literature. We wrote it up and got an award in a nephrology nursing journal. We identified many barriers that affect compliance. Trusting the system and advisors was part of it, but (not in order) dosing schedule, side effects perceived or real, affordability, belief the treatment works or would for them, hassle factor (like 18 meds six different times a day-empty stomach, full stomach, between meals, ac, pc, hs, TIW, QM, etc.), ability to afford rent, child care, and premiums. Most people realized that the sanest response was non-compliance.
Hey Dr. Karen, you brought the heat, my friend!! I'm here for it!🙌🏽
I think this is where the language issue gets even bigger. The words "provider" and "patient compliance” are not separate problems in my mind. They are symptoms of the same machine.
The stealth use of the word "Provider” flattens physicians into interchangeable labor units, making it seem harmless because the person on the other side of the interaction doesn't stop to think about its impact, but it keeps them compliant, I mean, complacent in demanding better care.
"Compliance," on the other hand, flattens patients into people who are supposed to obey a plan, even when that plan may not fit their money, life, fear, history, access, or actual body because in the mind of the physician, the training has taught them, I mean us, to be like demagogues.
And while we debate the words, the real question is, who benefits from flattening both sides? Maybe the insurance companies benefit by denying health care to their clients. Or it could be the health systems that benefit from being allowed to purchase practices across specialties and other smaller hospitals, cancel contracts, and freeze out practices that don't fall in line to control the regional market. Or it could be private equity that swoops in to devour the providers—oops, I mean doctors—to make a fast buck, then suck the resources out of that system only to declare bankruptcy.
If the Medical Industrial Complex can keep physicians thinking of themselves as just “providers,” then clinical judgment can be scheduled, measured, rushed, and replaced. And if the MIC can keep a patient sick and tired and on the verge of bankruptcy, then they are judged by “compliance” measures, all while the burden of a failed plan quietly shifts onto the person who had the least power in designing it.
I keep coming back to in my observations.
1. Who decided a physician gets seven minutes with a patient?
2. Who decided the visit is structured that way?
3. Who decided the price is unknowable until after the care is delivered?
4. Who decided patients should enter one of the most expensive systems in American life without knowing what anything costs?
This did not happen by accident.
I've trained and practiced inside these systems. I've watched medicine become more corporate in real time. I've watched practices get absorbed. I've watched physicians become employees. I've watched clinical decisions get squeezed by workflows that were not designed around care.
So I do not think this is just semantics. Language is how the system trains people to accept their position inside it, right?
Patients get trained to wait.
Physicians get trained to produce.
And the people designing the rules stay unnamed.
That is the part we have to stop allowing.
If we are going to talk about language, we have to name the system using the language to protect itself.
I dig this! Thanks for engaging! Yes I agree the system is the underlying problem, no doubt.
YET, I would add to this list of questions: who is publishing all those articles listed in pubmed that have “patient compliance” as key words?
That’s not insurers, payers, and pharma. That’s docs and researchers. And I think it’s connected to a ton of terrible reports people are posting about medical gaslighting.
So basically I think not all doctors are as sympathetic to the patient perspective as you, and the system is reinforcing all of that in ways you describe. 😉
ummm no one really gets a physician as a primary care anyway, and “providers” is the term they use for whatever it is we get, nurses of some variety or if you are lucky a PA.
"Provider" bothers physicians because it turns a profession into a function. "Compliant" does the same thing to the patient, turning a person trying to live with a treatment plan into a measure of whether the instruction was obeyed. The symmetry is exact, and only one half of it tends to get noticed.
What the word hides is that adherence is rarely the patient's private trait. It is where the recommendation meets money, fear, and the small humiliations of needing help. Calling the result compliance makes all of that look as though it happened inside the patient alone.
The word also protects the plan from being examined. If the patient is noncompliant, the instruction stays intact and the failure moves downstream, when sometimes the plan simply never became livable, and the clinic mistook agreement for feasibility. So the problem with the language is not only respect. It is diagnostic. The wrong word can make the wrong part of the encounter look like the cause.
In the late 1990’s nurses o know did a study where they personally administered a questionnaire to people with ESRD. The study structure was weak and loose and the data hung around for years, but in about 2003, we had an intern organize it and annotate other literature. We wrote it up and got an award in a nephrology nursing journal. We identified many barriers that affect compliance. Trusting the system and advisors was part of it, but (not in order) dosing schedule, side effects perceived or real, affordability, belief the treatment works or would for them, hassle factor (like 18 meds six different times a day-empty stomach, full stomach, between meals, ac, pc, hs, TIW, QM, etc.), ability to afford rent, child care, and premiums. Most people realized that the sanest response was non-compliance.
Thank you for this! There’s so much more to it than motivation, attitudes or understanding. Social reasons matter so much.
Hey Dr. Karen, you brought the heat, my friend!! I'm here for it!🙌🏽
I think this is where the language issue gets even bigger. The words "provider" and "patient compliance” are not separate problems in my mind. They are symptoms of the same machine.
The stealth use of the word "Provider” flattens physicians into interchangeable labor units, making it seem harmless because the person on the other side of the interaction doesn't stop to think about its impact, but it keeps them compliant, I mean, complacent in demanding better care.
"Compliance," on the other hand, flattens patients into people who are supposed to obey a plan, even when that plan may not fit their money, life, fear, history, access, or actual body because in the mind of the physician, the training has taught them, I mean us, to be like demagogues.
And while we debate the words, the real question is, who benefits from flattening both sides? Maybe the insurance companies benefit by denying health care to their clients. Or it could be the health systems that benefit from being allowed to purchase practices across specialties and other smaller hospitals, cancel contracts, and freeze out practices that don't fall in line to control the regional market. Or it could be private equity that swoops in to devour the providers—oops, I mean doctors—to make a fast buck, then suck the resources out of that system only to declare bankruptcy.
If the Medical Industrial Complex can keep physicians thinking of themselves as just “providers,” then clinical judgment can be scheduled, measured, rushed, and replaced. And if the MIC can keep a patient sick and tired and on the verge of bankruptcy, then they are judged by “compliance” measures, all while the burden of a failed plan quietly shifts onto the person who had the least power in designing it.
I keep coming back to in my observations.
1. Who decided a physician gets seven minutes with a patient?
2. Who decided the visit is structured that way?
3. Who decided the price is unknowable until after the care is delivered?
4. Who decided patients should enter one of the most expensive systems in American life without knowing what anything costs?
This did not happen by accident.
I've trained and practiced inside these systems. I've watched medicine become more corporate in real time. I've watched practices get absorbed. I've watched physicians become employees. I've watched clinical decisions get squeezed by workflows that were not designed around care.
So I do not think this is just semantics. Language is how the system trains people to accept their position inside it, right?
Patients get trained to wait.
Physicians get trained to produce.
And the people designing the rules stay unnamed.
That is the part we have to stop allowing.
If we are going to talk about language, we have to name the system using the language to protect itself.
I dig this! Thanks for engaging! Yes I agree the system is the underlying problem, no doubt.
YET, I would add to this list of questions: who is publishing all those articles listed in pubmed that have “patient compliance” as key words?
That’s not insurers, payers, and pharma. That’s docs and researchers. And I think it’s connected to a ton of terrible reports people are posting about medical gaslighting.
So basically I think not all doctors are as sympathetic to the patient perspective as you, and the system is reinforcing all of that in ways you describe. 😉
What a mess we have, right?
ummm no one really gets a physician as a primary care anyway, and “providers” is the term they use for whatever it is we get, nurses of some variety or if you are lucky a PA.
Yes it’s definitely become an umbrella term… maybe part of why doctors don’t like it, they don’t want to be lumped in with everyone else?
i think that’s it!
"Provider" bothers physicians because it turns a profession into a function. "Compliant" does the same thing to the patient, turning a person trying to live with a treatment plan into a measure of whether the instruction was obeyed. The symmetry is exact, and only one half of it tends to get noticed.
What the word hides is that adherence is rarely the patient's private trait. It is where the recommendation meets money, fear, and the small humiliations of needing help. Calling the result compliance makes all of that look as though it happened inside the patient alone.
The word also protects the plan from being examined. If the patient is noncompliant, the instruction stays intact and the failure moves downstream, when sometimes the plan simply never became livable, and the clinic mistook agreement for feasibility. So the problem with the language is not only respect. It is diagnostic. The wrong word can make the wrong part of the encounter look like the cause.