Adherence vs Compliance

Is adherence better than compliance? I recently saw a doctor tweet a list of words he hates to read in patient charts. One of those words was compliant. He indicated adherent was superior, always. I’ve been thinking about that in light of the difficulty many of us have in complying with medical advice – including specialized diets.

I know, it may seem like semantics. But maybe in this case semantics matter. And I think this doctor makes an important point.

To get the greatest benefit from medical advice, patients need to adhere to plans developed by their medical team and agreed to by them. But I’ve most often heard this described as compliance, not adherence.

Why does this distinction matter?

In the strictest definitional sense, compliance means acquiescing or yielding, especially in a weak or subservient way. I don’t want to feel weak or subservient when it comes to decisions about my health. I’m pretty sure no one does.

I strongly believe in patient-centered care. In such a system, the patient is a valued part of their medical team. I’m not sure you can feel valued as part of the team when are related to by medical professionals as though you are, or should be, weak and subservient.

And let’s be honest, many times there’s pressure from medical professionals for patients and families to behave in a subservient way. If they do not, they may receive dismissive or condescending treatment. When this happens, it seems predictable that patients will tire of such treatment and rebel.

If a doctor talks down to, bristles at questions, fails to explain, or refuses to listen to patients, that physician is not going to be as likely to get a buy-in on a prescribed health plan. If that professional perceives there is pushback and relies on a position of superiority to attempt to enforce compliance, the patient will rebel even more.

And why not?

Our lower brains may perceive this kind of pressure as danger. When that happens, the patient must try to somehow twist their being into compliance while feeling they could be in danger. And the feeling of danger is exacerbated by a constant barrage of advertising pushing medications and health screenings.

Essentially, we’re asking people to do something very difficult to do. Intellect may not intercept the lower brains signals on a conscious level leaving behavior to be guided by survival instinct or reflex. Of course this won’t be true in every case. But it may be true often enough that we could improve adherence just by changing our rhetoric.

Adhering connotes steady devotion, allegiance, and attachment. In other words, if I choose to adhere to something, I embrace it. That sounds like the relationship I want when it comes to my health. I hope to embrace a plan that I perceive as the healthiest for me in any given moment.

Adherence places the patient back in a position of power in charge of their health. It is willingly given and does not require pushing at all.

Why not change our approach to seek adherence? When we treat patients in a manner that encourages them to embrace a plan, there will be no need for pushing, cajoling, shaming, or arm twisting them into compliance.

Could such a subtle shift make a difference?

There’s no way to really know until we try it. But if one physician has recognized the benefit, I’m guessing there are others. And if we as patients push for this change, we may get more palatable healthcare.

I feel like eating plans tailored to the needs of an individual and presented respectfully will make many dietary recommendations less objectionable and easier to embrace. That will take us a long way toward adherence.

Some may determine that adherence vs compliance is a bit potayto, potahto. I disagree. I feel like a shift toward adherence is just the shift we need.