AS CHILDREN, most of us knew that when we were sick we were to follow "doctor's orders" (and our parents were generally the enforcers to ensure that we did). Once I became an adult and began practicing medicine, I found that many patients—even I, for heaven's sake—do not always follow doctor's orders. We can be, as they say, noncompliant.
Noncompliance with prescribed medications for chronic diseases (eg, most dermatologic diseases) is a particularly prevalent problem, approaching 50% in many studies.1 Moreover, noncompliance with prescribed therapies is a problem that does not go away; noncompliant patients often return without achieving the improvement they sought. Although some studies have not found a relationship between patient compliance and better health outcomes,2 there is growing evidence that in most clinical situations, noncompliance with therapies has a negative effect.3 Furthermore, intriguing evidence suggests that compliance itself may be good for patients' health independent of the effectiveness of the therapy itself. In one study,4 patients were prescribed either a medication or placebo after a myocardial infarction and followed up carefully for recurrent infarcts or death. Whether prescribed a placebo or an active agent, patients who took 80% or more of the protocol medication had substantially lower 5-year mortality rates than did those who were less compliant.
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