Modifying the treatment: Patient compliance, patient control and medical care

Abstract

A theoretical model, grounded in the experience of about 200 San Francisco Bay area Chicano p patients, of patient non-compliance as a means of asserting control in a patient-practitioner relationship in order to obtain satisfaction with the treatment is presented. The need to modify the treatment arises when it appears to the patient that the original treatment is not totally appropriate. The patient may rely upon convincing tactics (the demand, the disclosure, the suggestion and the leading question) to bring her concern to the practitioner's attention in order that he might modify the treatment. The patient may also take matters into her own hands and use countering tactics to modify the treatment herself. These may be of the augmentation type (simple and additive) or of the diminishment type (simple and subtractive). Convincing and countering tactics may be used sequentially or simultaneously. When a practitioner is aware of her modification attempts, he may be perceived to resort to counter-management tactics to neutralize her own actions. These tactics may be the overwhelming knowledge, the medical threat, the direct disclosure and the personal friend. Bargaining occurs, either unilaterally or bilaterally, during which each party tries for a settlement in which the treatment action of one is at least honored, if not adopted outright, by the other. If the bargaining ends to the satisfaction of both, a desire to maintain the relationship develops. If either or both parties are dissatisfied with the result of the bargaining, the relationship becomes strained and termination becomes likely.