noncompliance vs. nonadherence

[sardith]

My sister is an RN in a privately run dialysis clinic in the Northwest, and she just told me that they have recently been instructed to change their vocabulary when referring to or dialoging with patients. In every situation where the word 'noncompliance' would have been appropriate, they are instructed to use the word 'nonadherence' instead.

I was puzzled. She said it was considered pejorative to use the former term. The following was the best explanation I could find on the 'net' for this:


Some years ago, diabetes educators argued that the term ‘adherence’ be used preferentially instead of ‘compliance,’ and the term ‘nonadherence’ be substituted for ‘noncompliance.’ The rationale for this proposal was that the term ‘noncompliance’ implies a series of negative value judgments about patients as people. Instead, the term ‘nonadherence’ was thought to imply a description of a failure to follow the medical prescription without any bias toward the patient as a person.

Can someone out there attempt to explain this reasoning to me, because I am missing something.

Thanks,
Sardith

[Audiendus]

I think I can understand the idea behind this distinction.

'Noncompliance' has a slightly authoritarian ring, suggesting that the patient is not following orders. ("You should comply with this!") 'Nonadherence' is a more matter-of-fact term, lacking the implication of disobedience. ("You should adhere to this if you want to get better.")

This reminds me of the philosophers' distinction between a 'categorical imperative' (Do X because it is right) and a 'hypothetical imperative' (Do X if you want Y).

[Slava]

I agree with Audiendus, noncompliance is authoritarian in tone. i would even take it further and say it smacks of a legality issue. One should comply to the requirements of the law. You adhere, also, but compliance is the real meaning.

If you don't comply with this law, you go to jail.
If you don't adhere to this medical regime, you die.

Compliance also implies submission, not a choice to follow suggestions and recommendations.

[sardith]

I can understand the legal compulsion logic, that was very helpful from the both of you.

Thank you very much,
Sardith

[Perry Lassiter]

Sorry, but it still sounds motivated by political correctness. Whether noncompliance or nonadherence, you're still dead. Absolute neutrality might be "you're not following..." But the doc and other people DO have authority coming from training and experience. What's wrong with passing mild judgment on people. I've been diabetic for 35 years and have very loose compliance with the regimen. I'm both noncompliant and nonadherent, but neither am I offended should anyone label so.

[taufancool]

I think the word "nonadherence" is more polite than "noncompliance".

The rationale for this proposal was that the term ‘noncompliance’ implies a series of negative value judgments about patients as people. Instead, the term ‘nonadherence’ was thought to imply a description of a failure to follow the medical prescription without any bias toward the diabetic diet meal plan patient as a person.

It’s just like you write above. I prefer the word "nonadherence".

[Perry Lassiter]

Welcome Taufancool. Look forward to more posts from you.