Jim: The purpose of this post was to underline the reality that compliance is something we can’t just lay on the patient. In fact, the term “non-compliant” has become a term of derision when applied to a patient – a fact that really bothers me. I see non-compliance as one of two things:
1. A gap in education – I need to do a better job explaining things.
2. A personal choice by the patient – if I have done #1, then the patient has the right to not listen to me. I am OK with that. That’s where “I get paid regardless” fits in. My “job” is to allow an informed decision. I don’t want to be measured by what the decision is; I just want to make sure I allow them to make the most informed decision possible.

SJ: sorry for not using the right words. I will confess this to my priest and try to be better. (I do realize you are exasperated by this as well).

Is that so bad?

“How about physician compliance to evidence-based practice?”

Maybe we should use “adherence” to get better results.

“what if you didn’t get paid the same if people ignored what you said? Would you practice medicine differently?”

It’s never about results, it’s about FFS.

Gee, do ya think they’ll find a site that tells them they are likely to be irresponsible idiots!! Again, ready to be renamed health care serviceman soon?

“Current clinical practice guidelines indicate that patients classified as high risk based on high risk factor burden or existence of known high-risk disease states (e.g., diabetes) are regarded as candidates for intensive preventive therapies (medical treatments). There is no clear evidence that additional non-invasive testing in this patient population will result in more appropriate selection of treatments. ”

Why are you sending her for a stress test when she is asymptomatic? That’s a big money waste right there.

I might buy an argument that statin therapy is justified in an asymptomatic patient with high risk factors and high CAC score, even though data on efficacy of statins for primary prevention of MI has been poor, CAC might be an independent marker of a patient population that will benefit from medical intervention. But in the presence of muscle pain from the HMG-CoA inhibitor, an alternative cholesterol lowering therapy makes sense, and I think she made the correct decision to stop therapy. She should have just told you about it so you could modify your treatment strategy.

Compliance usually denotes an obedient relationship, adherence a cooperative one.

Don’t blame me, this was pointed out to me during a lecture on “recurrence” and “failure” for treating vascular disease.