Physicians' Role in Noncompliance
To the Editor.
—The editorial by Rudd, "In Search of the Gold Standard for Compliance Measurement," in the Archives (139:627-628, 1979), seems to make an assumption that most physicians are alert to, or attempt to identify, noncompliant patients. It has been my observation that physicians begin to consider this possibility only when the patient's response to treatment deviates from the expected, and sometimes when the response is less than optimal and there are no good alternatives. As a result, any minor deviations in therapeutic response are interpreted as being due to disease resistance or inadequacies in the initial modality. Having reached such a conclusion, most physicians decide, in the case of drug therapy, either to increase the dosage or to switch to another agent. The former carries the risk of producing side effects, and the latter, the use of a less well-tolerated compound.