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Peter Rudd, MD
Arch Intern Med. 1980;140(5):726-727. doi:10.1001/archinte.1980.00330170142045.
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I share Dr Westerman's concern that clinicians may contribute to patients' noncompliance. By placing little emphasis on compliance and by using inadequate reinforcement, the physician functionally shifts all responsibility for compliance to the patient. This approach is consistent with most physicians' disinterest and pessimism about patient compliance. Several recent studies, however, have reported substantial improvement in compliance from interventions suitable for most practitioners, as outlined in my editorial and elsewhere.1-4

Dr Westerman's call for greater use of the interval medical history is intriguing. The interval history certainly may provide valuable data about the patient's perceptions and efforts to achieve compliance. It further indicates the practitioner's interest in compliance. But in the end, the patient's history remains an imperfect measure of the compliance phenomenon. Even Dr Westerman's assertions about the inconsistencies of noncompliant behavior will remain assertions until we develop better measures of compliance. There is certainly no justification for any


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