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Compliance: The Dilemma of the Chronically Ill,

Peter Rudd, MD
Arch Intern Med. 1987;147(1):25. doi:10.1001/archinte.1987.00370010031005.
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This book reflects the experiences of a group of clinical psychologists working with a variety of medical patients in a large general hospital. Its complex focus is the result of several convictions, shared by the authors, that noncompliance is (1) a nonspecific symptom, (2) a multifactorial process generally unresponsive to a unifactorial solution, and (3) frequently a conscious, self-affirmative choice of independence and personal value.

Eight authors contribute 11 chapters that emphasize the special situations of the chronically ill, such as indirect self-destructive behavior, quality of survival, family relationships, staff perceptions of noncompliance, physician-patient communication, cognitive-behavioral relationships, and societal contributions to noncompliance. Their explicit audience consists of physicians and staff, both those in training and those in established practices, who harbor unrealistic and often self-defeating expectations and approaches in dealing with noncompliance. Collectively, they bemoan many health professionals' attitudes of treating patients as a "homogeneous group whose behavior should be


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