Trostle J A
Harvard Institute for International Development, Cambridge, MA 02138.
Soc Sci Med. 1988;27(12):1299-308. doi: 10.1016/0277-9536(88)90194-3.
Medical compliance researchers have produced more than 4000 scientific papers in the past two decades, but their research into the determinants of non-compliance has been inconclusive. This paper argues that the popularity of compliance and the uncertainty over its determinants can be understood if compliance is analyzed as an ideology that assumes and justifies physician authority. I explore compliance as a problematic concept, looking at its assumptions and its influences on clinical practice. The concept of patient compliance has a social history linked to the struggle to create and maintain physician control over infant feeding technology earlier in this century. But while physicians were successful in that struggle, they have never exercised complete control over health care products. Compliance must be reconceptualized and its research reoriented if it is accurately to portray medication usage and related health behaviors outside the clinic.
在过去二十年中，医学依从性研究人员发表了4000多篇科学论文，但他们对不依从性决定因素的研究尚无定论。本文认为，如果将依从性分析为一种假定并证明医生权威的意识形态，那么就可以理解依从性的流行及其决定因素的不确定性。我将依从性视为一个有问题的概念，审视其假设及其对临床实践的影响。患者依从性的概念有着一段社会历史，与本世纪初为建立和维持医生对婴儿喂养技术的控制而进行的斗争有关。但是，尽管医生们在那场斗争中取得了成功，但他们从未对医疗保健产品行使过完全的控制权。如果要准确描述诊所之外的药物使用及相关健康行为，就必须重新界定依从性并重新调整其研究方向。
