Beltrán Sourik, Cronholm Peter F, Bartels Stephen J
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts.
Ann Fam Med. 2025 May 27;23(3):255-261. doi: 10.1370/afm.240358.
Promoting adherence to medical recommendations remains one of the oldest yet most persistent challenges of modern clinical practice. Although increasingly sympathetic to structural forces that affect health behavior, standard models frequently conceptualize nonadherence as a phenomenon of patient behavior, a self-evident quality belonging to patients that is responsible for a myriad of undesired outcomes. We contend, however, that this approach not only fails to consider the role of the clinician in the concept's origins in clinical encounters, but also has facilitated the use of adherence terms (eg, nonadherent, noncompliant, treatment resistant) as pejorative social labels to the detriment of the physician-patient relationship. Used without care, such terminology can alter the meaning assigned to patients' behaviors so that structural barriers to care such as poverty and systemic racism are reframed as problems of poor attitude or effort. This article explores the functions of adherence terms as social labels by reviewing their underlying logic in clinical settings and outlining pitfalls in the pathologization of nonadherence in research and practice. We propose the concept of adherence labeling-the assessment, classification, and dissemination of clinicians' perceptions of patients' adherence through social labels-as an alternative model to understand how adherence terms may inadvertently obstruct the care of marginalized patients.
促进对医学建议的依从性仍然是现代临床实践中最古老且最持久的挑战之一。尽管越来越多地关注影响健康行为的结构因素，但标准模型通常将不依从概念化为患者行为现象，这是患者自身显而易见的特质，会导致无数不良后果。然而，我们认为，这种方法不仅没有考虑临床医生在临床诊疗过程中该概念起源方面所起的作用，还促使人们将依从性术语（如不依从、不顺从、治疗抵抗）用作贬损性的社会标签，损害了医患关系。如果不加谨慎使用，此类术语会改变赋予患者行为的含义，以至于将贫困和系统性种族主义等医疗保健的结构性障碍重新界定为态度不佳或努力不够的问题。本文通过审视依从性术语在临床环境中的潜在逻辑，并概述研究与实践中不依从病理化的陷阱，探讨了依从性术语作为社会标签的功能。我们提出依从性标签这一概念——即通过社会标签对临床医生对患者依从性的认知进行评估、分类和传播——作为一种替代模型，以理解依从性术语可能如何无意地阻碍对边缘化患者的治疗。
