Patients' noncompliance and how doctors manage this

The purpose of this study was to examine doctors' behavior towards patients' noncompliance and to explain it within the framework of frustration theory. Two groups of physicians participated. The first group of 30 was selected from a larger group, based on tape-recordings of patients' visits where obvious examples of noncompliance were found. The 63 physicians forming the second group were interviewed to discover their attitude/behavior towards noncompliance. The tactics observed in the first study group and reported by the second group were then analysed according to the same system of categories. In the second group RPFS (Rosenzweig Picture-Frustration Study) was also applied to find determinants of the doctors' behavior. In general, 11 different tactics were identified but only five were applied by more than 10% of doctors from either group. These were: medical threat (most frequently used in both groups) carrying the doctor's point in an indulgent atmosphere, authoritarian tactics, medical information, withdrawal. There were no significant differences between the groups as to the tactics used (i.e. no differences between observed and reported behavior), on the contrary, a positive correlation was found. The doctors applied certain tactics of doubtful effectiveness which might worsen the patient's emotional state or harm him as a person. On the other hand, many valuable techniques of proved efficacy were not used. When the doctors' tactics were interpreted within the framework of frustration theory as task-oriented or ego-defensive, it was found that in both groups the ego-defensive tactics predominated. The kind of tactics adopted towards noncompliance was strongly determined by the attitude towards frustration measured by RPFS (Kendall Q COEFFICIENT = 0.92). Results obtained suggest that patients' noncompliance is a source of doctors' frustration and is perceived as an ego-threatening event by the majority of them. As a consequence, doctors' activity is aimed first of all at ego-defense, while the original goal of behavior, i.e. the management of noncompliance, is neglected.