Pediatric Compliance From
a Patient and Family Perspective
Barbara M. Korsch
Stephanie N. Marcy
Children's Hospital of Los Angeles, Los Angeles, CA
Pediatric compliance has been one of my interests for many years. Not that I am as preoccupied with having patients do what doctors tell them as many of my colleagues. Being a therapeutic minimalist and having a profound faith in the wisdom of the body, with the tincture of time as my preferred prescription for self and others, I have often thought that some patients who elected to refuse or modify the advice they got were quite wise. Having become aware of the doctor-patient relationship dilemma, I was interested in subjecting this broad and important issue to scientific inquiry and quantitative analysis, with hopes that the ensuing body of scientific information would be applied to pediatric education and practice.
In our first large-scale study of over 1,000 patient visits carried out in the 1960s ( Francis, Korsch, & Morris, 1969; Freemon, Negrete, Davis, & Korsch, 1971; Korsch, Gozzi, & Francis, 1968), there was a high incidence of noncompliance. Although the quality of care was not one of the foci of study, we could not avoid noticing that a great many prescriptions given were unnecessary and that some of the advice offered was open to question.
Yet we, like so many other investigators, used compliance as one of our outcome measures because the physicians we interviewed all stated that one of their goals in every medical encounter was to have the patient follow the advice he or she was given. In those days, no one would have said the advice was offered or negotiated. It was given with the expectation that it would be faithfully followed, and those patients who did not were labeled uncooperative (then and unfortunately even now).