Compliance and noncompliance are words used by doctors and nurses to describe whether a patient is following instructions and cooperating with recommended treatments.
Compliance means that a patient is being cooperative.
Noncompliance means that a patient isn’t being cooperative.
Health care providers document in medical records whether a patient is compliant or noncompliant to help guide future care and, in some cases, to point the blame at patients when something is going wrong.
When our team at Painter Law Firm reviews potential medical malpractice cases, we study the medical records carefully to see if patient noncompliance will be an issue in the case. One thing’s for sure—if there are references in the medical records to a patient being noncompliant, lawyers for the defendant doctor or hospital will bring it up during the case.
Here are some examples of noncompliance notes that we’ve seen in medical records:
• Patient is noncompliant with recommended diet.
• Patient needs to be compliant with massage therapy for lymph drainage.
• Patient noncompliant on smoking, which delays wound healing.
• Patient noncompliant and won’t cooperate with physical therapy.
In some situations, noncompliance is just that—a patient isn’t cooperating with recommended treatments. For example, smoking after a surgery is a bad idea because it delays wound healing. If the patient ends up having a surgical wound that opens and gets infected, that noncompliance would be damaging to any potential medical malpractice case.
In other situations, there’s another side to the story. For example, it’s not noncompliance when a patient won’t participate with physical therapy because her baseline pain is abnormal and excruciating. Instead, that’s an issue that needs to be evaluated and treated by a physician.
For the dual purposes of receiving quality care and making sure your medical records are accurate, it’s important to provide context to your doctors, nurses, and therapists if you have been unable to follow their treatment recommendations. Don’t allow yourself to be labeled as a noncompliant “problem patient,” when there’s more to the story that the physicians and nursing staff need to figure out.