Hocus Pocus: Perspective on Noncompliance

“Hocus pocus” is a saying that most of us have heard before, perhaps you’ve even seen the movie with that name. It’s generally associated with a magician using the phrase to cast a spell or known as a term for trickery or magic. The origin of the saying, however is a perversion of a Latin phrase, Hoc est corpus meum, which was used in Catholic liturgy. In the 1500s, during the time of the Reformation when criticism of the church increased, it became a way to ridicule the church. It was used as a tongue in cheek remark, a statement to infer that things were not what they seemed to be. I was reminded of the origin of the saying recently and it got me thinking of other words or phrases that started out meaning one thing and evolved to have a different meaning and how the original meaning can be lost completely over time.

In many ways it seems that the way we use and perhaps misuse “noncompliant” in the medical setting has changed from the true meaning. The use of this descriptor may also be considered a perversion of the original meaning. Compliance comes from the word comply, which means to go along, so by extension noncompliance is to not go along. When we accept the label of noncompliant as it applies to a patient and use it in its narrowest meaning it can become a hard stop. When that happens, we may neglect to investigate why a patient chooses not to comply with medical advice. I’ve often pondered how much easier it would be if there was a pill for compliance that our patients could take that would have them following medical advice, but then of course they would have to comply with that. A conundrum of sorts.

The term noncompliant assumes in part that the patient has accepted the premise of what they are instructed to comply with. Say, for instance, that a patient has a heart condition, a heart medication is prescribed and they are expected to take the medication. If they fail to follow instructions and don’t take it, they may be labeled as noncompliant. But what if the patient does not accept the premise, for whatever reason? Are they then being noncompliant? This may sound like word soup, but if we stop for a moment to consider a different perspective it adds a layer of deeper comprehension.

The dictionary definitions of noncompliance are interesting, they include:

• Failing to act in accordance with a wish or command.
• To be defiant and resistant to authority.
• The fact of not obeying a rule or law:
• In medicine, the term noncompliance is commonly used in regard to a patient who does not take a prescribed medication or follow a prescribed course of treatment.

In reading these definitions we can see that noncompliance is often considered bad behavior.

There is the fact of noncompliance ― treatment is prescribed but not taken. And often there is an explanation for it ― for example the patient finds the side effect burden is unacceptable. It is easy to get stuck on the act of noncompliance and fail to recognize the rationale behind it, one that may make sense to a patient within the context of their reasoning.