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From Patients to Populations: Rhetorical Considerations for a Post-Compliance Medicine

Daniel Skinner, Berkeley Franz

Abstract


Scholars have criticized the rhetoric of compliance for decades. For example, they have offered a more nuanced account of why patients are “noncompliant,” recasting noncompliance itself as rational behavior. While these insights made important strides toward the larger goal of disrupting power dynamics within medical encounters, and while they yielded new rhetorical inventions such as adherence and concordance, these new terms retained many of compliance’s problematic features. Building on the work of rhetoricians of health and medicine and other scholars, we cast compliance’s persistence as a symptom of shortcomings in the dominant medical model and its tendency to discipline individual patients instead of work with communities to facilitate health. We argue that this model is being challenged in especially dramatic ways with the increased focus on populations and communities. Drawing on the work of Michel Foucault to understand how to navigate problems associated with the disciplinary approach, the authors argue not just for a better understanding of the causes of noncompliance, but for a post-compliance conception of medicine. Among other things, such a view of medicine will require new rhetorical structures that can better support the aims of population health and community-based medicine.


Keywords


compliance; adherence; concordance; Foucault; population health

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DOI: http://dx.doi.org/10.5744/rhm.2018.1013



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