Non-compliance in orthopaedic surgery and its ethical challenges

SummaryNon-compliance is described as “the degree to which patient behaviour (in terms of taking medication, following diets, executing lifestyle changes) is congruent with the recommendations of the health care provider.Non-compliance is a difficult problem, and can take many forms including patients not attending follow-up appointments and not taking prescribed medications. In trauma and orthopaedic surgery, the final outcome can be significantly compromised by poor compliance, resulting in morbidity to the patient as well as substantial financial implications to the health system. Knowing sub-groups of patients who are more likely to be non-compliant should enable us to predict those at risk of non-compliance in order to take necessary steps for improvement. In order to consider refusing treatment to a non-compliant patient there has to be robust ethical justification. All surgeons have a duty of care, which includes taking steps to improve patient compliance.