Background and Theory overview: Promoting adherence to medical recommendations remains one of the oldest yet most persistent challenges of modern clinical practice. Traditional models treat nonadherence as an intrinsic patient behavior, which can undermine patients' autonomy as well as blame them for poor health outcomes. The authors draw on sociological labeling theory to show that "nonadherent" is not a neutral clinical finding but a social judgment made by clinicians.
What Is New: The authors name and model "adherence labeling" as the process by which clinicians produce "nonadherence" data rather than diagnose a patient trait. Rather than locating nonadherence solely in the patient, the authors show that the clinician's decision to observe, interpret, and record behavior generates the label. This shift from patient fault to clinician choice reveals how labels can obscure structural barriers such as underinsurance or systemic racism, stigmatize vulnerable patients and skew care decisions.
Why It Matters: The "nonadherent" label embeds stigma and clinician bias into patient records, often resulting in delayed therapy escalation, clinic dismissal, and poorer health outcomes.
Adherence Labeling: Understanding the Origins, Limitations, and Ethical Challenges of "Diagnosing" Nonadherence
Sourik Beltrán, MD, MBE, et al
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
