The logic of noncompliance: management of epilepsy from the patient's point of view.

Studies of patient compliance with medical regimens reveal that one-quarter to one-half of patients act at variance with their physician's suggestions. Using anthropological methods of long-term participant observation, seven epileptic patients were intensively studied for ten months in a variety of social contexts, including visits to health resources. Their conceptions of proper management of epilepsy were elicited, and their communication of these conceptions to providers of health care was observed. Although most of these patients were noncompliant, no single pattern of noncompliance encompassed their behavior as a group, and some of them had more than one drug consumption strategy. Furthermore, some patients were found to be noncompliant with biomedical regimens, yet actively and consistently pursuing alternative regimens. A range of such alternative therapies were identified both for low-income and middle-income patients. These case histories suggest that patients actively assess the quality of care given by their providers of health care. From the patient's point of view, biomedical strategies form one facet of many coping mechanisms in the management of epilepsy.