... the disease and a lack of acceptance of the purpose of a particular treatment. For instance, a patient with a chronic disease actually may establish a comfort level with the current stage of the disease. In contemporary context, the awareness that patients often are not compliant with their health care advice, coupled with the realization that this behavior has costly implications, both for managed care and society as a whole, has led to different proactive approaches in managing the patient-provider relationship. This awareness has led to a shift from treating the patient as a passive pill-taker to treating the patient as an active participant in decision-making. It also is seen in a shift from treating the healthcare provider passively accepting noncompliance to managing patient interaction actively. Health plans and systems are turning to primary care providers to follow up more actively with patients who fail to return for treatment. ...

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