BMJ  2003;327:867 (11 October), doi:10.1136/bmj.327.7419.867

Filler

The challenge of concordance

This paragraph from The Spirit Catches You and You Fall Down by Ann Fadiman (New York: Farrar, Straus and Giroux, 1997; ISBN 0 374 52564 1) describes the drugs taken by Lia Lee, a Hmong child with severe epilepsy. Her parents came from the mountains of Laos to California, and Fadiman's book describes the mutual incomprehension of the healthcare workers in California and Lia's family. For more information on the book read Editor's Choice.

The first 150 words of the full text of this article appear below.

By the time she was four and a half, Lia's parents had been told to give her, at various times, Tylenol, ampicillin, amoxicillin, Dilantin, phenobarbital, erythromycin, Ceclor, Tegretol, Benadryl, Pediazole, Vi-Daylin Multivitamins with Iron, Alupent, Depakene, and Valium. Because these medications were prescribed in varying combinations, varying amounts, and varying numbers of times a day, the prescriptions changed twenty-three times in less than four years. Some of the drugs, such as vitamins and anticonvulsants, were supposed to be given every day no matter how Lia was feeling, and when they ran out, her parents were supposed to renew the prescriptions; some, such as antibiotics, were supposed to be given for a specific period of time, and though they were prescribed only when Lia displayed certain symptoms, the prescriptions were to be finished (but not renewed) even if those symptoms disappeared; antifebrile medications, prescribed in the hope of warding off fever-triggered . . . [Full text of this article]

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An extreme failure of concordance

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