Editorials

Compliance becomes concordance

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7082.691 (Published 08 March 1997) Cite this as: BMJ 1997;314:691

Making a change in terminology produce a change in behaviour

  1. Patricia Dolan Mullen, Professora
  1. a Center for Health Promotion Research and Development, University of Texas School of Public Health, Box 20186, Houston, Texas 77225, USA

    At long last the “compliance problem” may be getting a new name and, with it, a new view of the patient's role in the doctor-patient relationship. A report published this week by the Royal Pharmaceutical Society of Great Britain's working party on medicine taking recommends that “concordance” should replace the term “compliance.”1 Although substitute terms have been suggested and used previously without much impact, this eloquent analysis of the importance of a new concept by a highly visible and distinguished panel may hold the promise of change. Moreover, the panel recommends a £1.8m ($2.7m) research budget to support analysis of the problem and training of health professionals.

    Compliance has long been criticised as denoting obedience-“following doctors' orders.” Although many researchers and practitioners have carefully avoided the term,2 the common alternatives-“adherence” or “cooperation”-do not take the user very far from compliance. One member of the working party, David Sackett, in his 1976 …

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