Taking medicines: concordance is not complianceBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7212.787 (Published 18 September 1999) Cite this as: BMJ 1999;319:787
- David Dickinson, lay member,
- Patricia Wilkie, lay member,
- Miriam Harris, secretary
EDITOR—Consultations between patients and doctors most often involve two contrasting sets of health beliefs. Concordance recognises that the health beliefs of the patient, although different from those of the doctor, nurse, or pharmacist, are no less cogent or important when making decisions about the best approach to the treatment of the individual.
In October 1998 the Concordance Coordinating Group, chaired by Marshall Marinker, was formed to take forward the programme of work outlined in a 1997 report.1 The group comprises general practitioners, pharmacists, academic researchers, consumer representatives, and members of the pharmaceutical industry. The group's website (www.concordance.org) explains our activities. But misconceptions remain about what concordance means.
“Concordance is a new approach to the prescribing and taking of medicines. It is an agreement reached after negotiation between a patient and a healthcare professional that respects the beliefs and wishes of the patient in determining whether, when, and how medicines are to be taken.”
The concordance initiative aims to help patients and prescribers to make choices that are as well informed as possible about diagnosis and treatment, and benefits and risks, and to help them to collaborate fully in a balanced therapeutic alliance and so optimise the potential benefits of medical care.
Concordance, however, is not a replacement for compliance. Some professionals use the word concordance as a synonym for compliance and talk about improved patient concordance. The problem with the word compliance is that it implies that a patient takes orders from a health professional.
Concordance is not a one way communication. Concordance requires the agreement of two parties. It is not possible to impose concordance Patients should be able to express their concerns about drug treatment and be encouraged to make decisions about their drug treatment. Some patients will not wish to be involved in this partnership; their wishes need also to be respected.
Concordance is not a recipe for a comfortable life. If concordance is successful some patients will decide not to take their medicine and some may decide to alter their treatment, and the outcome may not be what the clinician thinks is best.
Concordance is not a wholly new concept. Many doctors, nurses, and pharmacists have been practising concordance for years. And many patients have worked with their practitioners, explaining their concerns and working towards true partnership in treatment.