It might not make much difference

The concept of concordance—consensual prescribing—emerged after an inquiry “into the causes and consequences of non-compliance with medicines.”1 The notion of “doctor's orders,” where the passive patient is given treatment by the authoritarian and supposedly knowledgeable doctor is replaced by the idea of discussion and agreement between patient and prescriber before treatment. The final aim is “to optimise the potential benefits of medical care.”1 Two thirds of older patients prescribed a statin for coronary artery disease will have given up treatment within two years.2 Concordance implies that these patients are denied real benefits if they do not take treatment as prescribed, and informed discussion should improve matters. Constructive dialogue between patient and prescriber is ethically and professionally desirable, even if the public good sometimes demands an authoritarian approach, as with directly observed treatment for tuberculosis or methadone maintenance. Usually, however, the patient, who has most to gain by success and the most to lose from …