Education and debate

“Doing prescribing”: how doctors can be more effective

BMJ 2003; 327 doi: 10.1136/bmj.327.7419.864 (Published 9 October 2003)
Cite this as: BMJ 2003;327:864

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  1. Glyn Elwyn, professor (g.elwyn@swansea.ac.uk)1,
  2. Adrian Edwards, reader1,
  3. Nicky Britten, professor of applied health care research2
  1. 1 Primary Care Group, Swansea Clinical School, University of Wales Swansea, Swansea SA2 8PP
  2. 2 Institute of Clinical Education, The Peninsula Medical School, Exeter EX1 2LU
  1. Correspondence to: G Elwyn

    What is the best way to achieve concordance? The authors summarise the evidence and indicate the way ahead for doctors to involve patients in making decisions about treatment

    Much prescribed medicine is not taken, and we know that few patients adhere to “prescription” guidance.1 It is also clear that patients' beliefs and attitudes influence how they take drugs.2 This is particularly true for preventive medicine (thus largely for conditions without symptoms) and for drugs that have side effects or other drawbacks. As interest in the concept of patient autonomy increases, we are becoming more aware, and more respectful, of intentional dissent—where better informed patients decline certain drugs.3 Concordance describes the process whereby the patient and doctor reach an agreement on how a drug will be used, if at all. In this process doctors identify and understand patients' views and explain the importance of treatment, while patients gain an understanding of the consequences of keeping (or not keeping) to treatment.

    “When we want your opinion, we'll give it to you”

    Credit: PUNCH CARTOON LIBRARY

    Evidence base

    Few well conducted, randomised controlled trials of interventions to help patients follow their prescriptions have been done.4 Our article is based on a number of reviews in this field and a recent systematic review of concordance.1 4–6 Changes in terminology in this area have mirrored an increasing rejection of the power relation implicit in the term “to prescribe.” The authority laden term “compliance” gave way to the view that patients “adhered” (or not) to treatment. Recently the term concordance has been used to describe an agreed plan between patient and doctor about the use of treatment—one of the results of a shared decision making process.7 8

    Box 1: Concordance tasks

    Elicit the patient's views on the possibility of having to take medicine

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