Sir: Whether at any time doctors' orders have been followed is open to debate. The very term suggests a degree of contempt. With political correctness having moved the term from this to compliance, then adherence and now concordance, may reflect the seriousness, or lack thereof, with which our instructions are taken. More basic than how much patients value the instructions given to them by medical practitioners, may be the belief patients' attribute to the physicians directions. Coming at the problem from another angle one might wish to consider to what extent patients believe how much the disease that doctors label a patients illness with accords with their own perceptions of their problem.

Certainly, in psychiatry particularly, this element of 'insight' is a major determinant of so called lack of concordance. Were more time spent in trying to explain to patients the nature of their problems, as seen through a doctors eyes, a more reliable uptake of advice might be expected. To anticipate an improvement in this area, within the shortsighted government encouragement of doctor bashing, internet misinformation overload and sensationalisation of medication side-effects, is probably overoptimistic, but still worth trying.

Competing interests:   None declared