The reasons why medicine-taking often bears little resemblance to what is written on prescriptions are numerous and complex.1 New relationships and understandings need to be established between interested groups to achieve the best possible health outcomes for (medicine-taking) individuals and the community.
Changes in human interaction often cause changes in the way we communicate, whether we like it or not. In medicine, compliance is a measure of how closely a person follows a course of prescribed treatment. However, compliance is now considered to be a paternalistic concept. The search is on for a more acceptable term. Social scientists use the term adherence, but this has not been universally accepted. Recently concordance has been proposed as an alternative term2, but is this word appropriate?
Dictionaries suggest that:
- concord comes from concordat, which is an agreement between the Pope and a secular government regarding the regulation of ecclesiastical matters
- concord refers to the matching of words within a sentence in terms of their number (singular or plural) and in terms of gender or person
- concord is two sounds making harmony together, and concordant is harmonious
- Concord(e) is also an aeroplane
- concordance refers to an alphabetical list or index of subjects or topics; its verbs are concordanced, or concordancing.
The negative of concord is discord. So if a person does not take their pills does this mean they are discordant, or are they non-concordant?
In its newly fashioned context, concordance is an agreement or partnership between patient and prescriber about obtaining the best use of treatment, compatible with what the patient desires and is capable of achieving. Non-concordance then relates to the patient-prescriber consultation, and not to the patient.
Compliance and concordance are not interchangeable terms. Achieving concordance between doctor and patient by identifying beliefs about illness, treatment and medicine-taking is a worthy concept. It should impact positively on compliance with treatment, and thus health outcomes may be improved. While we should be striving for concordance, some of us will no doubt still wish to be able to evaluate compliance. Although the terms compliance and non-compliance can have a negative connotation for some people, they remain the most useful descriptions of this process in the absence of anything better.
Concordance aficionados or those who may wish to know more should visit www.concordance.org
- Hopkins H, Wade T, Weir D. 'Take as directed', whatever that means. Aust Prescr 2000;23:103-4
- Mullen PD. Compliance becomes concordance [editorial]. Br Med J 1997;314:691-2.