BMJ  2003;327:864-867 (11 October), doi:10.1136/bmj.327.7419.864

Education and debate

"Doing prescribing": how doctors can be more effective

¹ Primary Care Group, Swansea Clinical School, University of Wales Swansea, Swansea SA2 8PP, ² Institute of Clinical Education, The Peninsula Medical School, Exeter EX1 2LU

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

Few well conducted, randomised controlled . . . [Full text of this article]

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Rapid Responses:

Read all Rapid Responses

Placebo effect?

Graham LG McAll
bmj.com, 13 Oct 2003 [Full text]

Can concordance be achieved without knowledge of the frequency of a drug's side effects?

Robert Christopher Guy Bracchi
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Cost effectiveness of concordance

Adam Jacobs
bmj.com, 15 Oct 2003 [Full text]

Nobody HAS to take medicines

David K Lewis
bmj.com, 17 Oct 2003 [Full text]

Improving compliance with medication.

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bmj.com, 20 Oct 2003 [Full text]