Compliance, concordance and respect for the patient's agenda

This article is based on findings from my doctoral thesis, which set out to explore lay and professional perspectives on compliance with treatment, focusing specifically on people of Pakistani origin with a diagnosis of type 2 diabetes. One of the aims of my thesis was to explore how patients and professionals conceptualised decisions to comply, or not to comply, with the treatment of diabetes. I also wanted to assess the role lay health beliefs (or what is more appropriately referred to as lay knowledge) played in shaping decisions to comply. As a medical sociologist, I had been influenced by a body of social science research which questioned the paternalistic and authoritarian assumptions of the compliance model and I saw the report of the Concordance Working Party, which called for a sea-change in the culture of both prescribing and relating to patients, as taking this critique into health policy. The Working Party argues that “concordance is based on the notion that the work of the prescriber and patient in the consultation is a negotiation between equals and the aim is therefore a therapeutic alliance between them. . . . Its strength lies in a new assumption of respect for the patient’s agenda and the creation of openness in the relationship, so that both doctor and patient together can proceed on the basis of reality and not of misunderstanding, distrust and concealment.”