One of the most potent messages coming from my post grad studies is the one that states "No matter how effective a medicine might be, it won't work if it is not taken".
This came back to me last week when reading the October 11th BMJ featuring a number of papers/articles on compliance/concordance with medications.
As pharmacists how can we ensure that our patients are actually following the directions we carefully type on labels and so obtaining the most benefit?

"Information" you all cry, possibly remembering studies published by the Society of Hospital Pharmacists which show that combined written and verbal directions from pharmacists prior to discharge from hospital gives the best chance of directions being accurately followed by patients.
But, can we really rely on the results of these studies being translated to community practice where patients are less likely to focus and absorb what the doctor or pharmacist tells them?
All through my professional life we have talked about "compliance" with directions but this, it now
appears, is a dirty word.

Health professionals talking down to and giving poor patients orders on what to do is said to create a very negative picture, often used to explain why up to 50% of medications are not taken appropriately. Concordance is the current buzz concept, whereby doctor and patient enter into an agreement about diagnosis (?) and treatment of medical conditions.
I know, the modern patient demands to know all the details but isn't it somewhat unrealistic to expect any sort of equal partnership arrangement for medical consultations?
Doctors (and pharmacists) spend years honing their skills and increasing their knowledge as they try to provide the most effective treatment.
Even those playing devil's advocate in this situation must agree that health professionals have significantly more expertise in their fields than anyone would expect of the average patient.
If you are not going to rely on the professionalism of your doctor or pharmacist why waste your time going to consult them in the first place?
We've all had customers/patients who seem to make a practice of wasting our time by asking for something to treat a complaint or condition, taking up significant amounts of time, then ignoring all our advice because their next door neighbour has recommended a product that "worked for them".
You grit your teeth, smile sweetly and sell them what they asked for, knowing full well it has little chance of success.

I know, it's the customer's choice but it seems counter-productive to relegate professional expertise to little more than a point of view in a negotiation process.

This demand by patients to "take control of their own treatment" goes a long way to explaining the strength of the complementary medicine market.
Complementary medicine practitioners have become very skilled at the negotiation process that is the backbone of concordance, emphasising the "holistic" nature of the treatment.
Patients seem much more ready to forgive these practitioners when the expected improvement does not eventuate.

We, like doctors, are bound by the tenet that we should "first do no harm" but I would also like to feel that we do much to ensure the quality use of medicines by our patients.
This might mean that certain instructions must be followed when taking medication, primarily in terms of how and when to take it and there may be little scope for a negotiation to take place between patient and health professional.
If this is seen as being overly directive, so be it - sometimes it is necessary to give "orders" if you want the desired result.

Concordance may, or may not, increase the chance that medicines are taken correctly, the jury is still out.