I’d been on a bit of a concordance road show last month. Concordance is:
“an agreement between the patient and the health professional, reached after negotiation that respects the beliefs and the wishes of the patient in determining whether, when and how the medicine is taken, and (in which) the primacy of the patient’s decision is recognised” De Las Cuevas (2011)
The road show has involved me facilitating discussions on the limits of concordance at various conferences. My basic thesis is that if you listen to people you will find something out; hopefully useful information that may assist in understanding the best sort of medicine intervention for that individual. However, there may be limits to this thesis. For example most of my clinical career was spent with people with advanced dementia, where preferences were sometimes difficult to obtain and apply. So for practical purposes I want to find out just how far we can push concordance before it becomes meaningless. If we can identify and agree on such a point or set of circumstances then we can better apply the principles of person centred care.
I began the month at Leeds University, asking whether concordance was philosophically possible at the International Philosophy of Nursing Conference; teasing out some fine ethical distinctions with clinical nurses. Later in the month I was lucky enough to ask some similar questions of an international audience of mental health nurses at the Horatio festival of psychiatric nursing in Stockholm.
This was a fabulous conference and my session was really well attended.
Nurses from Sweden, Norway, Denmark, USA, Canada, Hong Kong, Germany, Cyprus, Malta, Greece and UK all joined in and together presented a highly nuanced view of the role of the nurse in medicine management.
As part of the workshop I also wanted to gather individual views from this unique audience so that I could compare them with similar data I had already gathered from UK. I had brought enough questionnaires but had not brought pens, thinking that the conference would have enough and that people would have their own. However, just to be sure, prior to my session I gathered up a selection of free pens from the various stands that usually accompany these events. I must confess I didn’t pay any attention to the products these stalls were promoting. Besides, they were in the conference and had sponsored it. You can guess what’s coming can’t you?
This is a picture from the promotion pamphlet below.
I don’t think there could be a better illustration of the interface between the rhetoric and reality of concordance. So here’s a question for you.
Where is the concordance here?
It’s a genuine question, and one that needs to be confronted.
Meanwhile, I shall pay more attention to the free gifts I pick up at conferences.
Austyn Snowden is Reader in the Institute of Mental Health, UWS
De Las Quevas, C. (2011). Towards a Clarification of Terminology in Medicine Taking Behavior: Compliance, Adherence and Concordance are Related Although Different Terms with Different Uses. Curr Clin Pharmacol, 6(2), 74-7. Retrieved from http://apps.isiknowledge.com/full_record.do?product=MEDLINE&search_mode=GeneralSearch&qid=5&SID=U1ENpc6ge131EFdp7CG&page=1&doc=2
Tomorrow, in day 2 of 7 of our daily blog @markfleming1 discusses his role as a nurse, manager and eHealth leader.