Existing research into appropriateness has concentrated on defining the concept in terms of clinical indices. This has been utilised by a few studies that differentiate, in clinical terms, between inappropriate and appropriate prescribing or patient care. This simplistic use of appropriateness is very misleading. Appropriateness is a multifaceted concept, its evaluation various according to who does the evaluating (patient, health professional), who the evaluation concerns (groups of patients, individual patients, or carers).

Existing research inherently assumes that patients utilise the same clinical dimensions but in a different order. Social science research, on the other hand, suggests that people do not utilise such dimensions. Illness, from this discipline's standpoint, is seen as fluid and dynamic, weaving itself into peoples' lives. The impact of illness and its treatment, and its subsequent evaluation, can only be known through its impact upon peoples' everyday capacities and expectations.

To investigate the patients' perspective in isolation, only serves to highlight the dichotomy of lay and professional knowledge. These bodies of knowledge are distilled from real peoples' medical cases. It is epistemological and ontological assumptions that create the 'illusion' that each is a real and separable object.

Using a qualitative approach, the study investigates three perspectives of a clinical encounter, namely the patients', general practitioners' (GPs') and that suggested by evidence-based medicine. Using discursive methods to analyse the in-depth interviews of hypertensive patients, their GP's, and notes extracted from a review of patient's medical records, the dimensions of each perspective can be explored, not only as separate entities but how they inter-relate in real-life situations. Hypertension has several attractive features, it has a well-established treatment guidelines, it is an asymptomatic condition (from a medical point of view), and has low compliance.

In order to develop a semi-structured interview schedule, and to confirm that patients experiences and expectations of their care and treatment of hypertension is available to the research, a pilot study has been conducted with eight patients. The preliminary findings of this pilot study suggest:

• that illness is very much woven into the fabric of people's lives,, supporting existing social science research.
• The treatment of hypertension, by medication, is evaluated by the degree that affects the patient's way of life. Very little change in lifestyle or their capabilities is seen as the most effective treatment, assuming that their blood pressure is 'within acceptable limits', as defined by their GP.
• Patients consider, on reflection, various 'symptoms' to be related to hypertension, mainly because they decrease or disappear when high blood pressure returns to a more acceptable level.
• At the initial diagnosis of hypertension, the first reaction is to get treatment. It is only when blood pressure 'becomes normal again' that patients begin to consider choices, and require more information.

These preliminary findings suggest that the concordance issue is not as important to patients during the initial stages of diagnosis. It is only later that they wish to be involved in their overall care decisions. What these decisions are and how they, the patient, evaluates them is very individual and not necessarily in accordance with what health professional would expect.