Introduction

The concordance paradigm incorporates a recognition that patients' evaluation of health care will be closely bound up with the quality of their relationships with professionals, and that active partnerships involving both parties will result in more effective consultations and a more rational and effective use of medicines. An exchange of information between patient and professional is the basis for mutual understanding and accommodation. Access to good information is also a prerequisite for the patient's genuine choice and consent to treatment. The discussion of concordance has focused primarily on the doctor-patient dyad as the basic unit of analysis. However, the treatment of chronic or severe health problems involves a complex network of interactions between individual patients, carers and health professionals and support workers across a range of different disciplines and often over an extended period of time. Patients' understanding of their illness and their evaluation and participation in consultations will be influenced by the accumulated experience of past encounters with all the health professionals involved in their care. Concordance thus extends to the complex network of interactions linking different staff with individual patients. Professional expertise carries an ethos of standardised 'scientific' exactitude and unanimity. In practice, however, models of pathology and treatment preferences differ widely not only between professional groupings, but also between individual practitioners within a single discipline. The effect on patients of conflicting professional advice and information, and their implications for concordance require investigation.

Method

The study involved a series of fourteen focus groups involving 90 participants from a range of patient and professional interest groups within a psychiatric hospital. Group discussions were taped and fully transcribed for content analysis using the NUD*IST software programme to facilitate organisation of data.

Finding

All groups agreed that better and more accessible information should be provided for patients and carers. Several factors inhibited the disclosure of information to patients. Professionals tended to be uncertain about what patients had been told by other staff, and who was responsible for providing information. There was also a desire not to contradict or interfere with what other colleagues had disclosed, particularly among more junior members of staff in relation to senior. These factors contributed to professional reticence in informing patients about their condition.

Conclusion

The study findings point to the organisational constraints on the provision of information to patients which impede the achievement of concordance in medical consultations. It is necessary to consider concordance in relation to the wider nexus of relations between patients and their professional advisors, rather than confine analysis to the single consultation.