Page 198 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Models of Concordance 173

term concordance is a sham, and that this new focus on joint
decision making has not made any difference to the extent to
which patients follow prescribed treatments. Indeed Segal
( 2007 ) goes further, suggesting that concordance is simply
compliance by another name. She argues that clinicians use
this concept as a guide for asking how best to persuade
patients to do as they say, rather than for asking how they can
ensure they demonstrate respect for the patient perspective.
Whilst it is true that the need for concordance puts emphasis
on the communication between clinician and patient, this
should not be about the power of persuasion. Communication,
as discussed throughout this chapter, is about listening as well
as talking. As Metcalfe ( 2005 ) notes, there will always be
some determined patients who will choose their own course
of action even in the face of good evidence which contradicts
said action. In these cases, the clinician should make their
opinion and advice clear, but may have to accept they can do
no more. Likewise at the other extreme, there will be patients
that simply want to be directed by their clinician – in these
instances clear communication will still be essential, and if
that is the patient standpoint, such an approach remains con-
cordant. However, for those patients (the majority) who do
want to engage in meaningful discussion about their treat-
ment plan, involving them in planning and decision making is
essential; for these patients, simply telling them what they
must do is likely to be counter-productive (Metcalfe 2005 ).

Models of Concordance

Various models have tried to explain why patients choose to
follow medical advice. The most enduring of these is the
Cognitive Hypothesis Model (Fig. 7.1 ) developed by Phillip
Ley ( 1981 , 1989 ). According to this model, the extent to which
a patient follows prescribed treatment can be predicted by:

• their understanding of the information provided during
the consultation;

• their recall of this information;

• their satisfaction with the process of the consultation