Doctors and patients must forge therapeutic alliance

Doctors have got to start treating patients as equals if they want them to take their medicine, says a report published today. As many as half of all patients with serious chronic illnesses do not take their medication, with one in five kidney-transplant patients, for example, not taking anti-rejection drugs.

A joint working party, set up by the Royal Pharmaceutical Society of Great Britain and Merck Sharp and Dohme Ltd, today proposes an entirely new approach to the problem, whereby doctors and patients would "negotiate" with each other and forge a "therapeutic alliance". The patient should no longer be seen as the passive recipient of the doctor's advice.

The working party's research shows that patients fail to take their medicine for a variety of reasons, including physical and practical difficulties, such as problems in opening poorly designed containers or in remembering to take a number of different tablets at particular times of day. But the most powerful influences are the beliefs that they hold about their medication, such as the fear that they might become addicted, and these beliefs are firmly rooted in personal, family and cultural experiences, the report says.

9 From Compliance to Concordance, available free from the Royal Pharmaceutical Society of Great Britain, 1 Lambeth High Street, London SE1 7JN. Annabel Ferriman