OVERALL RATING Very good
STRENGTHS Thoroughly researched; well organized; interesting suggestions for prescribing
WEAKNESSES Diverging focus on clinicians and researchers
AUDIENCE Primary care providers and researchers
In the book Patient-Centered Prescribing, the authors describe and reframe the process of giving and taking medications. Family physicians are often frustrated by patients’ seemingly irrational failure to take recommended medications, which is termed noncompliance. This book offers concordance as an alternative. According to the authors, concordance is agreement on common goals between physicians and patients, with medication-taking included in this agreement.
Seeking concordance (instead of compliance) in taking medications might be a new concept for many of us. The authors present their arguments for a change in practice cogently and in a well-organized manner. The first part of the book presents current knowledge on the problem of noncompliance with prescribed medications. The second half offers new methods of seeking concordance in prescribing by using a patient-centred method. Patient vignettes are included to help put the recommendations in a practical light. The authors also do a good job of describing the likely barriers to this approach, including the time that is taken in the negotiations between patients and physicians. They offer several suggestions for dealing with challenging patients.
I found their views to be interesting but also challenging at times. For example, consider the following statement: “Concordance has not been achieved if significant disparity exists between the two parties’ view of the problem, treatment goals or solution. Where this occurs, the patient’s view takes priority unless they are not competent .… This requires the clinician to be prepared to let go. They must be willing to let the patient make what they might consider to be the ‘wrong’ decision.” This could be interpreted as, say, approval for giving a patient an antibiotic for a viral upper respiratory illness should the patient feel strongly enough about it. However, the authors do partially address the problem in chapter 8, “Unresolved Issues.”
Overall, this is a useful addition to the patient-centred method. I would recommend this book to family physicians interested in addressing prescribing issues in their practices.
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