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From Compliance to Concordance and Beyond: Rhetoric, Reality and Qualitative Research

This commentary begins with a brief overview of recent developments in healthcare policy and practice in the UK. Particular attention is paid to the demise of the concept (and practice) of compliance along with and rise of the concept (and practice) of concordance. Analysis suggests that despite considerable changes in the organisation and delivery of healthcare there remains a clear gap between rhetoric and reality. Drawing on insights from qualitative health research issues of identity, embodiment and self-care are explored and synthesised in a single descriptive framework. Neither compliance nor concordance alone adequately captures the reality of patient experiences in everyday life. The framework of understanding proposed here contextualises compliance and concordance and their corollaries within distinct horizons of expectation. For a truly user-driven healthcare it is not a question of either/or but both and more and asking, in reality, what can a body do?