ABSTRACT
A significant feature of concordance is the recogmnon it accords the patient perspective. Awareness of patients' understanding and experience of illness and the values and aspirations which underpin treatment preferences are seen to be central to delivery of effective healthcare. As the process of care, rather than its outcome, assumes increasing importance, the success of interventions comes to be determined by the subj ective evaluation of patients, rather than the 'obj ective' measurements of clinical medicine (May et al. 2004; Sullivan 2003 ) . Patient satisfaction has developed as a legitimate outcome as well as a proxy indicator of the quality of care (Kelstrup et al. 1 993 ; Stallard 1 996; Williams 1 994; Williams & Wilkinson 1 99 5 ) . A concern with the reflexive modification of services in response to consumer feedback developed from the managerial reforms of the Griffiths report of 1 983 ( Callan & Littlewood 1 988; DHS S 1 983 ; Mciver 1 9 9 1 ; Sitzia & Wood 1 997 ) . Patient-centred medicine has become the central policy commitment in a system supposedly focused on individual choice and reflexive sensitivity to patient preferences and satisfaction with care (Department of Health 1 999, 2 000, 200 1 , 2003 ) . It is also widely assumed that satisfied 'customers' will be more highly motivated and compliant with treatment regimes, leading in tum to improved outcomes and a more cost-effective use of resources ( Callan & Littlewood 1 988; Crawford & Kessel 1 999; Williams 1 994) .
