"The doctor never said why"

Sometimes that's true. Appointments are short and a prescriber can explain the dose and forget to explain the point. The reader leaves with a name and a frequency and no picture of what the tablet is standing between them and. Then the tablet gets weighed against side effects, cost, and the wish not to take it, with nothing on the other side of the scales.

The research on beliefs says this gap matters more than most things about a medicine. In the 94-study review of the necessity-concerns framework, a stronger sense that the medicine was personally necessary went with higher adherence, and stronger concerns went with lower, and the effect held across countries and across ways of measuring it. Necessity isn't a fact about the medicine. It's a belief about the medicine that the patient either has or doesn't, and a prescriber who never said why has left it to chance.

Here's what to do with the gap. Ask. Not at the next annual review, but this week, and not necessarily the doctor. The NHS says that when you're prescribed a medicine for the first time, a pharmacist may be able to give you up to three appointments, in person or by phone, to answer your questions, help you use it safely and check it's right for you. That service exists because the gap in this chapter is common enough to need one. And for a medicine you've been on for years, the questions are the same and the pharmacist is still the person standing nearest to the answer. What is this for. What happens if I don't take it. How long is it for. What should I do if I miss one.

I'd suggest one more question that isn't on any list. What would tell us it's working. For the holding ones the answer will be a feeling. For the silent ones it will be a number, and chapter 16 is about getting that number yourself.