Factors involved in therapeutic discordance in physician and patient relationship: a grounded theory study

Rationale: For patients, therapy has a stronger meaning than prescriptions. Context background: 50% of patients do not use their medications as recommended. This entails a significant increase in costs for health services, premature deaths, and hospitalizations. Research question: The research question explored “What factors contribute to the construction of therapeutic discordance between physician and patient in relation to the loss of meaning of a pharmacological treatment?”. Method: We adopted Charmaz's constructivist Grounded Theory, involving 42 participants (16 patients, 5 relatives, and 21 health care professionals). Results: The core category emerged is called "neglecting the relationship", and allows to understand and focus the main categories (non-negotiating contract; substituting the other; avoiding the conflict and being emotionally involved) in a conceptual framework. Conclusions: Therapeutic discordance theory is part of the concordance debate, highlighting the implicated factors that bring to light a negative result of the relational process between doctor and patient. Recommendations: The emerged knowledge of the factors involved in the therapeutic discordance can be useful to spread in training courses for physicians and medical students, a category that sees in training programs a strongly biomedical, centred imprint on illness, and often not centred on the person, family, and society.