Although there has been a shift from “compliance” (doctor-centered) to “adherence” and successively to “therapeutic alliance” (centered on the patient and the doctor-patient relationship), the basic concept remains complex and has multiple models of boarding. Many investigations have been made to determine the factors responsible for low compliance. However, the findings are inconsistent with respect to the effects of numerous variables, and lack practical interest, because they do not really clarify the reasons for non-compliance. The non-adherence cannot be correctly predicted by medication beliefs, chronic disease, and socio-demographics characteristics. Doctor may consider routinely inquiring about non-adherence, but he has to emember that he usually stays with superficial reasons of little practical utility. “The heart has reasons, which the reason cannot understand”; there are reasons (of the patients) that the reason (of the doctor) does not understand. Medication-taking decisions are not the subject of rational choices by patients, influenced only by the attributes of treatments and psychosocial, socio-demographic, and disease-related factors, etc. The more we delve into the reasons, the more we could understand why patients “do not want, do not know, or cannot” comply with our prescriptions. Knowing “reasons for reasons” can only be done by “tuning in” with the patient and with ourselves. If the patient feels that their voice is listened to carefully, they will begin to identify more clearly the meaning of each symptom and event related to their illness. Satisfaction with the doctor is the main reason why many patients comply with the treatment.
Physician-patient communication; Adherence; Pharmaceutical treatment; Therapeutic adherence; Therapeutic alliance; Medical patient relation