Negotiating accountability for medicine non-adherence in interactions between pharmacists and patients

This article examines how clinical pharmacists and patients negotiate medicine non-adherence in medication reconciliation—a discussion between a pharmacist and a patient to update the patient's list of home medications. We focus on instances that reveal a discrepancy between the doctor's prescription and the patient's actual use of the medicine. By analyzing such instances of medicine non-adherence, we show how the participants orient to the social normativity of taking one's medicines as prescribed, and how this is reflected in the participants' orientation to treat the patient as the one accountable for these violations. The analysis illustrates how the non-present doctor plays a major role in the pharmacists' and the patients' interactional management of accountability. We argue that even though both the pharmacists and the patients treat non-adherence as the violation of a norm, the pharmacists nevertheless treat non-adherence as unproblematic if the patient volunteers an account of the violation. In contrast, if the pharmacist needs to pursue an account, more problematic interactional trajectories can arise. The conclusion is that it is not so much the violation itself that is more likely to cause interactional trouble, but the actors' moral positioning with respect to the violation. The data consisted of video- or audio-recordings of 48 pharmacist–patient encounters, which were analyzed using Conversation Analysis. • Pharmacists and patients orient to the normativity of taking medicines as prescribed. • Both participants treat the patient as accountable for instances of non-adherence. • Pharmacists treat non-adherence as unproblematic if the patient volunteers an account. • If an account has to be pursued, more problematic interactional trajectories can occur. • Volunteering an account is the patients' way of upholding their moral positioning.