Unpacking ‘patient‐centredness’: how knowledge is negotiated dialogically in the interweaving of genres and voices in counselling conversations

Abstract

In the literature, difficulties in implementing policy principles of patient-centredness are often understood as obstacles to patient-centred care leading to a gap between the ideals and practice. This article proposes that what are often identified in the literature as obstacles can be usefully construed as intrinsic tensions that cannot be eradicated. It offers a theoretical framework for exploring the tensions that builds on Bakhtin's theory of dialogue and Foucault's theory of power/knowledge. The framework is designed to "unpack" the tensional, context-specific nature of "patient-centredness" through empirical exploration of how particular forms of "patientcentredness" are produced through tensional meaning-making in particular contexts. The use of the framework is illustrated in an analysis of how "patient-centredness" is ascribed specific meanings and enacted in collaborative telephone counselling conversations in a Danish patient-centred programme entitled "Active Patient Support". The analysis shows how the interweaving of genres and voices works to manage the patient's uncertainty in ways that both empower and self-discipline the patient. The discussion explores the implications of the specific form of "patient-centredness" articulated in the conversations with respect to patient empowerment and participation. It also critically reflects on the theoretical framework as a reflexive approach to tackling the tensions in "patient-centredness".

From loyalty to resignation: Patient–doctor figurations in type 1 diabetes

“…Some of these contradictions have been pinpointed in the sociological literature. For instance, Greener ( 2008 ) stressed the co‐existence of the logics of caring and empowering, whereas Phillips and Scheffmann‐Petersen ( 2020 ) stressed the co‐existence of both models of doctor‐ and patient‐centredness and considered the relationship as the unstable product of dialogic meaning‐making processes that are inherently complex and full of tensions. By the same token, MacArtney ( 2020 : 855) underlined the ‘limitation of dichotomised framings of the patient–doctor relationship’, by stressing both the asymmetries of knowledge and social capital, on one side, and patients' empowered choices and individualised care, on the other side.…”

A narrative journey into the borderland of patient safety: Toward an expanded, relational concept of safety

“…With inspiration from Frank ( 2010 ), who does not offer a set way of practicing DNA, and Phillips and Scheffmann-Petersen ( 2020b ), who apply Bakhtinian theory in analysis of patient-centredness, I have formulated the following set of context-sensitive analytical questions to “help thought move” (Frank, 2010 , p. 85): i) Which tensions arise across different voices and from which narrative resources do they emanate? ii) How are knowledge and meaning negotiated through the re-accentuation of voices in which the storyteller appropriates perspectives as her own by investing them with her own “accent?” iii) How does the narrative create a tension between forces that finalize lives and unfinalizable meaning-making?…”