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Patient-centeredness in the 21st century: Instrumentalisation or improved communication?
Abstract
Objective: The objective of the current study was to investigate the contemporary concept of patient-centeredness compared to the original notion of patient-centeredness in practice and politics.
Methods: This is accomplished through a concept-analysis of patient-centeredness on the basis of the original publications by Michael and Enid Balint as well as policy documents regarding patient-centeredness in the Danish healthcare system in the period 2014-2016. A case study was conducted on patient-centeredness in the Danish healthcare system using interviews with doctor and patient before and after the consultation and video observation of the consultation. The interviews and observations were transcribed and analysed using a framework derived from Pragmatics of Human Communication.
Results: Substantial differences between the original patient-centeredness and contemporary patient-centeredness were identified. Both types of patient-centeredness were practised. However, contemporary patient-centeredness was only realised in the patient performing the doctor’s role-obligations of prescribing and monitoring treatment, resulting in a breakdown of the doctor-patient relationship that was only restored by the doctor’s practice of original patient-centeredness. Conclusion: Contemporary patient-centeredness over-emphasises content aspects of the doctor-patient encounter in favour of relationship aspects. Original patient-centeredness emphasises the relationship aspects of the encounter and support addressing existential concerns that might have important implications for treatment.
Keywords
References
Marcum, J. (2018). Mapping similarities and differences to progress mutual understanding and dialogue: A comparison and contrast of evidence-based practice and person-centered healthcare. European Journal for Person Centered Healthcare 6 (3) 462-469.
Taylor, K. (2009). Paternalism, participation and partnership - the evolution of patient centeredness in the consultation. Patient Education and Counseling 74 (2) 150-155.
Balint, E. (1969). The possibilities of patient-centered medicine. Journal of the Royal College of General Practitioners 17 (82) 269-276.
Joosten, E.A., DeFuentes-Merillas, L., De Weert, G.H., Sensky, T., Van Der Staak, C.P. & de Jong, C.A. (2008). Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychotherapy and Psychosomatics 77 (4) 219-226.
Street, Jr., R.L. & Epstein, R.M. (2008). Key interpersonal functions and health outcomes. Health Behavior 237.
Duggan, P.S., Geller, G., Cooper, L.A. & Beach, M.C. (2006). The moral nature of patient-centeredness: is it “just the right thing to do”? Patient Education and Counseling 62 (2) 271-276.
Nielsen, B.K., Lomborg, K., Munch-Hansen, T. & Riiskjær, E. Indikatormål for” patientinddragelse”-teoretiske og metodiske overvejelser. [Indicators for “patient-involvement” - theoretical and methodological elaborations]. Aarhus: Defactum.
Løhde, S., Damm, M. & Hansen, B. (2016). Nationale mål for sundhedsvæsenet. [National goals for the health-system] Available from: http://www.sum.dk/~/media/Filer%20-%20Publikationer_i_pdf/2016/Nationale-maal/SUM-Nationale-maal-L-april-2016.ashx.
Mead, N. & Bower, P. (2002). Patient-centred consultations and outcomes in primary care: a review of the literature. Patient Education and Counselling 48 (1) 51-61.
Ministeriet for Sundhed og Forebyggelse [The Department of Health and Prevention]. Nationalt kvalitetsprogram for Sundhedsområdet 2015-2018 [National quality-programme for public health, 2015-2018]. Available from: http://www.sum.dk/~/media/Filer%20-%20Publikationer_i_pdf/2015/Nationalt-kvalitetsprogram-for-sundhedsomraadet/Nationalt%20kvalitetsprogram%20for%20sundhedsomr%C3%A5det%20-%20april%202015.ashx
Pedersen, L. (2011). Patientinddragelse: refleksion, læring, innovation og ledelse. Copenhagen: Hans Reitzels.
Stewart, M. (2003). Patient-centered medicine: transforming the clinical method. London: Radcliffe Publishing.
Epstein, R. & Street, R.L. (2007). Patient-centered communication in cancer care: Promoting healing and reducing suffering. Bethesda, MD: National Cancer Institute, US Department of Health and Human Services, National Institutes of Health.
The Danish Government. (2014). Jo før - Jo bedre. Tidligere diagnose, bedre behandling og flere gode leveår for alle [The ealier – the better. Earlier diagnosis, better treatment and more good years of living for everyone]. Copenhagen: Regeringen (The Danish Government).
Danske Regioner (Danish Regions). (2015). Plan for Borgernes Sundhedsvæsen – vores sundhedsvæsen (Plan for the citizens health care system – our health-care system). Available from: http://regioner.dk/media/1269/plan-bs.pdf
Heritage, J. & Maynard, D.W. (2006). Problems and prospects in the study of physician-patient interaction: 30 years of research. Annual Review of Sociology 32, 351-374.
Davis, K. (1988). Power Under The Microscope; towards a grounded theory of gender relations in medical encounters. Dordrecht, NL: Foris.
Pilnick, A. & Dingwall, R. (2011). On the remarkable persistence of asymmetry in doctor/patient interaction: A critical review. Social Science & Medicine 72 (8) 1374-1382.
West, C. (1984). Routine complications: Troubles with talk between doctors and patients. Bloomington: Indiana University Press.
West, C. (1984). When the doctor is a “lady”: power, status and gender in physician‐patient encounters. Symbolic Interaction 7 (1) 87-106.
Balint, M. (1988). The doctor, his patient and the illness. London: Churchill Livingstone.
Hopkins, P. (1972). Patient-centred medicine. Based on the 1st International Conference of the Balint Society in Great Britain on 'The doctor, his patient and the illness'. London: Royal College of Physicians.
Bateson, G. (2000). Steps to an ecology of mind: Collected essays in anthropology, psychiatry, evolution, and epistemology. Chicago: University of Chicago Press.
Bavelas, J.B. (1990). Behaving and communicating: A reply to Motley. Western Journal of Speech Communication 54 (4) 593-602.
Rogers, E.M. (1994). History of communication study. New York: Free Press.
Watzlawick, P., Bavelas, J.B. & Jackson, D.D. (2011). Pragmatics of human communication: A study of interactional patterns, pathologies and paradoxes. New York: W.W. Norton & Company.
Byrne, P.S. & Long, B.E. (1976). Doctors talking to patients. A study of the verbal behaviour of general practitioners consulting in their surgeries. London: Department of Health.
Bensing, J. (1991). Doctor-patient communication and the quality of care. Social Science & Medicine 32 (11) 1301-1310.
D’Agostino, T.A. & Bylund, C.L. (2011). The nonverbal accommodation analysis system (NAAS): Initial application and evaluation. Patient Education and Counseling 85 (1) 33-39.
Robinson, J.D. (2006). Nonverbal communication and physician–patient interaction. In: The SAGE handbook of nonverbal communication. Manusov, V. & Patterson, M.L. (Eds.), pp. 437-459. London: SAGE Publications Ltd.
Beck, R.S., Daughtridge, R. & Sloane, P.D. (2002). Physician-patient communication in the primary care office: a systematic review. Journal of the American Board of Family Practice 15 (1) 25-38.
Jørgensen, P.S. (1973). Indledning. In: P.S. Jørgensen, E. Ostenfeld & B. Thygesen (Eds.). Dyaden - Forsøg og Overvejelser. Copenhagen: University of Copenhagen.
Jørgensen, P.S. (2016). Broen til det andet menneske. Fra den første kontakt til den dybe samhørighed. (Bridging the gap to the other person - from the first encounter to the deep connection). København K: Kristeligt Dagblads Forlag.
Jørgensen, P.S. (1983). Den sociale relation: kvalitative analyser. (The social relationship. Qualitative analyses I). København: Akademisk forlag.
Bensing, J. (2000). Bridging the gap: The separate worlds of evidence-based medicine and patient-centered medicine. Patient Education and Counseling 39 (1) 17-25.
DOI: http://dx.doi.org/10.5750/ejpch.v7i2.1673
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