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The singular patient in patient-centred care: physiotherapists’ accounts of treatment of patients with chronic muscle pain
  1. Birgitte Ahlsen1,2,
  2. Eivind Engebretsen2,
  3. David Nicholls3,
  4. Anne Marit Mengshoel2
  1. 1Physiotherapy, OsloMet - Oslo Metropolitan University Faculty of Health Sciences, Oslo, Norway
  2. 2Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
  3. 3School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
  1. Correspondence to Birgitte Ahlsen, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University P.O.Box 4 St.Olavs plass, Oslo 0130, Norway; birgitte.ahlsen{at}oslomet.no

Abstract

A patient-centred approach has gained increasing interest in medicine and other health sciences. Whereas there are discussions about the meaning of a patient-centred approach and what the concept entails, little is known about how the patient as a person is understood in patient-centred care. This article investigates understandings of the patient as a self in patient-centred care through physiotherapy of patients with chronic muscle pain. The material consists of interviews with five Norwegian physiotherapists working in a rehabilitation clinic. Drawing on Kristeva’s discussion of subjectivity in medical discourse, the study highlights two different treatment storylines that were closely entwined. One storyline focuses on open singular healing processes in which the treatment was based on openness to a search for meaning and sharing. In this storyline, the “person“ at the centre of care was not essentialised in terms of biological mechanisms, but rather considered as a vulnerable, irrational and moving self. By contrast, the second storyline focused on goal-oriented interventions aimed at restoring the patient to health. Here, the person in the centre of the treatment was shaped according to model narratives about “the successful patient”; the empowered, rational, choosing and self-managing individual. As such, the findings revealed two conflicting concepts of the individual patient inherent in patient-centred care. On the one hand, the patient is seen as being a person in constant movement, and on the other, they are captured by more standardised terms designed to focus on a more stable notion of outcome of illness. Therefore, our study suggests that the therapists’ will to recognise the individual in patient-centred care had a counterpart involving a marginalisation of the singular.

  • physiotherapist
  • health care education
  • philosophy of medicine/health care

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Footnotes

  • Contributors BA planned the study, conducted the interviews and drafted the paper. BA, AMM, EE and DN have contributed in the analysing process and in developing the paper as a whole. BA submitted the paper and is responsible for the overall content of the article.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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