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.