The singular patient in patient-centred care. Physiotherapists' accounts of treatment of patients with chronic muscle pain

Abstract

A patient-centered approach has gained increasing interest in medicine and other health sciences. Whereas there are discussions about the meaning of a patientcentered approach and what the concept entails, little is known about how the patient as a person is understood in patient-centered care. This mticle investigates understandings of the patient as a self in patient-centered 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 center of care was not essentialized in terms of \ i biological mechanisms, but rather considered as a vulnerable, in-ational 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 center 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 patientcentered 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 standardized te1ms designed to focus on more stable notion of outcome of illness. Therefore, our study suggests that the therapists' will to recognize the individual in patient-centered care had a counterpmt involving a marginalization of the singular.