The shiny new object: Deconstructing the patient‐oriented paradigm in health sciences

Abstract

Rationale: A 'patient-oriented' research paradigm, also known as patient and public engagement, has infiltrated the field of health sciences and continues to spread. At first blush, it is difficult to reprove anything labelled 'patient-oriented'; however, the patient-oriented paradigm may easily become an ideological 'good', leading to unintended consequences that may well prove more detrimental than beneficial.While patient-oriented research has its roots in more radical forms of patient and public engagement, its recent instantiation betrays its roots and forecloses on more radical forms of engagement, such as critical participatory research.Aim and Objectives: The objective of this article is to deconstruct the patientoriented research narrative and to demonstrate how such a discourse imposes itself as a dominant approach in health sciences.Approach: Following Derrida's deconstructive approach, we bring to light the unexamined presuppositions, false pretences, and presumed 'goodness' and 'naturalness' of patient-oriented discourse.Discussion: By deconstructing the patient-oriented narrative we demonstrate how pre-existing power structures (biomedical, economic, etc.) shape the conduct of the approach and serve to depoliticize the truly participatory aspects of research. Rather than being modelled on the evidence-based movement or seen as its natural 'evolution', patient-oriented research should resist by affirming itself as a radical form that is both participatory and emancipatory.

On crowns, caravans and windmills: Commentary on an essay by Turcotte P., et al.

“…This may be considered to be, at once, the strength and, ultimately, the failure of their argument. 11 reflecting the Canadian experience and also cited by Turcotte et al, 2 and in a systematic review that was commissioned by PCORI. 12 Throughout their commentary, Turcotte et al 2 portray POR and PAR as inherently antagonistic, warring, perspectives.…”

“…11 reflecting the Canadian experience and also cited by Turcotte et al, 2 and in a systematic review that was commissioned by PCORI. 12 Throughout their commentary, Turcotte et al 2 portray POR and PAR as inherently antagonistic, warring, perspectives. Such a notion is not supported by the literature they cite.…”

“…Such a notion is not supported by the literature they cite. Notably, Wallerstein et al 13 Unlike Wallerstein, and in contrast to the authors of other articles that they cite, 17 Turcotte et al 2 do not recognise a legitimate foundation for the POR agenda. Nor is CBPR specifically mentioned by Turcotte et al 2 as a healthcare modality for PAR.…”

“…According to Deleuze and Guattari, it is precisely when the war machine is appropriated by the State apparatus that war becomes a primary objective and evolves toward 'total war. 2 Florid passages such as the above are interspersed between less metaphorical elaborations of the argument underlying the critique as well as of the methodology of deconstructionism being employed.…”

“…This would require critical intellectuals to go to 'war' with the fascist State apparatus and mount a theoretical and critical 'revolt' (deterritorialization). 2 The commentator finds this ending of their critique to be disappointing, and for the very reason that, underlying the smoke and mirrors of the writing style, a legitimate critique is detectable, one that is independently grounded in cited as well as extended literature and which deserves to be taken seriously, particularly as the issues of public engagement in healthcare and the importance of healthcare disparities have come to the fore in the wake of the COVID-19 pandemic. The following segment of this commentary will draw upon the aforesaid literature and will seek to identify potentially actionable implications of Turcotte et al's 2 proposed critique.…”