The singular patient in patient-centred care: physiotherapists’ accounts of treatment of patients with chronic muscle pain

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.

Person-Centered Rehabilitation Model: Framing the Concept and Practice of Person-Centered Adult Physical Rehabilitation Based on a Scoping Review and Thematic Analysis of the Literature

“…22,[42][43][44][45][46][47] Hence, PCR is respectful of and tailored to the unique characteristics and circumstances of the person (perspectives, preferences, values, experiences, worldview) beyond consisting of individualized interventions addressing the impairments or symptoms of unique patients. 21,36,44,45,[47][48][49][50][51][52][53][54][55] PCR nurtures notions of personhood, the person's self-determination, and values the singularities (ie, unique characteristics) of each person. 37,38,45,49,53 Persons should be treated with respect, dignity, and valued as persons with needs, resources, and capabilities.…”

Goal setting practices used within anterior cruciate ligament rehabilitation: An exploration of physiotherapists understanding, training and experiences

“…Physiotherapists who typically used a physio mandated approach in the study findings certainly appears to be a recurring theme when compared to the literature (Bassett & Petrie, 1999;. Communication skills, in particular using a patient/practitioner approach, are of paramount importance so that patients' views are elicited and incorporated fully during the goal setting process (Ahlsen et al, 2020). Furthermore, using a patient/practitioner approach is said to incorporate more microcounselling skills such as active listening, empathy and reflection which have been empirically shown to enhance a patient's psychological wellbeing during their ACL rehabilitation .…”

“…For goal setting practices used within ACL rehabilitation to be a worthwhile transformational treatment tool, it is imperative that physiotherapists are sufficiently trained in both the process and theory to ensure that all aspects are understood and employed effectively. These important psychological exchanges that occur when goals are set in concordance of patients/athletes values enhances patient empowerment, thus giving patients a higher degree of autonomy over their rehabilitation (Ahlsen, Engebretsen, Nicholls, & Mengshoel, 2019).…”

Mobilizing Knowledge in Physiotherapy

“…Ill persons criticize disease and deficit-oriented practice for depersonalizing them by reducing them to a disease or failure (Deegan, 2003) or reducing their illness experiences into scores on questionnaires (Gibson et al, 2019). Physiotherapists can devalue a person's illness experiences by asking closed, factual questions when taking patient histories (Ahlsen et al, 2019) or by stereotyping the delivery of physiotherapy according to 'cookbook recipes' (Mengshoel et al, 2019). Studies show that ill persons wish to be at the centre of physiotherapists' concern, preferring the latter to shift their focus away from techniques to providing information they find meaningful (Wijma et al, 2017).…”