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Dr. Wong: Associate Professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada . Dr. Kitto: Professor, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada . Dr. Kumagai: Vice Chair for Education and Professor, Department of Medicine, and F.M. Hill Chair in Humanism Education, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada . Dr. Whitehead: Professor, Department of Family and Community Medicine, and Director and Scientist, The Wilson Centre, BMO Financial Group Chair in Health Professions Research, University Health Network, and Professor, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
Published: October 2021
AI Article Synopsis
Article Abstract
Introduction: Patient-centered care (PCC) is widely considered as essential in chronic disease management. As the underlying rationale for engaging patients in continuing professional development (CPD) is commonly described as fostering care that is more patient-centered, we hoped to understand the discursive conditions for how educators and health professionals can (or cannot) learn with, from, and about patients.
Methods: Using diabetes as a case, we conducted a Foucauldian discourse analysis of an archive of relevant policy documents, professional and educational texts, to explore different conceptualizations of practice and the implications for PCC. We also conducted in-depth interviews with a purposive sample of physicians to understand their experiences in providing and teaching PCC. We sought to understand: How has PCC been discursively constructed? Whose interests does advocating PCC serve? What are the implications for patient involvement in CPD?
Results: We describe three discursive constructions of PCC, each extending the reach of biomedical power. PCC as a disease intervention emphasizes knowing and relating to patients to normalize laboratory test results. PCC as a form of confession promotes patients to come to their own realizations to become responsible for their own health, but through the lens and evaluation of physicians. PCC as a disciplinary technique makes visible the possibility of using a checklist to judge physician competency in providing PCC.
Discussion: PCC may be constructed in ways that paradoxically reinforce rather than challenge conventional, provider-centric paradigms. Our results challenge educators to acknowledge the existence and effects of discourses when involving patients in the planning and delivery of CPD.
