What's wrong with patient centred care?

Professor Alison Pilnick will discuss the extensive research underpinning her book (winner of the Foundation for the Sociology of Health and Illness Book Prize in 2023), which helps to explain why patient-centred care has not produced the hoped-for improvements in outcomes. The lecture will be of interest to a broad audience, including health scientists, medical sociologists, conversation analysts, social policy researchers - and just about anyone who has experience of delivering or receiving healthcare!

Overview

Patient-centred care (PCC) is typically framed as a means to guard against the problem of medical paternalism, exemplified in historical attitudes of ‘doctor knows best’. In this sense it is often regarded as a moral imperative. However, systematic reviews of its adoption in healthcare settings do not find any consistent improvement in health behaviours or outcomes as a result. Rather than raising more fundamental questions about the PCC approach, these findings are generally interpreted as pointing to the need for more or ‘better’ staff training.

As a result, empirical research is often focused on the extent to which practice does or does not live up to checklists of PCC criteria, though these checklists are many and varied, and can produce conflicting results. Patient autonomy is generally foregrounded in conceptualizations of PCC, to be actualized through the exercising of choice and control. But examining healthcare interaction in practice using conversation analysis shows that when professionals attempt to enact these underpinnings, it often results in the sidelining of medical expertise that patients want or need.

Drawing on a large corpus of audio and video recorded healthcare interactions collected over 25 years from a wide range of practice settings, Professor Alison Pilnick will argue that in rightly problematizing unbridled medical authority, PCC has inadvertently also problematized medical expertise. The end result is that patients can feel abandoned to make decisions they feel unqualified to make, or even that care standards may not be met. Understanding this helps to explain why PCC has not produced the hoped-for improvement in health outcomes. It also shows the importance of analyses of healthcare interaction for healthcare policy. The broad moral principles of a values-based approach may be attractive to policy makers but may also create intractable interactional dilemmas for practitioners who have to talk these policies into being.

About the speaker

Alison Pilnick is Professor of Language, Health and Society at Manchester Metropolitan University. She specialises in the use of conversation analysis as a method to explore interactions in healthcare settings, and for over 25 years has worked with health professionals including doctors, pharmacists, midwives, physiotherapists and nurses, across a wide range of health and social care contexts.

Her work has been funded by funders including the British Academy, ESRC, NIHR, Foundation for the Sociology of Health and Illness, Swiss National Science Foundation and the General Research Fund of Hong Kong. Her research aims to produce findings of practical relevance for healthcare practice which are underpinned by high quality social science analysis.

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