title: Differences that matter: developing critical insights into discourses of patient-centeredness.
abstract: Patient-centeredness can be considered a popular, and at the same time "fuzzy", concept. Scientists have proposed different definitions and models. The present article studies scientific publications that discuss the meaning of patient-centeredness to identify different "discourses" of patient-centeredness. Three discourses are presented; the first is labelled as "caring for patients", the second as "empowering patients" and the third as "being responsive". Each of these discourses has different things to say about (a) the why of patient-centeredness; (b) the patient's identity; (c) the role of the healthcare professional; (d) responsibilities for medical decision-making, and (e) the role of health information. This article compares and contrasts the discourses in ways that allow us to see differences that matter for practitioners in healthcare. On the basis of a relational constructionist philosophy, it is argued that discursive diversity is both an inevitable and a potentially valuable aspect of conversations in healthcare. We are therefore invited to center the challenge of dealing with diversity in productive ways. This article ends with a discussion of the practical implications of the discourse analysis for projects that aim to make healthcare more patient-centered. Debates on patient-centered "Health Information Exchange" are used to explain the need for a recognition of different discourses of patient-centeredness and a reflexive stance towards them.
authors.affiliation: Utrecht University School of Governance, Bijlhouwerstraat 6, 3511 ZC, Utrecht, Netherlands. b.pluut@uu.nl.
authors.forename: Bettine
authors.initials: B
authors.lastname: Pluut
mesh_terms: D003657:Decision Making; D066275:Health Information Exchange; D006801:Humans; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011209:Power, Psychological
keywords: Discourse Analysis; Health Information Exchange; Patient empowerment; Patient-centered care; Shared decision-making