It all starts with a relationship.

Did you say some bold things early in your career?

I did.

This was one of them.

The patient-centred model is not the answer! Success in health communication means recognising that healthcare starts with an interpersonal relationship.

Circa a decade ago the patient-centred model was all the rage. This was meant to be the means to end all our issues with patient non-compliance and failure to adopt to the ‘right way of doing things’ that clinicans have determined.

Well, I, boldly, and looking back - to some degree - ignorantly, thought that this was a dumb idea.

And it turns out the literature at the time was thinking the same thing.

What is this all about?

My focus at the time was on health communication. Health communication is important because we all will need to engage in it. And it turns out that being more educated, while helpful, isn’t a panacea for addressing the issues that arise during patient-provider interatctions.

What had been the focus?

The thinking at the time was that we needed to undo, or re-balance the relationship between patients and providers as it had become to controlled by the provider. The idea was that we had ‘disempowered’ patients through taking away their autonomy, telling them how things needed to be, and generally not considering how they felt or what they wanted.

The answer?

Patient-centered care.

This approach was meant to equal the playing field and put control back in the hands of patients. Patient choice was central to ensuring patients achieved better outcomes and felt better about the experience.

BUT

All this did was SHIFT the issue of power imblance. It didn’t resolve the issue of managing power-dynamics in the patient-provider relationship.

Ok, so what then should we be looking at?

Rather than demonising power we should be looking at how it plays out and how it shifts across different contexts. The relational model of heathcare / health communication, draws on systems theory and argues that all actions have a ripple effect; we can no longer think action and reaction but rather we must understand the complexity of feedback, secondary effects and power.

The relational model places the focus on interpersonal relationships focusing on bilateral construction of meaning rather than an all or nothing clean cut transaction between individuals.

This model is a more accurate representation of the patient-provider interaction because it accounts for the diversity and difference both individuals bring to the relationship. What is then most important from a health communication perspective are the barriers for both parties in expressing their needs and desires.

The relational model allows both parties move within the relationship, dictating roles suitable for them and making changes as necessary.

But what does it mean in practice?

It means that rather than thinking of interactions as transactions we must start to think of them as on-going sense-making activities, which are influenced by many other factors outside the immediate conversation.

It means that we must be aware of how the interaction is always dyanmic and that the objective should be to create shared understanding rather than focus on outcomes.