How Discourse Theories Can Critically Engage Identity Formation in Patient-Centered Care.

How discourse theories can critically engage identity formation in patient-centered care.

Patient-centered care (PCC) is increasingly assumed to be synonymous with quality patient care, reflected in healthcare policies across the world. However, the performances of patient identity that must follow lack conceptual grounding in the research literature. The patient identity implied by PCC sees an identity shift from directive to performative ways of being that require patients to negotiate increasingly ambiguous scopes of responsibility and involvement in decision-making processes in the clinical encounter. They are positioned as active and informed consumers of healthcare. The PCC patient has significant parallels with the self-managing worker configured by neoliberal discourses of ‘empowerment’ that extend the reach of productivity deep into the self, putting identity and relational dynamics increasingly at risk. In this way, patient identity in the context of PCC may be considered as implicated in a wider ‘identity crisis’, that has resulted from rapid reconstitutions and associated conducts in interpersonal, social and organizational spheres. I suggest that the insights offered into identity from discourse scholarship have promising theoretical potential for engaging with the changing landscape of patient identity marked by PCC. Through a discursive lens we might explicate unmarked power relations that underpin patient identity performances in a PCC context, with the aim to develop work in this area both theoretically and on a practice-level. This engenders a conceptual effort to bring contributions from discourse scholarship to studies of identity in healthcare, with the purpose of critically engaging powerful neoliberal discourses that increasingly pervade healthcare systems across the world. As calls for bottom-up participation and empowerment become increasingly notable in the healthcare sphere, the social sciences must equip themselves with the theoretical tools necessary to permeate the re-articulations of power that follow.