Legitimacy in clinical practice: How patients with chronic muscle pain position themselves in the physiotherapy encounter, 2022, Ahlsen et al

Abstract

Rationale, Aims & Objective
Patients who seek healthcare for long-lasting pain and symptoms without a detectable disease must put in extra work to be taken seriously and gain recognition as a patient. However, little is known about how patients' help-seeking is performed in clinical practice. The aim of the current study was to gain knowledge about the ways in which patients with chronic muscle pain position themselves as help-seekers during their first physiotherapy encounter.

Method
The material consisted of observation of 10 therapist-patient clinical interviews in primary care clinics and was analyzed using perspectives from discourse theory and the concept of positioning.

Results
The study highlights how the patients positioned themselves in continually shift between two discourses: that of disease (considering the patient as an object under study) and that of illness (positioning the patient as an active and participating but also troubled individual). This shifting of position was negotiated in interaction with the therapist: patients' opportunities to position themselves within the discourse of illness were limited by therapists' focus on facts and causal relationships within the discourse of disease.

Conclusion
Patients with chronic muscle pain seek to establish their legitimacy through the positivistic discourse of medicine and also through their compliance with the moral discourse of the patient as someone active, willing to take responsibility for their own health—and therefore worthy of treatment.

Open access, https://onlinelibrary.wiley.com/doi/10.1111/jep.13768

 

This just suggests that the patients are put into the position of trying to be mind readers. They have to try and work out what will get them the healthcare they think they need from a therapist that they may never have met before. They won't know the therapist's prejudices, beliefs, and dislikes, so the patient / therapist relationship may end up being a poor one just because the patient can't read the therapist.

I can't read people. Most of them baffle me. So I accidentally piss people off all the time, and that includes healthcare professionals of any kind, and they do seem to be a remarkably sensitive bunch of people, in my experience.

 

Good grief, tone down the contempt a bit there, Marie Antoinette. This has "we make the poor monkeys dance for their food and need to figure out how to make them dance the way we want them to". It describes massive systemic failure, yet places the responsibility entirely on the people failed by the system. Do patients really "must" put in that work? No, of course not, that's plain silly and frankly dereliction of duty given the total monopoly medicine has over healthcare.

It's truly as if medicine completely lacks a theory of self regarding illness, is simply so baffled by the concept of illness they can't process why being failed this way is a problem. Honestly this is becoming more and more a problem of basic humanity, medical science progresses with science and technology but medical practice is in some of the most dire need of humanity I can think of. Giant bureaucracies looking at ants from too high above us to understand what's even happening to us.