The Patient, The Doctor and Their Technologies – Change and Continuity Within Patient-Centred Care

Abstract

This article aims at analysing the history of the logic of patient-centred care (PCC) by addressing change and continuity within the development of this rationality of healthcare government. Making use of the theoretical framework of governmentality, the problematization of healthcare as insufficiently patient-centred is examined in relation to both the thoughts and actions of Michael Balint in the 1950s and 1960s and the ideas and initial research projects connected with the establishment of the University of Gothenburg Centre for Person-Centred Care in 2010. It is shown that in both cases the aim is to take account of the „whole patient‟ in the organization of healthcare delivery, but that the goals and methods for doing so differ significantly. It is shown that Balint emphasized the doctor‟s own personality as the most decisive tool for achieving quality in healthcare delivery meaning that the logic of PCC should be directed towards shaping and forming the subjectivity of the doctor in his professional role as a general practitioner. Within the contemporary logic of person-centred care found in Gothenburg, the ambition is to reform the conduct and subjectivities of doctors and patients alike in order to enable both to become more accountable, self-directing and self-regulating in their actions. Such a realignment of healthcare delivery is seen as necessary and desirable in order to facilitate a more efficient and responsible management of chronic long-term illnesses. It is argued that this new programme of healthcare government can be associated with a more general shift in government rationality from welfarism to advanced liberalism.