Putting patients into the centre: Patient empowerment in everyday health practices.

Abstract

Patient empowerment is a key topic in public health, medical sociology and in public debates on the modernisation of healthcare. This article joins the on-going discussion on public and patient involvement by offering a patient-centred perspective on patient empowerment outside the usual institutionalised context of chronic disease management. We present results from a qualitative study on individuals' practices of dealing with acute non-life-threatening medical conditions conducted from 2012 to 2017 in Denmark. Based on 34 home visits including in-depth interviews and participant observations with a sample of 28 informants, we uncover a spectrum of four patient tactics governing these practices: delegating, informing, consuming and resisting. The findings suggest disruptive changes to the role of the patient-physician relationship as well as the existence of practices indicative of patient empowerment outside the context of patient empowerment initiatives. Some patients are found to take over responsibility for their health, employing tactics where the role of general practitioners is severely demoted. These empirical contributions lead to the two theoretical contributions of the article: an extension of an existing model of patient empowerment and a conceptual reconsideration of patient empowerment, advocating viewing it as emerging from a bricolage of tactical interactions with social environments rather than as the consequence of an external strategic process.