Provider-patient communication, patient-centered care, and the mangle of practice

Patient-centered care (PCC) is a popular movement among health services researchers, health policy analysts, and health professionals. PCC requires that patient needs, preferences, and beliefs be respected at all times. The PCC movement is an outgrowth of macrosocial trends, including the aging of the population, the growth of chronic illness, the focus on quality, the advent of managed care, and the realization that psychosocial factors impact on health. Although recognizing the import of psychosocial factors, PCC still lacks an overarching integrative theory that explains how biological and psychosocial factors can simultaneously affect health. Thus, communication research and clinical research from the PCC perspective tend toward the two poles of biomedical realism or social constructionism, neither of which offer a satisfactory account of health. To put communication research on a firmer footing with respect to PCC, and to avoid the discourse of dualism, this article describes an integrative theory (based on ''the mangle of practice'') wherein health is seen as an interactively stabilized configuration of self-image, interpretive accounts, and performances. The implications of this perspective for communication research and training are discussed, and the article concludes with a consideration of the problems that still face the PCC movement.