PROVIDER-PATIENT COMMUNICATION, PATIENT-CENTERED CARE, AND THE MANGLEOF PRACTICE

Patient-centered care (PCC) is a popular movement among health service s researchers, health policy analysts, and health professionals. PCC r equires that patient needs, preferences, and beliefs be respected at a ll times. The PCC movement is an outgrowth of macrosocial trends, incl uding 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 impor t of psychosocial factors, PCC still lacks an overarching integrative theory that explains how biological and psychosocial factors can simul taneously affect health. Thus, communication research and clinical res earch from the PCC perspective tend toward the two poles of biomedical realism or social constructionism, neither of which offer a satisfact ory account of health. To put communication research on a firmer footi ng with respect to PCC, and to avoid the discourse of dualism, this ar ticle describes an integrative theory (based on ''the mangle of practi ce'') wherein health is seen as an interactively stabilized configurat ion of self-image, interpretive accounts, and performances. The implic ations of this perspective for communication research and training are discussed, and the article concludes with a consideration of the prob lems that still face the PCC movement.