Content area
Full text
CASE REPORT
INTRODUCTION
In a traditional model of interaction between a healthcare practitioner and a patient, the practitioner identifies a problem and prescribes a solution to the patient. An underlying assumption is that the patient's acceptance of the professional's advice would improve or ensure a positive outcome, whereas the patient's rejection of the advice might compromise health or recovery. The practitioner assumes a paternalistic role, implicitly keeping the patient's best interests in mind while focusing on the disease or condition with little weight given to the patient's concerns or beliefs. A more contemporary viewpoint sees practitioners and patients as partners in designing an intervention to maximize outcomes while considering the 'problem' within the context of the patient's life.
The tension between these two models for practice may be illustrated by a continuum with practitioner-centred care at one end and patient-centred care at the other. Practitioner-centred care is aligned with the traditional biomedical model of practice, which describes an interaction whereby practitioners attempt to 'fix' patients' physical symptoms by curing the underlying disease process (Stewart et al., 1995). Alternatively, patient-centred care follows a disablement model, such as the International Classification of Impairments, Disabilities and Handicaps, which emphasizes the physical, personal and social aspects of patients' conditions (Jette, 1994). The patient-centred approach is frequently used by expert practitioners who hold the philosophy that teaching and guiding patients is more effective than `doing for' them (Martin et al., 1998; Jensen et al., 1999; Jensen et al., 2000).
This case report describes a therapeutic intervention in which patient and therapist collaborate to design a treatment regimen that attempts to address the personal and social dimensions of the patient as well as his physical disability. The case is framed by use of the patient-practitioner collaborative model (Jensen et al., 1997). The model's four phases will be used to describe the patient and the interactions, the phases are:
* Establishing the therapeutic relationship.
* Diagnosing through mutual enquiry.
* Finding common ground through negotiation.
* Intervening and following up.
CASE DESCRIPTION
Establishing the therapeutic relationship
Therapists and patients must first establish a relationship in which patients feel comfortable sharing their goals and beliefs about their disability and the examination and intervention process. During the patient interview, therapists may use...