An ethnographic study of physiotherapists' perceptions of their interactions with patients on a chronic pain unit.

Changes in health care brought about by the increased incidence of chronic conditions have resulted in an increased focus on patient self-directed care. This ethnographic study explores from the therapists' perspectives how therapist/patient interactions influence success or contribute to meeting the patients' goals on a pain management program. A team of physiotherapists were observed individually with their patients over a period of 6 months. Their interactions were audiotaped, transcribed, analysed, and cross-referenced to the field notes and the follow-up interviews with the therapists after each observation. The analysis was iterative, guided by questions and contextualised. Codes, categories, and evolving patterns of behaviour were documented, and three major themes were identified. The therapist/patient interactions demonstrated certain consistent standpoints toward the purpose of the program. The team judged those who achieved positive outcomes, as having entered into interactions typified by assertiveness, negotiation, and critical reflection. However, even the most able team of therapists will not be able to create a collaborative framework unless their patients are willing to grasp the opportunity offered to them, and they judged their least successful patients as having adopted unwilling and unrealistic interactions. Interactions of resistance or an inability to carry over problem solving skills into their lives resulted in a negative outcome for the patients and a stunting of the team's potential.