Johnsen Sara
University of California, Los Angeles, Los Angeles, CA, USA.
J Health Soc Behav. 2025 Jun;66(2):197-211. doi: 10.1177/00221465241262029. Epub 2024 Aug 5.
Patient-centered care is widely cited as a component of quality contraceptive health care, but its operationalization in clinical interaction is contested. This article examines patient-centered care as an interactional phenomenon using the case of patient dissatisfaction with side effects of hormonal contraceptive medications. Drawing on transcript data from 109 tape-recorded reproductive health visits, I find that provider responses to treatment dissatisfaction range from patient-centered to relatively authoritarian. Providers typically offer patient-centered responses that validate patient experiences and integrate them into contraceptive counseling and method selection. At the same time, explicit communication about patients' contraceptive priorities is rare. In its absence, providers use patient-centered communication to smooth the interactional path toward uptake of highly effective hormonal methods, mostly ignoring the possibility that some patients may prefer less effective methods. Patient-centered contraceptive care was circumscribed by the clinical goal of pregnancy prevention.
以患者为中心的护理被广泛认为是优质避孕医疗保健的一个组成部分，但它在临床互动中的实施存在争议。本文以患者对激素避孕药物副作用不满为例，将以患者为中心的护理作为一种互动现象进行研究。通过对109次录音的生殖健康就诊记录数据进行分析，我发现医护人员对治疗不满的回应从以患者为中心到相对专制不等。医护人员通常会给出以患者为中心的回应，认可患者的经历，并将其纳入避孕咨询和方法选择中。与此同时，关于患者避孕优先事项的明确沟通很少见。在缺乏这种沟通的情况下，医护人员使用以患者为中心的沟通方式来顺利推进高效激素避孕方法的采用，大多忽略了一些患者可能更喜欢效果较差方法的可能性。以患者为中心的避孕护理受到预防怀孕这一临床目标的限制。
