‘After all, you should rather want to be at home’. Responsibility as a means to patient involvement in the Danish health system

Abstract

This article discusses how the neo-liberal regulations in a Danish hospital – which are said to increase patient involvement – risk reducing patient involvement in practice. To do this we analyse how three different patients are positioned as responsible or irresponsible in different ways in the concrete practices of a hospital ward. This analysis focuses on how the relationship between home and hospital is practised. Drawing from Fairclough's concept of ‘orders of discourse’, we reveal how different ways of practising the relationship between home and institution are affected by dominant discourses of medicine, care and neo-liberalism. The different discourses enable differentiated ways to become responsible, but the various discourses also influence and challenge each other in the concrete practices. We suggest that the hegemonic relationship between the discourses is changing and it appears that the discourse of neo-liberalism in a mixed version with a biomedical discourse has become dominant. Thus, the article points to the paradox that neo-liberal discourses have the effect of narrowing the space for patient involvement in practice.

Keywords:

• hospitalization
• Denmark
• patient involvement
• neo-liberalism
• Foucault
• Fairclough

Notes

¹ See IKAS (2011).

² In some cases, other staff members have been given a limited authority to refer and discharge patients (IKAS, 2009) – but still based on medical criteria.

³ INR indicates the ability of the blood to coagulate.

⁴ Wrong figures of coagulation, kidney problems.

⁵ Insulin.

⁶ The average number of days patients are hospitalized is important criteria for an assessment of how well the hospital sector functions.

⁷ See also a pamphlet that poses the question, ‘Why ask the patient?’ and delivers the answer, ‘Staff is not able to assess quality on behalf of the patient’ (pamphlet, Enheden for Brugerundersøgelser, 2008).