Metaphors in a Patient's Narrative: Picturing Good Care

Abstract

This paper is premised on the idea that the metaphors patients use in their efforts to articulate ‘good care’ can deepen our understanding of the limitations of particular patient–professional relations and help us imagine and justify new ones. Its intent is to extend critical scholarship about patient involvement, and professional disengagement, in contemporary healthcare contexts. The paper draws from a study that highlighted the range of ways women with cancer responded to the call to ‘take charge’ of treatment decision making and care co-ordination. The metaphors that are the focus of the paper—‘voting’ and ‘walking me there’—emerged from a patient's felt discomfort with specific care interactions. I show how these metaphors can be used to raise critical questions about the discourses of patient autonomy and choice that dominate Western cancer care contexts; sharpen our attention to practices of care that are obscured by prevailing discourses; and suggest alternative value frameworks for the knowledge, identities and practices enacted between health professionals and patients.

Keywords:

• Patient Involvement
• Professional-service User Relations
• Relational Autonomy
• Treatment Decision-making
• Care Coordination
• Feminist Ethics

Acknowledgements

With deep appreciation to the women who have spoken about their experiences of cancer care, and to the healthcare professionals participating in this study. I'am grateful to Pamela Hudak, Lisa Schwartz, Lisa Watt and two anonymous reviewers for thoughtful and useful comments on this paper. The Canadian Institutes of Health Research funds the study, Negotiating Equity: Toward the elimination of disparities in cancer care [grant number 167190] and provides the salary award that enabled this research.