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.

中文翻译：

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以患者为中心的护理实践：临床医生如何应对患者对避孕药副作用的不满


以患者为中心的护理被广泛认为是优质避孕保健的组成部分，但其在临床互动中的可操作性存在争议。本文以患者对激素避孕药物副作用不满意的案例来研究以患者为中心的护理作为一种相互作用的现象。根据 109 次录音生殖健康就诊的记录数据，我发现提供者对治疗不满意的反应范围从以患者为中心到相对专制。提供者通常提供以患者为中心的响应，验证患者体验并将其纳入避孕咨询和方法选择中。与此同时，关于患者避孕优先顺序的明确沟通很少。如果没有这种方法，提供者会使用以患者为中心的沟通来平滑互动路径，以采用高效的激素方法，而大多数情况下忽略了一些患者可能更喜欢效果较差的方法的可能性。以患者为中心的避孕护理受到预防妊娠的临床目标的限制。