The power paradox of patient-centred care in chinese community health : towards a conceptualisation

Abstract

Patient-centred care (PCC) is widely heralded as a transformative healthcare paradigm, designed to prioritise patients' unique needs, preferences, and values in clinical decision-making. By potentially shifting away from the historically provider-centric model, PCC aims to empower patients as autonomous, active participants. However, critical questions remain: Does PCC genuinely dismantle power asymmetries, or does it merely serve as rhetoric subtly reinforcing existing hierarchies under the guise of empowerment? This study examines this power paradox—the disconnect between PCC's rhetorical positioning and its superficial implementation—through Steven Lukes' three dimensions of power, focusing on China's community healthcare system, where patient-centred ideals are strongly advocated. A year-long non-participant observation at a major community health centre in Shenzhen, complemented by semi-structured interviews with 16 general practitioners (GPs) and 18 hypertensive patients (HPs), informed an iterative thematic analysis. The analysis identified three paradoxes that complicate PCC's vision of patient empowerment. First, protective authority demonstrates how GPs' protective intentions manifest as directive behaviours, fostering dependency and limiting patient agency. Second, framing authority reveals how organisational norms, policies, and clinical expectations constrain patient choice, prioritising compliance over autonomy. Lastly, internalised compliance highlights PCC's ideological power, where HPs internalise adherence as integral to their identity as ‘good’ patients, embedding deference to medical authority within their sense of well-being. These findings offer critical insights into PCC's power paradox, questioning its theoretical capacity to redress entrenched provider-patient power imbalances. Addressing these challenges necessitates systemic reforms and shifts in clinical practice to genuinely prioritise patient-centredness.