Narrative modulations in patient-practitioner communication: Exploring attunement and misattunement in supported self-management

Abstract

This paper investigates the experiences of patients in communicating with healthcare practitioners within the context of supported self-management in the UK. Employing an innovative analytical concept of “narrative modulation”, this study examines narrative data from patients’ focus group discussions. Two contrasting processes, attunement and misattunement, emerge as narrative modulators that shape and form the meaning and trajectory of participants’ storytelling. The study identifies multiple instances of misattunement in patient-practitioner interactions, highlighting a prevailing emphasis on diagnosis and treatment-focused perspectives, often at the expense of individual patients' experiences during clinical encounters. Despite these challenges, the participants expressed a desire for care that listens to and understands their unique experiences. They also wished to play an active role in their healthcare decisions, endorsing attunement, which promotes understanding and collaborative self-management supported by practitioners. This paper further discusses the implications of these findings for improving both patient-practitioner communication and supported self-management.