Patient-centred medicine and the broad clinical gaze : Measuring outcomes in Paediatric deep brain stimulation

Policy makers have argued that patient-centred approaches, which emphasize ‘greater patient involvement’ and ‘comprehensive care’, can improve healthcare outcomes and lead to a more efficient use of health resources. As a way of anticipating some of the implications of these approaches, this paper examines a context that is heavily influenced by the ideals of patient-centred medicine. Drawing on ethnographic research conducted with a multidisciplinary team providing deep brain stimulation to children with movement disorders, this paper will illustrate that patient-centred principles can become embedded within particular sociotechnical arrangements involving architectural forms, assessment tools and clinical team structures. These arrangements, it is argued, are implicated in the emergence of a broad clinical gaze: a clinical interest that extends from the shapes and structures of the body, to the subjective thoughts and emotional state of the patient, to elements of the patient’s social context and their ability to act within it. The implications of this gaze will be discussed, and this paper will suggest that it constitutes a form of disciplinary power that seeks to reaffirm and perpetuate particular way of being human.