Patient-Physiotherapist Relationships in South Indian Outpatient Settings: An Ethnographic Discourse Study

Therapeutic relationship traditionally has been considered as one of the non-medical factors that influence on patient’s treatment outcome. Previous literature explored the different dimensions of the relationship between patients and various health professionals in healthcare settings. However, in the field of physiotherapy, only very limited number of studies explored the social dimension of the therapeutic relationship. So, the purpose of the study is to identify how the interactional features, contextual factors and the underlying power mechanism influence the formation of the therapeutic relationship in the outpatient physiotherapy settings in South India. Critical realist ethnography is adopted as a method of this study (Hammersely & Atkinson, 2007, Sinead, 2017). Data were collected from outpatient physiotherapy departments in Kerala. Total 21 physiotherapists and 36 patients have participated in this study. Participant observation and semi-structured interviews were used to collect the data. The data collected in the local Malayalam language were translated to English and analysed using the elements from Fairclough’s critical discourse analysis and pragmatics (Fairclough, 2001; Alba-Juez & Mackenzie, 2016). Patient compliance to the treatment, solidarity forming conversations and issues associated with expectation are identified as the main elements that influence in creating the better therapeutic relationship. Based on these findings, three therapeutic relationship models were identified include mutual, consumerist and paternalistic therapeutic relationship model. This study discussed the possibilities of how the different elements associated with these models influence the formation therapeutic relationship. The findings of this study enable the Indian physiotherapist to identify the underlying social phenomena and provide an opportunity to determine how to create the better therapeutic relationship based on that. Also, this study acknowledges and provides an insight to the global physiotherapist to think further about the important role of the power discourse and the social exchange happening between the therapist and patient in different aspects of the therapeutic process.