Hearing what cannot be said

摘要

Rationale, aims, and objectives The way in which care providers describe incapacitated elderly people is not without implications. The different ways in which they describe their patients-client, patient, or a sick human being-have consequences for their relationships with these patients and the decision-making processes. The aim of this study is to use insights from complexity thinking to understand the dynamic relations between various patient descriptions in decision-making. Method We conducted a retrospective qualitative empirical study. Health care professionals were interviewed on how their decisions with the families of the patients were made during the course of the patients' illness. Transcriptions of interviews with physicians, residential practitioners, nurses, and head nurses were made regarding their contribution to the decision-making process. Methodologies of complexity thinkers can be helpful to not articulate the implications of individual patient descriptions, but also their interrelationships. Results Instead of reducing their patients with the logic of the market to clients or with the logic of medicine to patients, health care providers learn in an emergent dialogic encounter to care for them as sick persons. Conclusions Shared-decision-making favours the involvement of patients and their families in decision-making. However, due to a domination of the logic of the market and the logic of medicine, decision-making is problematic. As professional mediators, health care providers learn, however, to balance client demands, medical perspectives, and embodied dialogic care in decision-making for voiceless patients.