While patient-provider interactions are commonly understood
as mutually constructed relationships, the role of patient behaviour,
participation in interactions, and characteristics, particularly ideals
surrounding notions of ‘good’ and ‘bad’ patients, are under-examined. This
article examines social representations of ‘a good patient’ and how these
representations affect patient-healthcare provider relationships and
antiretroviral treatment (ART) for people living with HIV.
Using thematic network analysis, we examined interview and
focus group transcripts involving 25 healthcare staff, 48 ART users, and 31
carers of HIV positive children, as well as field notes from over 100 h of
ethnographic observation at health centres in rural Zimbabwe.
Characteristics of a good patient include obedience,
patience, politeness, listening, enthusiasm for treatment, intelligence,
physical cleanliness, honesty, gratitude and lifestyle adaptations (taking
pills correctly and coming to the clinic when told). As healthcare workers may
decide to punish patients who do not live up the ‘good patient persona’, many
patients seek to perform within the confines of the ‘good patient persona’ to
access good care and ensure continued access to ART.
The notion of a ‘good ART patient’ can have positive effects
on patient health outcomes. It is one of the only arenas of the clinic experience
that ART patients can influence in their favour. However, for people not
conforming to the norms of the ‘good patient persona’, the productive and
health-enabling patient-nurse relationship may break down and be detrimental to
the patient.
We conclude that policy makers need to take heed of the
social representations that govern patient-nurse relationships and their role
in facilitating or undermining ART adherence.
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