Beyond the restitution narrative : lived bodies and expert patients

In this book on clinical reasoning this chapter speaks of reasoning that goes beyond the practitioner's frame of reference and beyond the dominant medical paradigm. Our aim in this chapter is to explore what it means to be living beyond the restitution narrative (Frank 1995) in which the restoration of health, cure and medical science construct practitioners' behaviour and restrict the role of patients. In doing so we focus on practitioner-patient interactions. Our underlying belief is that even while people are chronically ill they can live a life worth living, and this is made easier when they are allowed to rise above 'patient' status, are seen as their own best experts about their bodies, and are treated with dignity and respect regardless of their 'failure' to get better. Essentially, what we want for patients living beyond the restitution narrative is the right to create a new 'normal' for themselves, even while medically speaking they can never be normal again. This is important because society looks to medicine to define 'normal' and 'abnormal', and therefore reinforces the right of a person to participate in life as a normal person or not. In keeping with the group whose experiences speak in this chapter, we refer to patients as female.