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In the literature, difficulties in implementing policy principles of patient-centredness are often understood as obstacles to patient-centred care leading to a gap between the ideals and practice. This article proposes that what are often identified in the literature as obstacles can be usefully construed as intrinsic tensions that cannot be eradicated. It offers a theoretical framework for exploring the tensions that builds on Bakhtin’s theory of dialogue and Foucault’s theory of power/knowledge. The framework is designed to “unpack” the tensional, context-specific nature of “patient-centredness” through empirical exploration of how particular forms of “patient-centredness” are produced through tensional meaning-making in particular contexts. The use of the framework is illustrated in an analysis of how “patient-centredness” is ascribed specific meanings and enacted in collaborative telephone counselling conversations in a Danish patient-centred programme entitled “Active Patient Support”. The analysis shows how the interweaving of genres and voices works to manage the patient’s uncertainty in ways that BOTH empower AND self-discipline the patient. The discussion explores the implications of the specific form of “patient-centredness” articulated in the conversations with respect to patient empowerment and participation. It also critically reflects on the theoretical framework as a reflexive approach to tackling the tensions in “patient –centredness”.