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妊娠期糖尿病检测、叙述与医疗不信任。

Gestational Diabetes Testing, Narrative, and Medical Distrust.

作者信息

Edwell Jennifer, Jack Jordynn

机构信息

Department of English and Comparative Literature, University of North Carolina at Chapel Hill, 310 Greenlaw Hall CB#3520, Chapel Hill, NC, 27599, USA.

Department of English and Comparative Literature, University of North Carolina at Chapel Hill, 512 Greenlaw Hall CB#3520, Chapel Hill, NC, 27599, USA.

出版信息

J Bioeth Inq. 2017 Mar;14(1):53-63. doi: 10.1007/s11673-016-9762-9. Epub 2016 Dec 22.


DOI:10.1007/s11673-016-9762-9
PMID:28005250
Abstract

In this article, we investigate the role of scientific and patient narratives on perceptions of the medical debate around gestational diabetes (GDM) testing. Among medical scientists, we show that the narrative surrounding GDM testing affirms that future research and data will lead to medical consensus. We call this narrative trajectory the "deferred quest." For patients, however, diagnosis and their subsequent discovery that biomedicine does not speak in one voice ruptures their trust in medical authority. This new distrust creates space for patients to develop a Frankian quest narrative where they become the protagonist in their story. Additionally, across these different narratives, we observe how character is constructed and employed to negotiate trust. We conclude that healthcare providers should assess the narrative trajectory adopted by patients after diagnosis. Also, we suggest that providers acknowledge the lack of medical consensus to their patients. This veracity would foster women's sense of trust in their provider as well as allow women to be active interlocutors in a debate that ultimately plays out in their deliberation about their body, pregnancy, and risk.

摘要

在本文中,我们探究了科学叙事与患者叙事在围绕妊娠期糖尿病(GDM)检测的医学辩论认知中所起的作用。在医学科学家当中,我们发现围绕GDM检测的叙事肯定了未来的研究和数据将达成医学共识。我们将这种叙事轨迹称为“延迟探索”。然而,对于患者而言,诊断以及他们随后发现生物医学并非众口一词,这破坏了他们对医疗权威的信任。这种新的不信任为患者创造了空间,使他们能够形成一种弗兰肯式的探索叙事,在这种叙事中他们成为自己故事的主角。此外,在这些不同的叙事中,我们观察到角色是如何被构建和运用来协商信任的。我们得出结论,医疗保健提供者应该在诊断后评估患者所采用的叙事轨迹。同时,我们建议提供者向患者承认缺乏医学共识。这种真实性将增强女性对其提供者的信任感,也能让女性在这场最终在她们对自己的身体、怀孕和风险的思考中展开的辩论中成为积极的对话者。

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Gestational Diabetes Testing, Narrative, and Medical Distrust.

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引用本文的文献

[1]
Perinatal outcomes following nonadherence to guideline-based screening for gestational diabetes: A population-based cohort study.

Acta Obstet Gynecol Scand. 2025-5

[2]
Experiences of pregnant women with gestational diabetes mellitus: a systematic review of qualitative evidence protocol.

BMJ Open. 2020-2-18

[3]
Rearranging Deck Chairs on a Sinking Ship? : Some Reflections on Ethics and Reproduction Looking Back at 2017 and Ahead at 2018.

J Bioeth Inq. 2018-3

[4]
Prestidigitation vs. Public Trust: Or How We Can Learn to Change the Conversation and Prevent Powers From "Organizing the Discontent".

J Bioeth Inq. 2017-3

[5]
Investigating Public trust in Expert Knowledge: Narrative, Ethics, and Engagement.

J Bioeth Inq. 2017-3

本文引用的文献

[1]
Risk factor medicalization, hubris, and the obesity disease.

Narrat Inq Bioeth. 2014

[2]
Reconceptualising the doctor-patient relationship: recognising the role of trust in contemporary health care.

J Bioeth Inq. 2015-6

[3]
Gestational diabetes: new criteria may triple the prevalence but effect on outcomes is unclear.

BMJ. 2014-3-11

[4]
Diagnostic thresholds for gestational diabetes and their impact on pregnancy outcomes: a systematic review.

Diabet Med. 2014-3

[5]
Applying current screening tools for gestational diabetes mellitus to a European population: is it time for change?

Diabetes Care. 2013-6-11

[6]
NIH consensus development conference: diagnosing gestational diabetes mellitus.

NIH Consens State Sci Statements. 2013-3-6

[7]
Evolution of diagnostic criteria for gestational diabetes mellitus.

Acta Obstet Gynecol Scand. 2013-5-15

[8]
Establishing consensus in the diagnosis of gestational diabetes following HAPO: where do we stand?

Curr Diab Rep. 2013-2

[9]
Proposed new diagnostic criteria for gestational diabetes--a pause for thought?

Diabet Med. 2012-2

[10]
The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus.

Am J Obstet Gynecol. 2010-6

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