Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Warwick, UK.
Research Centre for Cancer Diagnosis in Primary Care, Research Unit of General Practice & Department of Anthropology, Aarhus University, Aarhus, Denmark.
Sociol Health Illn. 2020 May;42(4):844-861. doi: 10.1111/1467-9566.13067. Epub 2020 Feb 26.
Experiences of cancer diagnosis are changing in light of both the increasingly technological-clinical diagnostic processes and the socio-political context in which interpersonal relations take place. This has raised questions about how we might understand patient-doctor relationship marked by asymmetries of knowledge and social capital, but that emphasise patients' empowered choices and individualised care. As part of an interview study of 155 participants with bowel or lung cancer across Denmark, England and Sweden, we explored participants' stories of the decisions made during their cancer diagnostic process. By focusing on the intersections of care, choice and medical authority - a convivial pastoral dynamic - we provide a conceptual analysis of the normative ambivalences in people's stories of their cancer diagnosis. We found that participants drew from care, choice and medical authority to emphasise their relationality and interdependence with their doctors in their stories of their diagnosis. Importantly negotiations of an asymmetrical patient-doctor relationship were part of an on-going realisation of the healthcare processes as a human endeavour. We were therefore able to draw attention to the limitations of dichotomising emancipatory-empowerment discourses and argue for a theorisation of the patient-doctor relationship as a contextually bounded and relationally ambivalent humanity.
由于日益复杂的技术临床诊断过程以及人际互动所发生的社会政治背景，癌症诊断的体验正在发生变化。这引发了一些问题，即我们如何理解以知识和社会资本不对称为特征但强调患者有能力做出选择和接受个体化护理的医患关系。作为丹麦、英国和瑞典 155 名肠癌或肺癌患者参与的访谈研究的一部分，我们探讨了参与者在癌症诊断过程中所做决策的故事。通过关注关怀、选择和医疗权威（一种和谐的牧领动态）的交集，我们对人们在癌症诊断故事中所体现的规范性矛盾进行了概念分析。我们发现，参与者在描述自己的诊断时，从关怀、选择和医疗权威中汲取了与医生的关系，并强调了他们之间的关系和相互依存性。重要的是，对医患关系不对称的协商是对医疗保健过程作为一项人类事业的持续认识的一部分。因此，我们能够注意到将解放性授权话语进行二分法的局限性，并主张将医患关系理论化为一种具有语境限制和关系矛盾的人性。
