Morality in sugar talk: Presenting blood glucose levels in routine diabetes medical visits. (May 2020)

• Record Type: Journal Article
• Authors: Montenegro, Roberto E.; Dori-Hacohen, Gonen
• Is Part Of: Social science & medicine. Volume 253(2020)
• Publication Date: 2020-05
• Subjects: Doctor-patient communication -- Doctor-patient relationship -- Diabetes -- Diabetes management -- Conversation analysis -- Knowledge and health -- Morality; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2020.112925
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Diabetes is a chronic illness with individual, social, and structural-level factors that contribute to its successful management. This paper utilizes conversation analysis to analyze a corpus of 60 audiotaped adult doctor-patient interactions. We examine how patients with diabetes and their physicians discuss blood glucose level management, including how physicians present patients with their test results and how patients respond to these presentations given the possible moral orientation around these activities. We show that physicians are more likely to present "good" blood sugar levels using assessments that explicitly evaluate the patients' condition. Contrastingly, physicians present "bad" glucose levels using report formats of numerical values alone. Interactionally, this requires that patients respond to these numbers by making sense of or accounting for their glucose level. The different practices of discussing blood glucose levels suggests that physicians approach this topic cautiously. This sensitivity balances epistemic asymmetry and may help physicians avoid direct moral characterizations of their patients. Our analysis connects interactional practices to the continuous negotiation of both medical epistemic responsibility and morality between physicians and patients with diabetes as well as the implications this may have in the medical management of this illness. Highlights: Blood glucose level discussions are central to a doctor-patient relationship. Blood glucose level reviews are delicately discussed in diabetes medical visits. Physicians present good levels with assessments and bad levels with numeric reports. These practices create a negotiation of knowledge between the doctor and the patient. These practices and negotiations have moral implications in diabetes self-care.