A Foucauldian Discourse Analysis of Diabetes Knowledge Translation and the Governance of Family Physicians and Endocrinologists in Canada
Year: 2020
Type: dissertation
Abstract: Over the past thirty years, improving the health and lives of people with diabetes has been discussed from the perspective of diabetes knowledge translation: the process of implementing clinical practice guidelines into the care of as many people with diabetes (PWDs) as possible. While the majority of research has focused on discovering and implementing knowledge translation initiatives to overcome the problem of clinical inertia, there is less attention being awarded to what is actually happening in these well-intentioned practices. This thesis uses a critical social theoretical perspective from which to examine the ways in which we think and talk about good diabetes care shape the possibilities for physician scope of practice. The conceptual framework used to inform this study is built primarily from Michel Foucault’s concept of governmentality - a historically locatable way of thinking about how we “conduct the conduct” of ourselves and others to achieve specific goals through a variety of explicit and implicit practices, techniques, knowledge and power relations (Dean, 2010). More specifically, I examined the manner in which family physicians and endocrinologists in Canada are governed by, and also govern themselves through discourses of good diabetes care. Data collection, conducted from September 2014 to April 2017, involved analysis of formal documents and 15 semi-structured interviews with family physicians and endocrinologists. Analysis was informed through Dean’s (2010) analytics of government. My findings reveal shifts in the expected conduct of physicians over the past ninety years related to dominant discourses in different historic times. My analysis makes visible the material effects, diversity, contradictions and conflicts as physicians enact historically-constituted roles to engage with PWDs as both passive recipients of care and active participants in care. I bring attention to how discourses of good diabetes care intersect and intertwine in ways that have implications for the success of diabetes knowledge translation initiatives, the intraprofessional relationship between family physicians and endocrinologists, and the provision of patient- centered care.
Source: TSpace (University of Toronto)
Author: René Wong
Language: English
Topic: Foucault, Power, and Ethics
Subfield: Sociology and Political Science
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W3131391173