Discourses of Diabetes Management in Patient-Physician Interactions

Discussions of diabetes management are challenging for patients and physicians during treatment plan appointments—in large part because “diabetes management” has multiple, competing meanings. Our goal in this study was to examine talk between patients and physicians over multiple visits to: (1) determine the multiple meanings of diabetes management, and (2) determine the specific ways these meanings compete with each other. To accomplish this goal, we gathered data at a family medicine residency clinic in the Midwestern United States, video-recording the interactions of six different patient-physician dyads over multiple visits. Next, we performed in-depth analyses of these interactions using Baxter’s (2011) Relational Dialectics Theory 2.0, which focuses on discourses occurring within interpersonal interactions, rather than on the individuals within interpersonal interactions. Our results reveal meanings associated with two dominant oppositional discourses comprising the meaning of diabetes management: high self-efficacy and low self-efficacy. Additionally, we found that—during conversations between patients and physicians—the central discourse of high self-efficacy competed with the less-central discourse of low self-efficacy. Our results also reveal that both patients and physicians used both discourses. Finally, our results revealed that at times, both patients and physicians mixed these discourses, creating a new “hybrid” meaning for diabetes management: Moderation. Understanding these discourses and how they compete can help physicians focus on the cultural discourses that shape their own and patients’ views of diabetes management and realize the transformational possibilities that can occur in treatment plan discussions through a more moderate discourse