The Disruptive Consequences of Discourse Fragmentation in the Organization and Delivery of Health Care: A Look Into Diabetes

Abstract

The aim of this study is to contribute to a better understanding about how discourse fragmentation is affecting the way doctors perceive the patient's role and expectations that are being redefined under the influence of media and other information sources. The diabetes case provides the empirical evidence to support the fragmentation thesis. This condition offers a unique mix of complexity, scope, and controversy to understand the dialectics of discourse fragmentation. Through a combined analysis of media discourse and experts' discourse (researchers and clinicians), this article describes the connections between the macro (the realm of the public sphere) and the micro (the localized medical practice) in the context of health care delivery. The study concludes that a fragmented media discourse tends at the same time to nourish the public perception about the “diabetes complexities” (a multifaceted and growing epidemic), and to normalize some emerging concepts such as “prediabetes” and metabolic syndrome. This fragmentation seems to have a double-edged sword effect on doctor–patient relationships; in some occasions the atomized discourse about diabetes has a clear disruptive impact on their medical practice, adding an “extra burden” to the disease management, while in other opportunities it has a more convergent effect facilitating the dialogue and the interaction between the actors.