Discursive Struggles in “Diabetes Management”: A Case Study Using Baxter’s Relational Dialectics 2.0

Abstract

This case study employs Relational Dialectics 2.0 as a theoretical framework, deeply analyzing one patient–physician dyad over the course of three visits as the meanings of “diabetes management” are discursively contested. This study examines two understudied links on the chain of speech communion: the proximal-already-spoken and the proximal not-yet-spoken. The analysis reveals two primary contested discourses: “change for the better” (subdiscourses: “personal control over one’s circumstances” and “rational science”) and “stasis” (subdiscourses: “helplessness” and “shame”). Understanding the discourse occurring at these sites can move patient/physician dyads from repeating unproductive conversations to working as partners to achieve better patient health outcomes.

Keywords:

• Case Study
• Diabetes Management
• Discursive Struggles
• Patient–Physician Relationships
• Relational Dialectics Theory 2.0

Notes

1. Baxter and Montgomery (1998) contains deeper explanation of the relational contradictions and how relational partners manage them.

2. Particular research emphasis in RDT has been placed within family contexts. See Baxter and Braithwaite (2010) for an extended review of this work.

3. See Flyvbjerg (2006) for an excellent essay that examines and thoroughly refutes “five common misunderstandings” about case-study research in the social sciences.

4. Pseudonyms are used to protect participants’ identities.

5. This case is part of a larger data set (on which I am working with a coresearcher) examining contested meanings of “diabetes management” between patients and physicians. As such, my coresearcher and I both completed independent rounds of initial coding and theme-building in the larger data set (which includes this case). My coresearcher and I also engaged in a confirmatory coding process to arrive at consensus regarding basic themes for the larger data set. However, for this case analysis I performed my own, more fine-grained discursive analysis of the patient/physician talk at both the proximal-already-spoken link and the proximal not-yet-spoken links. After this analysis, my coresearcher confirmed and/or challenged my interpretations of the data, at which point I refined them for the present analysis.

6. The A1c blood test determines a patient’s average level of blood glucose over a 3-month period.