Re-thinking theory as a vector for discussing difficulty in medicine

Background

Discussions about ‘difficult subjects’ in healthcare are tough and for this (amongst other reasons) difficulty can be left unexplored and unchallenged. I define ‘difficult subjects’ as those topics not often talked about in healthcare including those surrounding equality, diversity and inclusion as well as moral injury and burn out. Limited conversation and training about difficulty in this context appears to be having an effect on healthcare provision (Dogra et al 2015) and physician wellbeing (GMC 2019), and interventions put in place to tackle difficulty have little evaluative data to support their use (Woolf et al 2017). As such in this presentation, which represents my emerging PhD thesis I explore how theory might guide a change in perspective on this issue and enable the silenced to be heard in medical education.

Methodology

I use theories of complexity, inter-subjectivity and inter-objectivity to explore the possibilities of enabling meaningful conversations about difficulty with medical professionals in the UK. In particular I consider post-structural (Foucault 1969), post-human (Barad 2003) and entanglement (Benjamin 2004, Haraway 2016) theories as ways of tackling this subject within this population. The use of positivism, the biomedical model and non-intersectional approaches are challenged and the importance of reflexivity is also discussed.

Results

Taking into consideration context, space and place I argue for the use of a dynamic approach that reflects the complexity and uncertainty of discussing difficulty in medicine. I therefore argue for an inter-objective lens and the use of a tentacular, entangled approach drawing on the concept of the ‘ third space’ (something outside of the you-me interaction that enables a change in perspective on the you-me interaction). Within this I argue for an ethnographic, intersectional transdisciplinary methodology (Bintley and George 2019) as a way of appropriately creating dialogue about difficulty.

Discussion

To discuss my findings I use two examples from my research, which use intersectional transdisciplinary methodology to explore difficulty in medicine. Explaining and using Haraway's concept of tentacularity, Benjamin's concept of the ‘third space’ and Nicolescu's concept of transdisciplinarity I demonstrate how theory can be used to enable difficult conversations in online (Bintley and George 2019) and face-to-face educational contexts. In these examples I highlight the advantages of embracing complexity but also the challenges of doing so in terms of resources, medical curriculum alignment and on-going support.