Abstract
Experiences of cancer diagnosis are changing in light of both the increasingly technological‐clinical diagnostic processes and the socio‐political context in which interpersonal relations take place. This has raised questions about how we might understand patient–doctor relationship marked by asymmetries of knowledge and social capital, but that emphasise patients’ empowered choices and individualised care. As part of an interview study of 155 participants with bowel or lung cancer across Denmark, England and Sweden, we explored participants’ stories of the decisions made during their cancer diagnostic process. By focusing on the intersections of care, choice and medical authority – a convivial pastoral dynamic – we provide a conceptual analysis of the normative ambivalences in people's stories of their cancer diagnosis. We found that participants drew from care, choice and medical authority to emphasise their relationality and interdependence with their doctors in their stories of their diagnosis. Importantly negotiations of an asymmetrical patient–doctor relationship were part of an on‐going realisation of the healthcare processes as a human endeavour. We were therefore able to draw attention to the limitations of dichotomising emancipatory‐empowerment discourses and argue for a theorisation of the patient–doctor relationship as a contextually bounded and relationally ambivalent humanity.
Highlights
A cancer diagnosis can be both a single moment of categorisation and a process through which a doctor and patient collaborate their respective expertise (Jutel and Dew 2014)
As we analysed and reflected upon the interviews across the three countries we found that participants drew on understandings of care, choice and medical authority in their encounters with doctors in family (GP) practices, Emergency Rooms or oncology departments
In our findings we found that the intersections of care, choice and medical authority made participants’ stories of their diagnosis intelligible in two main ways
Summary
A cancer diagnosis can be both a single moment of categorisation and a process through which a doctor and patient collaborate their respective expertise (Jutel and Dew 2014). After several decades of intensive research and intervention survival rates are broadly improving (Holleczek et al 2015, Walters et al 2015) Those interventions have served to increase the complexity of embodied knowledge and practices around cancer diagnostic processes (Andersen 2017, Kerr et al 2018, Ziebland et al 2018). This has come at a time when greater responsibility has been argued to lie with the patient for their health and care decisions, not just normatively (Buetow and Elwyn 2006), but legally (Chan et al 2017)
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