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Engaging cultural humility diffractively
  • RORY CRATH,
  • J. Cristian Rangel
RORY CRATH
Smith College
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J. Cristian Rangel
University of Ottawa
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Abstract

Rationale: Conventional models of cultural humility - even those extending analysis beyond the dyad of healthcare provider-patient to include concentric social influences such as families, communities and institutions that make the clinical relationship possible - aren’t conceptually or methodologically calibrated to accommodate shifts occurring in contemporary biomedical cultures. More complex models are required that are attuned to how advances in biomedical, communications and information technologies are increasingly transforming the very cultural and material conditions of health care and its delivery structures, and thus how power manifests in clinical encounters. Methodological Intervention: In this paper, we offer a two-pronged intervention in the cultural humility literature. At a first level of analysis, we suggest the need to broaden understandings of culture and associated workings of power to accommodate the effects of biomedicine’s technologising turn. A second level of intervention invites experimentation to broaden the availability of methodological tools to analyse and assess the multidimensionality of technologies and their agentic effects in healthcare encounters. Drawing from new materialism theories, practices of care are approached “diffractively” as contingent and dynamic material-discursive events. Our neo-materialist framework for cultural humility expands analytical sight-lines beyond hierarchical relationships and dichotomies privileging humans (practitioner and/or patient) as sole actants in the clinical exchange. Attended to are the ongoing dynamics of practices entangling big-data driven knowledges and interventions, pharmacological technologies and material instruments and devices, diseases, and the bodies/subjectivities of health care providers and patients. We investigate the implications for clinical assessment if a cultural humility framework is methodologically attuned to the clinical encounter as a discontinuous, discursive-material process producing multiple, contextually emergent data moments and objects for analysis. Engaging evaluative inquiry diffractively allows for a different ethical practice of care, one that attends to the forms of patient and health provider accountability and responsibility emerging in the clinical encounter.

Peer review status:ACCEPTED

11 Dec 2019Submitted to Journal of Evaluation in Clinical Practice
17 Feb 2020Submission Checks Completed
17 Feb 2020Assigned to Editor
05 Mar 2020Reviewer(s) Assigned
16 Mar 2020Review(s) Completed, Editorial Evaluation Pending
16 Mar 2020Editorial Decision: Revise Minor
08 Apr 20201st Revision Received
10 Apr 2020Submission Checks Completed
10 Apr 2020Assigned to Editor
10 Apr 2020Reviewer(s) Assigned
20 Apr 2020Review(s) Completed, Editorial Evaluation Pending
20 Apr 2020Editorial Decision: Accept