Gestational Diabetes Testing, Narrative, and Medical Distrust

Abstract

In this article, we investigate the role of scientific and patient narratives on perceptions of the medical debate around gestational diabetes (GDM) testing. Among medical scientists, we show that the narrative surrounding GDM testing affirms that future research and data will lead to medical consensus. We call this narrative trajectory the “deferred quest.” For patients, however, diagnosis and their subsequent discovery that biomedicine does not speak in one voice ruptures their trust in medical authority. This new distrust creates space for patients to develop a Frankian quest narrative where they become the protagonist in their story. Additionally, across these different narratives, we observe how character is constructed and employed to negotiate trust. We conclude that healthcare providers should assess the narrative trajectory adopted by patients after diagnosis. Also, we suggest that providers acknowledge the lack of medical consensus to their patients. This veracity would foster women’s sense of trust in their provider as well as allow women to be active interlocutors in a debate that ultimately plays out in their deliberation about their body, pregnancy, and risk.

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References

  1. Avalos, G.E., L.A. Owens, F. Dunne. 2013. Applying current screening tools for gestational diabetes mellitus to a European population: Is it time for change? Diabetes Care 36(10): 3040–3044

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bending, Z.J. 2015. Reconceptualising the doctor–patient relationship: Recognising the role of trust in contemporary health care. Journal of Bioethical Inquiry 12(2): 189–202.

    Article  PubMed  Google Scholar 

  3. Beaulieu, A., and A. Estalella. 2012. Rethinking research ethics for mediated settings. Information, Communication & Society 15(1): 23–42.

    Article  Google Scholar 

  4. Coustan, D.R., L.P. Lowe, B.E. Metzger, and A.R. Dye. 2010. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: Paving the way for new diagnostic criteria for gestational diabetes mellitus. American Journal of Obstetrics and Gynecology 202(6): 654.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cundy, T. 2012. Proposed new diagnostic criteria for gestational diabetes—A pause for thought? Diabetic Medicine 29(2): 176–180.

    CAS  Article  PubMed  Google Scholar 

  6. Cundy, T., E. Ackermann, E.A. Ryan. 2014. Gestational diabetes: New criteria may triple the prevalence but effect on outcomes is unclear. British Medical Journal 348: g1567.

    Article  PubMed  Google Scholar 

  7. Dubriwny, T.N. 2012. The Vulnerable Empowered Woman: Feminism, Postfeminism, and Women’s Health. New Brunswick, NJ: Rutgers University Press.

    Google Scholar 

  8. Erika. 2014. Gestational diabetes, my story. Mami Tales, February 24. http://mamitales.com/blog/gestational-diabetes-my-story/#sthash.E4GUFr3Z.GUM3D3Ho.dpbs. Accessed September 26, 2014.

  9. Foy. 2012. Gestational diabetes—My story and recipes. Foy Update, May 8. http://foyupdate.blogspot.com/2012/05/gestational-diabetes-my-story-and.html. Accessed February 20, 2016.

  10. Frank, A.W. 1995. The wounded storyteller  body, illness, and ethics. Chicago: University of Chicago Press.

  11. Gina. 2012. Sugar baby! The Parsley Life, June 18. http://www.theparsleylife.com/2012/06/sugar-baby.html. Accessed September 26, 2014.

  12. Hallowell, N. 2008. Encounters with medical professionals: A crisis of trust or matter of respect? Medicine, Health Care and Philosophy 11(4): 427–437.

    Article  Google Scholar 

  13. Hanna, F.W.F., and J.R. Peters. 2002. Screening for gestational diabetes; Past, present and future. Diabetic Medicine 19(5): 351–358.

    CAS  Article  PubMed  Google Scholar 

  14. Harrison, K. 2014. Online negotiations of infertility: Knowledge production in (in)fertility blogs. Convergence: The International Journal of Research into New Media Technologies 20(3): 337–351.

    Google Scholar 

  15. Hartling, L., D.M. Dryden, A. Guthrie, M. Muise, B. Vandermeer, and L. Donovan. 2014. Diagnostic thresholds for gestational diabetes and their impact on pregnancy outcomes: A systematic review. Diabetic Medicine 31(3): 319–331.

    CAS  Article  PubMed  Google Scholar 

  16. Houshmand A., D.M. Jensen, E.R. Mathiesen, and P. Damm. 2013. Evolution of diagnostic criteria for gestational diabetes mellitus. Acta Obstetricia et Gynecologica Scandinavica, 92(7): 739–745.

    Article  PubMed  Google Scholar 

  17. International Association of the Diabetes and Pregnancy Study Groups Consensus Panel. 2010. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3): 676–682.

    Article  Google Scholar 

  18. January. 2013. The truth about gestational diabetes {And why it’s not your fault!}. Birth Without Fear, June 24. http://birthwithoutfearblog.com/2013/06/24/the-truth-about-gestational-diabetes-and-why-its-not-your-fault/. Accessed February 20, 2016.

  19. Keränen, L. 2010. Scientific characters: Rhetoric, politics, and trust in breast cancer research. Tuscaloosa: University of Alabama Press.

    Google Scholar 

  20. Kristy. 2011. An idiot without cake: Gestational diabetes and my “treatment.” She Just Walks Around With It, February 26. http://shewalks.blogspot.com/2011/02/idiot-without-cake-gestatioal-diabetes.html. Accessed February 20, 2016.

  21. LaRue Park, D. 2015. How I beat gestational diabetes. Mom.me, November 12. http://mom.me/pregnancy/being-pregnant/24703-i-fought-gestational-diabetes-and-i-won/. Accessed March 2, 2016.

  22. Lena. 2013. Gestational diabetes: My story. The Beginners Runner, February 5. http://thebeginnersrunner.blogspot.com/2013/11/gestational-diabetes-my-story.html. Accessed October 15, 2014.

  23. Long, H., and T. Cundy. 2013. Establishing consensus in the diagnosis of gestational diabetes following HAPO: Where do we stand? Current Diabetes Reports 13(1): 43–50.

    Article  PubMed  Google Scholar 

  24. Markham, A., E. Buchanan, and the Association of Internet Researchers (AoIR) ethics working committee. 2012. Ethical decision-making and internet research: Recommendations from the AoIR Ethics Working Committee, version 2.0. http://aoir.org/reports/ethics2.pdf.

  25. McKee, H.A., and J.E. Porter. 2009. The ethics of Internet research: A rhetorical, case-based process. New York: Peter Lang.

    Google Scholar 

  26. Megan. 2012–2013. The GD Diaries. http://thegddiaries.blogspot.com/p/about-authors.html. Accessed September 26, 2014.

  27. Sadler, J.Z. 2014. Commentary: Risk factor medicalization, hubris, and the obesity disease. Narrative Inquiry in Bioethics 4(2): 143–146.

    Article  PubMed  Google Scholar 

  28. Samerski, S. 2007. The “decision trap”: How genetic counselling transforms pregnant women into managers of foetal risk profiles. In Gendered Risks edited by K. Hannah-Moffat and P. O’Malley, 55–74. New York: Routledge-Cavendish.

  29. Smith-Morris, C. 2015. Diagnostic controversy: Cultural perspectives on competing knowledge in healthcare. Routledge: New York.

    Google Scholar 

  30. Stebbing, M. 2009. Avoiding the trust deficit: Public engagement, values, the precautionary principle and the future of nanotechnology. Journal of Bioethical Inquiry 6(1): 37–48.

    Article  Google Scholar 

  31. VanDorsten, J.P., W.C. Dodson, M.A. Espeland, et al. 2013. National Institutes of Health consensus development conference statement: Diagnosing gestational diabetes mellitus. NIH Consensus Development Conference Statements 29(1): 1–30.

    Google Scholar 

  32. Williams, M. 2013. Gestational diabetes: The diagnosis debate. Harvard T.H. Chan School of Public Health, August 9. http://www.hsph.harvard.edu/news/features/shedding-light-on-gestational-diabetes-controversies-challenges/. Accessed February 14, 2016.

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Correspondence to Jennifer Edwell.

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Edwell, J., Jack, J. Gestational Diabetes Testing, Narrative, and Medical Distrust. Bioethical Inquiry 14, 53–63 (2017). https://doi.org/10.1007/s11673-016-9762-9

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Keywords

  • Rhetoric of health and medicine
  • Trust
  • Patient narratives
  • Medical narratives