Saslavki L, Sinay I, Rabey M. Discursos en colisión: brechas comunicacionales entre médicos y pacientes y el problema del incumplimiento en los tratamientos diabetológicos. [Discourses in collision: communication gaps between physicians and patients and the problem of non-compliance in the treatment of diabetes.] Cuadernos Médico Sociales [Medical-Social Notebooks] ( Rosario , Argentina ) 1994 November; 69: 47-55.

Objectives: To clarify the cultural values that characterize conversations about diabetes between diabetic patients and their physicians.

Methodology: Ethnographic.

Results: The authors confirm that the patient diagnosed as a diabetic suffers an upheaval in his/ her life and tries to find a meaning that goes beyond the diseased pancreas. The illness appears to the patient as a social fact that transcends the medical context and permeates every sphere of existence, to involve an ever-widening circle of people. The patient needs continually to reconstruct an order that has been altered by the illness.

Physicians generally focus the problem on the biological aspects of the disease or emphasize diabetic teaching, in which patients are expected to acquire knowledge about diabetes. In the physician’s judgment, the “culture of the patient” causes his/ her transgressions. Patients perceive physicians as “doctors who often do not understand the problems that we have.” Data from the field underscore that diabetic patients frequently consider their diabetes as a fact external to their lives; this belief creates difficulty in conceding that they are sick. They conserve the hope of recovering their health, once their “case of nerves,” or “misfortune,” or “bad luck” has passed. The complications arising from diabetes, called at times “wear and tear of the body,” are often seen as the true illness. The diabetic patient greatly fears the possibility of stigmatization, often behaves in ways diametrically opposed to his/ her physiological needs, and frequently does not tell others that he/ she is diabetic. In this way, diabetics manifest uneasiness and at times anguish in their inability to act like others, and in not being able to become slim, to work, to study, to travel, and to live freely.

Conclusions: Physicians who specialize in treating diabetes transmit the official medical parlance of the specialist. The “discourses” of patient and physician collide. A common culture gets constructed. Patient and physician become lost in a communication gap that they cannot circumvent.

Copyright 2007 University of New Mexico