Contextualizing patient-doctor relationships in Singapore

grantor: University of TorontoMy inquiry examines the disjuncture between experiences of people with diabetes and biomedical discourses that support global capitalism within the two-tiered biomedically-based health system in Singapore. I use an institutional ethnographic approach, which is both a method of inquiry and an analytical process, to explore bow relations of ruling are reproduced in specific relations between physicians and people with diabetes. As a subtext, I produced a critical autoethnography that critiqued my original research plans. My inquiry documents the lived experiences of people with diabetes through interview transcripts (describing physicians), relevant texts (including historical and present political practices), fieldnotes of over three years as a participant observer within the Diabetic Support Group of Singapore (DSGS) and a journal of my Canadian expatriate experiences. Diabetes is part and parcel of Singapore's economic 'miracle' and the adoption of consumerism. People with diabetes experience a bifurcation of consciousness as it is challenging to comply with the government ideology of hard work while simultaneously following a 'healthy' diabetic regimen. Singapore's local health care policies impose Western biomedicine within a two tiered system in which 80 percent of the population attend private for-profit clinics. Indigenous health practices are marginalized. A fiscal orientation inherent to contemporary global economics can be seen within patient-doctor interactions. For example, physicians are increasingly concerned about the accounting aspect of their profession and most people with diabetes tacitly accept this 'revolving door' efficiency. Members of the DSGS, a support group for insulin-dependent diabetic families, express dissatisfaction with existing physician services while health professionals associated with the group tend to critique other aspects of the system. Rather than rejecting the biomedical health care system itself, group members claimed friendship and diabetic education as primary reasons for their attendance. A Freirian dialogue can be seen to be part of the social process of this group. However, from a critical feminist perspective, the DSGS can also be seen as responding to external social forces. That is, it has undertaken the least revenue-generating health work of psychosocial support and patient education thus salvaging biomedicine and smoothing the transition to consumerism in medicine.Ph.D