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Constructing Competent Care: How Physicians’ Self-understandings Inform Notions of Expertise


Social scientific scholarship on clinicians’ and patients’ roles in medical treatment has emphasized the importance of exploring patients’ lifeworlds in understanding their unique contributions to intersubjectively constructed narratives of healing. Such work has often neglected similar variation in physicians’ subjective perspectives and experiences, however, that likewise imprint this caring relation. Using a narrative analysis of case material gleaned from extensive life-history interviews with two physicians who specialize in treating chronic vulvar pain, or vulvodynia, to illustrate the clinical perspective, I examine how physicians’ articulations of their unique treatment philosophies are tied to their broader life narratives and worldviews. I argue that attending to the ways in which physicians’ conceptions of self are imbricated with their clinical engagements can help illuminate the dynamic interplay between individual and cultural meaning systems in each physician’s philosophy, and in so doing, add to current understanding of how notions of biomedical competence and expertise are constructed. I also suggest that variations in clinical approaches rooted in the valuation of differing relational styles, which in turn are attached to variable understandings of ideal personhood and patients’ roles, may have important consequences for patients as physicians’ imprint the intersubjective construction of narratives of illness and healing.

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