title: Patchwork diagnoses: the production of coherence, uncertainty, and manageable bodies.
abstract: Using a material semiotics methodology, this paper explores the link between diagnostic practices, patient awareness of the body, and biopolitical governance. We collected video and audio recordings of a patient with chest pain involved in three medical interactions (a general practitioner [GP] consultation, an electrocardiogram stress test and a consultation with a cardiologist) in Wellington, New Zealand. Following the work of Annemarie Mol, we argue that each of these diagnostics interactions bring together a range of material and non-material entities that enact the body and disease. Consequently, we note how the diagnostic practices associated with cardiovascular medicine enable and prompt an awareness of the body based on uncertainty, and thus promotes the self-management of cardiac health and risk. This paper illustrates that a material semiotics methodology makes important contributions to the sociology of diagnosis. Firstly, it draws attention to the relationship between humans and material entities in rendering the body intelligible. Secondly, it illustrates that different diagnostic procedures can produce multiple, potentially conflicting, forms of self-awareness. Alongside these practices generating multiplicity, however, are those that presuppose and produce singularity and coherence. We illustrate how the cardiologist "patches" two potentially conflicting diagnoses together in order to provide a sense of coherence to the interactions. Thirdly, material semiotics illustrates how various diagnostic practices can reify risk, and produce bodies that lend themselves to particular forms of governance.
authors.affiliation: Centre for Biomedicine & Society, King's College London, King's Building, The Strand, London WC2R 2LS, United Kingdom. gardnerjohnyg@gmail.com
authors.forename: John
authors.initials: J
authors.lastname: Gardner
authors.forename: Kevin
authors.initials: K
authors.lastname: Dew
authors.forename: Maria
authors.initials: M
authors.lastname: Stubbe
authors.forename: Tony
authors.initials: T
authors.lastname: Dowell
authors.forename: Lindsay
authors.initials: L
authors.lastname: Macdonald
mesh_terms: D002309:Cardiology; D002637:Chest Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D004562:Electrocardiography; D005080:Exercise Test; D058005:General Practitioners; D006801:Humans; D009633:Nonverbal Communication; D010818:Practice Patterns, Physicians'; D012962:Sociology, Medical