Doctor uncovers the impact of diagnosis

Diagnosis is important in identifying and curing disease, but we cannot ignore that it also has a very strong social impact, says Doctor Annemarie Jutel, an associate professor at Victoria University of Wellington’s Graduate School of Nursing, Midwifery and Health. Sally Webster talks to Dr Jutel about information released this week.

Diagnosis itself might be the subject of journal articles, books and medical columns penned by Dr Jutel and friends like Yale professor Lisa Sanders, the Medical Director for the massively successful US medical drama, House. But it is not a subject usually accessible through main stream media, even though its importance to society is highly significant.

“Delivering a diagnosis can destabilise a person’s sense of his or herself…often as powerfully as the ailment itself—it can be a source of anxiety or relief, hope or despair” says the doctor. “I [also] hope that by analysing diagnoses from perspectives other than clinical ones, I can offer a broad understanding of how people react to disease—that potentially has a lot to offer medical professionals and the public in terms of health as well as social outcomes.”

Dr Jutel is also the founder and facilitator of the Critical Diagnosis Network, described by the University as a group of researchers, students and community members from a range of disciplines who are dedicated to exploring social, cultural, creative and critical perspectives of diagnosis.

“If you go to a doctor and get a diagnosis, nothing has changed physically—but that diagnosis can change your outlook on everything, and extend its impact to family and friends too.”

Dr Jutel didn’t start her career with any intention of studying diagnosis. She didn’t know this field existed when she was a nurse in the 1980’s, or even when she went on to Otago to study physical education. But she is now supported by Victoria’s University Research Fund to do just this.

“I actually started out studying the concept of ‘being fat’ and the physical disorders associated with that” says the self-confessed skinny distance runner. “I remember working at the hospital and people pinching me and saying how skinny I was, implying having no fat on my body was so good.” Conversely, carrying fat seemed to be accepted as bad. It got Dr Jutel thinking about the impact of words and labels.

This burgeoning desire to look “under the surface” was followed by studying miscarriage and noticing again that the choice of words and language used around the death of an infant or foetus -varying from country to country – all had a very strong impact on the patient and those around them.

After further work with prostate cancer screening Dr Jutel realised diagnosis was her calling, not condition. Interestingly, she classes this impact as a social phenomenon, not a psychological one.

“When we look at a patient-doctor diagnosis scenario most people see two individuals in a room. I see a crowded room. We come in with all the values we have acquired from our social settings. Social psychologists probably disagree here- but this area is actually about social and cultural structures which influence the way individuals behave.

“Let’s take for a minute the diagnosis of gout.” Dr Jutel says that we commonly associate this with an overly indulgent lifestyle involving a lot of alcohol. But she has seen cases where people who are dealing with immense pain are also careful eaters who abstain from alcohol for religious reasons. If the gout is seen as a drinkers disease in the cultural setting of the non-drinking patient, they will very much be adversely affected by a diagnosis they perceive as socially unacceptable.

Dr Jutel is currently working on a special medical journal issue featuring this kind of work. For more information on this, on her university research and the Critical Diagnosis Network, contact her on 04-463 6140 or annemarie.jutel@vuw.ac.nz