Assessing/engaging differently:
Barad’s conceptualisations of diffraction provide an alternative, and we
would argue a welcomed methodological intervention for engaging in
contemporary culturally humble healthcare work. Diffraction as a
scientific phenomenon is conventionally understood as the patterns
resulting when any type of wave (as example water, sound or light)
encounters an obstacle. The patterns result as wave components combine
or cancel one another out as a result of the
interference29. Repurposed as a metaphor, diffraction
is about the breaking apart and re-assemblage of physical properties in
new configurations and their iterative movements in alternative
directions14.
Several working points from Barad’s ”turning over”14the metaphor of diffraction as a strategy for ethically encountering and
investigating the social-material world making of scientific (health)
engagements inform our renewed cultural humility framework. A
diffractive analysis allows for a troubling and rethinking of
conventional culturally humble approaches to assessing social and
material difference articulating in healthcare
encounters14. Here, we can think of the types of
social differences or divisions that are normatively held and demarcated
in health care practices, such as clinician//patient; communications and
biomedical technologies// human bodies; the reflexive
practitioner//objects and subjects to be attuned to; big data driven
knowledge//patient self-knowledge. As a methodological standpoint,
diffraction attends to the ”relational nature of
difference”29. The clinician is afforded an
opportunity to ”record the heterogeneous histories”29- the patterns and effects of interferences, disruptions, and
reconfigurations that are agentially emerging in the technologised and
knowledge distributed space of the clinic. In other words, a diffractive
analysis ”highlight[s], exhibit[s], and make[s] evident the
entangled structure of the changing and contingent onto-epistemologies”
of the clinic29 including the embodiment and
materiality of knowing. Through a diffractive lens, different practices
of knowing (such as data driven population risk profiles,
technologically fed patient information, the patient’s body speaking
through symptoms, patients’ self-understanding(s) are approached as
”material engagements”29 entangling with other bodies,
technologies and meaning systems. It is in their complex intra-actions,
that prognosis and health effects are produced and become meaningful. In
this sense, a diffractive analysis is attuned to the contingent
materialities that emerge in the clinical encounter as markers of the
complex relationalities of heal-care encounters: what relational
elements are brought into play, what becomes meaningful, what
social-material properties are deduced, what boundaries enacted, what
relational forces of power are materialising, what alterities
proclaimed, and what rules for intervention are being put in place?
These questions of differences and their emergences also present an
ethical challenge for the culturally humble and attuned practitioner.
Questions of ethics in this framing of culturally humble diffractive
responsiveness aren’t separable form what gets materialised and made
meaningful in the clinical exchange29. In other words,
practitioners are encouraged to account for the performativity of their
own discursive-material imprinting in the clinical encounter, and their
own practices of assessment as co-constitutive of social-health effects.
We turn to, and repurpose, the lessons learned from a research case
illustration to highlight the benefits of approaching evaluation and
appraisal ”diffractively” in the context of technologised practices of
care.