Contextualising the need for a different approach to cultural humility:
Since the 1980s, social scientists have tracked the increasing democratization and technologising of medical knowledges, and the consequent ethical-political transformations that have been brought to research and medical practices15,16. As these authors differently suggest, current socio-cultural practices of health care systems have been reconstituted in several interconnected ways. Medical guidelines for assessment and intervention, together with the authority of practitioners have become organized epistemologically (and increasingly, legally) in line with mathematically driven evidence about population health and pharmacological treatment efficacy10. As previously mentioned, computer stations housed in the different spaces of clinical engagement (eg., examination room) feed a constant flow of health information to health care providers. The screen together with its informational flows demand material-discursive attention, and yet, the care provider is compelled to simultaneously stay near to the patient as an embodied physical presence and as a differently attuned source of knowledge17,18.
This felt tension between often incommensurate epistemologies - evidenciary truths revealed by computational, big-data analytics, and everyday patient and professional situated knowledges derived from the contingencies inhering in clinical based interactions10 - is reflective of the entwining of what19 and Rose and Novas20 have differently labeled bio-citizenship and the technologising of medical knowledges. The rise of grass-roots medical activism over the past four decades by those most affected by different diseases has been a central catalyst in a shift towards a consideration of the epistemologies of the patient in medical decision making and formation of health policy (including the rise of more culturally attuned models of care)21,22. Concomitantly, advances in technologies assisted storage and dissemination of information have allowed for the democratisation of access to a host of health knowledges, including those generated by corporate sponsors or patient-based social movements outside or alongside the knowledge producing apparatus of biomedicine15. From self-help strategies, to vaccination scepticism, to evidence generated via random control trials or social media reporting, distributed forms of knowledge are widely transmitted via the internet to a host of health consumer publics20, and are significant actants in the clinical exchange11.
Regulatory mechanisms of medical care systems have also been transformed. Governance structures have steered away from a “government by command” model that imbued physicians with decision making authority, towards an “uncoupled system of self-steering”10. This is a system of diffused management and “distributed accountability”10 where not only health care providers but patients - at least those represented by powerful lobby groups in advanced democracies - have become equally implicated in effecting positive health outcomes23,24. In this shifting, governmental, technologically mediated calculous, the very conceptualisation and (embodied) practices of patienthood have been rearticulated20. Patienthood is no longer being conceptualised as a site of localised pathogen, but as a site of agentic decision making, health/wellness/illness management and (moralized) accountability16,22.
In the wake of these transformations, the social-health experiencing body has become a site of technologised hybridization entangling the somatic body, social identity and technologies. Pharmacological prophylaxis, the growth of communications and new “smart” technologies are facilitating the intensification of physician guided and patient administered health surveillance and diagnostic capabilities. Boundaries between the previously conceptualized “natural” body, and the technologies understood to be integral to its existence and correct functioning have become confounded. So much so, in fact, that today’s “techno-scientific” bodies are comprehended as bodies in a continuous process of becoming ‘healthier’ – always in a state of ‘recovery’ from but also in avoidance of biological vulnerabilities9.