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.