From loyalty to resignation: Patient-doctor figurations in type 1 diabetes

Abstract

This paper contributes to the debate on the patient-doctor relationship by focussing on a specific chronic disease: type 1 diabetes. This field is characterised by an increasing use of technology, specifically therapeutic devices and a significant requirement of patient self-management. This paper presents the main findings of research conducted in Italy in 2018. It is argued that this relationship is more properly described as an interdependent figuration of actors characterised by a dynamic process of power balances, which recalls Elias' (What is sociology? Columbia University Press, 1978) figurational-processual and relational sociology. In this theoretical context, patients may manage their (dis)satisfaction with their diabetologists by choosing different behaviours that stem from Hirschman's archetype (Exit, voice, and loyalty. Responses to decline firms, organizations, and states. Harvard University Press, 1970): voice, exit, loyalty and, we would add, resignation. These categories are fluid, and all of them can be experienced by patients over time, depending on the quality of the figurations built among these transactors.

Keywords: diabetes; loyalty; patient-doctor figuration; power balance; relational sociology; resignation; self-management; therapeutic devices.