Navigating medical expertise

Red Deer College instructor Trish Campbell had somewhat of an ulterior motive for writing her PhD dissertation on how runners use mediated medical expertise in their self-care practices. The long-time runner and yoga instructor had battled injuries and wanted to delve deeper into the hows and the whys of self-care.

Red Deer College instructor Trish Campbell had somewhat of an ulterior motive for writing her PhD dissertation on how runners use mediated medical expertise in their self-care practices.

The long-time runner and yoga instructor had battled injuries and wanted to delve deeper into the hows and the whys of self-care.

In Public participation, mediated expertise, and reflexivity: How multiple medical realities are negotiated in runners’ (self)care practices, Campbell explores how people understand sources of medical expertise, use it, share it and produce it with different social groups.

There are lessons for both health-care practitioners and for people who are using medical expertise, said Campbell.

She said runners act as a lens for how the average person participates with medical expertise and her general conclusions apply to a broader group.

In her ethnographic research, Campbell looked at the Red Deer Runners as a face-to-face group and participants from Running Mania, a Canadian online running community. She observed online running injury forums and groups. In total she interviewed 37 runners in person and through email, about half from the Red Deer Runners in 2014.

She delved into the contextual factors such as rising health-care costs and how some care practices could be downloaded onto people from the hospitals.

“In popular culture and in all media forums, there has been a questioning of expertise,” said Campbell. “Part of what it is facilitated by Web 2.0, the idea that people can access multiple forms of medical expertise that were only available to experts before … this running group for an example – gives them a space where they can negotiate and create this expertise away from traditional sites of knowledge production.”

Runners are active participants in health care who negotiate medical expertise in light of their practice.

“Often times if a runner goes to a medical expert with a running injury, the expert will say, ‘stop running,’” said Campbell.

“This is not what runners want to hear. A runner’s framing of health is not necessarily to be pain free but to able to run, maybe experience pain, but still be able to run.”

That is a whole different framing of health between some health-care providers and some runners, said Campbell.

“Runners tend to seek out health care professionals who have the same kind of active approach,” said Campbell. “You just don’t want someone to tell you to stop running, you want them to tell you to do in order to keep running.”

She also learned runners produce knowledge around particular types of injuries such as blisters that medical experts might not possess. But it may also be common injuries in runners such as Achilles tendinitis. Campbell said runners create a body of expertise among themselves, which includes forms of medical expertise.

For example, a runner may cut a hole in his or her shoe so they do not run on a bunion or lose a toenail.

“There’s a lot of tinkering that goes on once that medical expertise is combined with experience expertise in everyday running practices,” she said.

The biggest surprise in her research was how runners deal with uncertainty and anxiety when multiple medical experts have conflicting knowledge claims. That idea didn’t really exist. Campbell said she thinks it has to do with the take charge attitude that runners have.

“I saw that they were willing to tinker with multiple forms of expertise and it didn’t generate anxiety that they couldn’t just go to one expert who could tell them this is what they have to do,”she said. “They were really willing to participate in their self-care practices. As a runner you can’t find your expertise from just one person, so you need your physiotherapist, your massage therapist, your runner community.”

Medical practitioners, on the other hand, need to have some reflexivity in their care practices, said Campbell.

“They need to examine where their knowledge comes from and where that knowledge may be understood outside of that expert group,” said Campbell. “Also when you look at those medical professionals that were really valued by runners, it was those ones that were willing to try new things, willing to tinker, willing to be open to different type of practices instead of just following routine ways of doing things.”

The focus of the dissertation is to describe and understand than prescribe a certain policy direction.

“It’s implicitly critical in the sense it recognizes that there are multiple realities that are negotiated in health care,” she said. “There’s not just one form of expertise or one way of understanding the body.”


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