Practicing oncology in provincial Mexico: A narrative analysis

This paper examines the discourse of oncologists treating cancer in a provincial capital of southern Mexico. Based on an analysis of both formal interviews and observations of everyday clinical practice, it examines a set of narrative themes they used to maintain a sense of professionalism and possibility as they endeavored to apply a highly technologically dependent biomedical model in a resource-poor context. They moved between coexisting narrative frameworks as they addressed their formidable problems of translating between theory and practice. In a biomedical narrative frame, they drew on biomedical theory to produce a model of cellular dysfunction and of clinical intervention. However, limited availability of diagnostic and treatment techniques and patients inability or unwillingness to comply, presented serious constraints to the application of this model. They used a practical narrative frame to discuss the socio-economic issues they understood to be underlying these limitations to their clinical practice. They did not experience the incongruity between theory and practice as a continual challenge to their biomedical model, nor to their professional competency. Instead, through a reconciling narrative frame, they mediated this conflict. In this frame, they drew on culturally specific concepts of moral rightness and order to produce accounts that minimized the problem, exculpated themselves and cast blame for failed diagnosis and treatment. By invoking these multiple, coexisting narrative themes, the oncologists sustained an open vision of their work in which deficiencies and impotency were vindicated, and did not stand in the way of clinical practice.