Interpreting Diabetes Mellitus: Differences between Patient and Provider Models of Disease and their Implications for Clinical Practice

Current medical literature suggests that Type 2 diabetes mellitus can becontrolled by diet and hypoglycemic agents or diet and insulin therapy.Nevertheless, adhering to a low glucose dietary regimen remainsproblematic for a majority of patients, and management of the disease isan ongoing source of frustration for physicians and other providers.While calling for more research on the physician's experience oftreating chronic conditions like diabetes, the authors argue that muchof the current frustration stems from the different frames orexplanatory models that physicians and patients use to understand thedisease. By comparing physician narratives collected in several clinicalcontexts (e.g., medical lectures, precepting sessions, patient caresessions and personal interviews) with patient stories obtainedprimarily through narrative interviews, the authors highlight crucialdifferences in the way physicians and patients experience and thinkabout the disease. In particular, the authors highlight differencesbetween physicians and patients across five dimensions: etiology,symptoms/signs, factors which affect blood sugar, ideal blood sugar,and future prospects. In concluding, the authors sketch out elements ofa theory of clinical practice involving diabetes care. Data for thestudy was collected at two family practice training sites in Chicago.     

Plant Remains From Waterlogged Sites In The Arawe Islands, West New Britain Province, Papua New Guinea: Implications For The History Of Plant Use And Domestication

Plant remains in the Arawe Islands were found preserved in waterlogged beach sediments. Remnants of edible fruit and wild nuts were found together with Lapita pottery, stone artifacts, and other evidence of human settlement. Previous discoveries of fruit and nut remains in Lapita pottery sites have been interpreted as evidence for an arboricultural complex based on a variety of tree species. Here we report direct evidence for plant use, but are unable to recognise any particular system of plant cultivation or harvest. All the genera and species recognised in the Arawe plant remains are known to enter modern beach drift by natural processes, from wild and cultivated sources. The archaeological assemblages pose intriguing problems for interpreting the history of plant use and domestication.