Collaboration or subordination: The role of rhetoric in the conception of primary healthcare giver.

摘要

What constitutes a primary care provider? Historically, the "statutorily designated individuals" entitled to be called primary care providers have been exclusively physicians. We must ask ourselves why these individuals have been given absolute authority over our health and well-being. I have argued that this authority derives not solely from an epistemic foundation but from a discursive perspective, that the discourse by and about physicians has persuaded the public and institutional authority of the superiority of medical knowledge over and above nursing theory and practice. I have argued that rhetoric has and will continue to play a major role in the shifting paradigm of how constitutes the primary healthcare provider.; I have seen in this study that, despite advances in medical science and improvement in both medical and nursing education, discourse drives the concession of epistemic authority. I have attempted in this study to deconstruct the master-narrative, to build on challenges to empirical, positivistic epistemology, and to open rhetorical spaces through using the Foucauldian tenet that discourse determines epistemic authority. I began with a study of the discourse of medical history, utilizing both canonized texts and the voices of medical practitioners. I have discovered that the rules determining who can be heard have been largely under institutional control. Further, these institutions have silenced women, and this silencing has suppressed the epistemic authority of women's knowledge, i.e., experiential, intuitive knowledge. Thus the discourse determines both epistemic and agent authority. Nursing history reverberates the constraint of nursing knowledge by the discourse, the rules of which are determined by institutional agency. This restriction on nursing discourse is duplicated in attempts by the nursing profession to create a nurse to link the division between nursing and medicine, the nurse practitioner. The medical community sees the nurse practitioner as adversary rather than adjunct, as challenger to medical hegemony rather than collaborator, due to the discourse created by and about the nurse practitioner movement. And rather than making clear the intention to expand rather than contract healthcare, proponents of the nurse practitioner movement have muddied the waters further through lack of rhetorical knowledge.