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Paper short abstract

Different reporting infrastructures within GDM care in Danish and Canadian hospitals produce distinct regimes of doubt. Yet this lingering mistrust proves productive in compelling dialogue/confession/avowal, restructuring the encounter, and enabling better, more patient-centered care.

Paper long abstract

Across Danish and Canadian healthcare contexts, gestational diabetes (GDM) management is a numbers game: focused on patients’ glycemia and the healthcare provider's (HCP) confidence in these reported numbers. Drawing on ethnographic fieldwork in Vancouver and Copenhagen, I explore how clinical mistrust persists, even in Denmark, where societal trust is generally high, and even in hospitals equipped with technology meant to mitigate doubt.

In one hospital, the glucose readings are automatically uploaded from the patient’s glucometer to the clinic’s computer - patient testimony is bypassed, and distrust of self-reporting is built into the system. At the other hospitals, patients keep a manual log of their sugars, affording a different form of trust that can be suspended if HCPs suspect something may be ‘off’. Despite these differences, mistrust persists in both cities, and HCPs ask for honesty and invite patients to confess if their numbers are not exact.

Following Holmes & O'Byrne's "confession technè" and Mayes's account of pastoral power, I argue that this request for avowal/confession is the providers' strongest clinical tool. This speech act reconfigures the relationship and becomes a form of repair; like a broken bone, that bond grows stronger for having been broken and mended.

Mistrust within GDM care is often productive. It opens a truthful, patient-centered exchange, where the patient decides what and how information is disclosed, and knows herself better in accounting for doubt. Confession/avowal, I suggest, is the mechanism by which mistrust, across divergent infrastructures, generates new forms of sociality, rather than dissolving them.