Paradigms and politics: shaping health care access for sickle cell patients through the discursive regimes of biomedicine.

The emergence of two different sickle cell disease and disease/treatment paradigms in two clinics, Children's Hospital West (CHW) and Children's Hospital East (CHE), demonstrates how physicians can influence institutional regimes of truth to improve patient access. Physicians at both clinics, far from simply acquiescing to dominant biomedical paradigms, recognize that their paradigms are in part rhetorical strategies designed to subvert problematic staff biases and perceptions, and to encourage a particular "self-efficacy" ethic in the patients. This paper positions physicians as struggling within the discursive regimes of biomedicine to create an institutional space where the disease and the sickle cell patient matter, and where patients comply with the performative rules of that space. This paper explores how physicians, patients, and institutions collaborate in the construction of sickle cell disease in such a way that biomedicine becomes a plural, as opposed to a singular and oppressive, discursive regime.