Podiatry and diabetes : an exploration in specialism

Within healthcare, the concept of specialisation remains both poorly defined and under-debated in the literature. This research analyses the concept of specialisation and assesses the maturity of the concept of the diabetes specialist podiatrist; tracing the origins, change over time and current status of podiatric specialisation in diabetes. Literature pertaining to the legal implications of specialist practice, settings and titles is reviewed and a definition of specialisation within the context of healthcare is proposed. The initial concept analysis led to refinement of research questions which directed further enquiry. Because answers to the research questions lie within the knowledge and experiences of key actors, managers and individual podiatrists who have held specific posts; a qualitative methodology featuring focus group and key actor interviews was utilised. The meaning of podiatric specialisation in diabetes, how diabetes evolved as a podiatric specialty, the impact of specialist titles and the longer-term, wider implications which accompany specialisation were explored. In presenting analysis of the data, the researcher focuses on theory which illuminates the findings. The centrality of Weber’s concept of charismatic authority to the development and contemporary face of specialist practice is illustrated by the data; thus it represents a guiding theoretical concept within the author’s thesis. Documentary analysis was used as a triangulation strategy, in a bid to corroborate findings elicited through interview techniques. The documentary data also illustrates both the scale of and the context within which podiatric specialisation in diabetes evolved – not in isolation, but rather as one of many specialist foci.