When it comes to controversies, people can either focus on building boundaries or bridges.

Louisiana Tech Communication and Media Studies Professor Dr. Jessica Houf is focusing on both in her new research on doctors and their communication with patients.

Houf published her latest article “Boundary Work and Boundary Objects: Synthesizing Two Concepts for Moments of Controversy” in the Journal of Technical Writing and Communication. In it, she focuses on how patients and doctors discuss controversial treatments, like the use of fecal microbiota transplants (FMT).

“Doctors and patients have a key boundary between them: doctors are experts in medicine, and patients often are not,” says Houf.

This boundary exists thanks to what’s called boundary work, or the establishment of differences between groups of people. Doctors are doctors in part because of this boundary work: they go to medical school and get licensed to practice medicine. Patients typically don’t have these credentials.

But when it comes to some diseases, such as recurring Clostridium difficile infections (C. diff.) – a deadly disease that kills tens of thousands of Americans a year – patients can run out of patience with doctor-approved treatments.

“Antibiotics are a common treatment for C.diff infection, but they ironically are also the cause of C.diff infections,” Houf said. “When a patient has recurring C. diff infection, they suffer greatly and may request getting an FMT to avoid surgery,” despite their doctors arguing against that treatment.

This leads to some patients taking their treatment into their own hands, doing FMT at home and without medical supervision. Such disputes between patients and doctors reflect the boundary work between groups of people or types of knowledge and experience.

How do we cross such boundaries and get patients and doctors working together? Houf shared a different way of thinking about boundaries, “boundary objects,” a concept from the sociology of science. She then looks at the “M” – microbiota – in “FMT.”

“The human microbiome is a new object for inquiry. It’s interdisciplinary – so many fields are looking at the collections of microbes that live on and in our bodies. Keeping those microbes in balance is now seen as a key to health.”

As an interdisciplinary object at the boundary of many fields, microbiomes allow people from a wide range of disciplines, medicine, genomics, data science – to communicate and collaborate. They can even do so while disagreeing.

“Boundary objects allow people to talk to each other, even in spite of controversies,” Houf said.

And because FMT involves transplanting not just human feces, but human microbiota, FMT allows for patients and doctors to talk about fecal transplants in a new way: as cutting-edge medicine. FMT is now increasingly accepted by doctors as a treatment for recurring C.diff infections, but the treatment does have risks.

Houf is currently working on a new article on how humans and bacteria relate to one another, as well as a book, tentatively titled Bacteria, Bodies, and Boundaries for Michigan State University press.