Notes on the Sociology of Medical Discourse: The Language of Case Presentation
Опубликовано на портале: 23-03-2007
Journal of Health and Social Behavior.
1988.
Vol. 29.
No. 4.
P. 357-375.
Тематические разделы:
This paper examines a segment of medical social life that has not been studied extensively:
formal presentations of case histories by interns, residents, and fellows. Because
they are presented by physicians in training to their status superiors, who are evaluating
them, case presentations are exercises in self-presentation which serve as a vehicle
for professional socialization. This analysis of the language of case presentation
is based on case presentations collected in two intensive care nurseries and an obstetrics
and gynecology service. Four features of case presentation are identified: 1) the
separation of biological processes from the person (de-personalization); 2) omission
of the agent (e.g., use of the passive voice; 3) treating medical technology as the
agent; and 4) account markers, such as "states," "reports," and "denies," which emphasize
the subjectivity of patients' accounts. The language of case presentation has significant,
if unintended, consequences for those who use it. First, some features of case presentation
eliminate the element of judgment from medical decisions and mitigate responsibility
for medical decision making. Second, some are rhetorical devices which enhance the
credibility of the findings that are presented. Third, the language of case presentation
minimizes the import of the patient's history and subjective experience. Finally,
case histories socialize those who present them to a culture or world view which
may contradict the explicit tenets of medical education.
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