Disease narratives: Constituting doctors

Abstract

In the course of their clinical training, medical students are taught how to take histories from patients and examine them physically, a process known as 'clerking'; students then 'present' the clerked patient to a critical supervising doctor. The author shows how, during the course of such presentations, students learn and are taught the traditional format of clinical narratives, the aim of which is to produce a diagnosis, preparatory to medical treatment. These 'disease narratives' are discussed and interpreted, along with their similarities to written scientific language and detective fiction. It is argued that medical students, in the process of constructing such narratives on the basis of which they are themselves examined by doctors, transform and constitute themselves as well as their patients. Finally, the author points out the major obstacles to introducing alternative, patient-centred therapeutic narratives into clinical training.