Ethics and the Daily Language of Medical Discourse

Abstract

Ethics and Daily Language of Medical Discourse Medicine is and always has been a profession that relies heavily on narrative. [1] Considerable writing has been done about psychiatric study as literature, but medical report can also be approached from a literary perspective and studied with many of same methodologies that one would apply to a literary genre. [2] The work of French theoretician Jacques Derrida is especially applicable to medical discourse. In Of Grammatology, Derrida States that words, either written or spoken, are an alteration of an actual presence, that is, immediate event or experience that is being put into words. [3] Language appropriates and inevitably alters reality by representing it and making it a reflection of speaker's (or writer's) perspective. In this way, Derrida considers use of language to be an activity of violence. The French word, with less of a physical connotation than English cognate, serves to suggest artificiality of language and ways it can manipulate reality. (*1) This sense of violence can be seen in creation of medical report. At moment of medical event, patient (in most cases) tells his or her to a physician. The physician--for example, a physician in emergency room--begins to manipulate that narrative by posing certain questions and organizing information to conform to format of medical report. If patient is admitted to hospital, ER physician will probably present case at morning report. A new physician, armed with patient's medical record, sees patient and adds to that record. The case is then presented repeatedly at morning rounds or attending rounds--often in absence of patient. With each retelling, presence of patient is further abstracted. The above description assumes presence that is verbalized for first time is encounter of physician and patient. The presence, however, could also be seen as experience that brings patient-to-be, voluntarily or not, to physician. Distinguishing between these two events, one centered in consciousness of patient and other in consciousness of physician, raises an issue central to theory and practice of medicine: Is story being told in medical report story of patient's life or of physician's relationship with patient's illness? The tension between these two possibilities is a frequent factor in various ethical dilemmas. Derrida remarks that when speech or writing replaces an actual presence, it becomes a of reality that can make one forget vicariousness of its own function. [4] This raises particular challenges for medicine. The report, by very nature of its purposeful, carefully ordered creation, runs danger of displacing (or replacing) in a reduced form unorganized, overwhelming amount of information contained in very presence of patient. This reduction, in turn, can lead to depersonalization of patient. The common criticisms of physicians who refer to the gall bladder in Room 204 clearly reflect an awareness of dangers that threaten when words replace reality. Derrida indicates that this symbolic reappropriation is an attempt to organize, and hence master present with words. In medical report, that present can be either patient or patient's illness. In this process, details of patient's life that are chosen to be reported by physician reflect methods--and values--of medicine, which emphasize diagnosis and treatment and support a belief in system and objectivity of medical science. When this happens, genre or text begins to control its writers. As Derrida observes: [T]he writer writes in a language and in a logic whose proper system, laws and life his discourse by definition cannot dominate absolutely. …