Abstract
Modern clinical case reporting takes the form of problem-solution narratives that redescribe symptoms in terms of disease categories. Authored almost always by those who have played a part in the medical assessment of the patient, reports historicise the salient details of an individual's illness as a complex effect of identifiable antecedent causes. Candidate hypotheses linking illness to pathological mechanisms are suggested by the patient’s experience, and by data that emerge from clinical examination and investigation. Observational and interpretive statements from these considerations are fitted into a temporally inflected account of the patient’s medical condition, configured from the vantage point of hindsight. Drawing on established forms of deferred telling, readers are invited to follow a story that drip-feeds a mixture of contingent and non-incidental information into the account, which engenders and frustrates curiosity, creates expectations, and challenges powers of reasoning and pattern recognition. Whereas case reporting once favoured memoir, the sentimental tale and eccentric biography as the means by which its historical narrative was cast, the preferred genres of contemporary case reporting include detective fiction, and puzzle and riddle narratives, formats that conceptualise the medical consultation in narrow problem-solution terms.
Highlights
Modern clinical case reporting takes the form of problem-solution narratives that redescribe symptoms in terms of disease categories
Whereas case reporting once favoured memoir, the sentimental tale and eccentric biography as the means by which its historical narrative was cast, the preferred genres of contemporary case reporting include detective fiction, and puzzle and riddle narratives, formats that conceptualise the medical consultation in narrow problem-solution terms
Authored almost invariably by those who have played some part in the medical assessment of the patient, published case reports are crafted statements of witness marked by scene-setting strategies and graphic descriptions of clinical findings
Summary
Modern clinical case reports are problem-solution accounts of how an individual’s felt experiences of illness have come to be understood in terms of disease categories. Despite its brevity the vignette ties together four individuals in a pairwise cooperative venture that shifts attention away from the ostensive medical focus on a cause and effect relationship of clear therapeutic benefit to the human relationships involved in the clinical scenario It thereby illustrates George Rousseau’s claim that ‘every time a patient enters a practitioner’s office a literary experience is about to occur: replete with characters, setting, time, It is not clear whether this account, written by a group of physician-scientists (one of whom several years later published a systematic review of case series featuring this manoeuvre) arises from personal witness; the fact that it is written in the third person suggests it may be a composite of several cases of this complaint and its treatment, an illustration of a typical example of it. ‘Narratology and the History of Science.’ Stud Hist Phil Sci 1995 vol 26.1, 1e71 at 56
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