The present paper is a commentary on an article by Drew Leder [1]. Leder identifies a series of texts in the clinical encounter, emphasizes the central role of interpretation in making sense of each of these texts, and articulates ordering principles to guide the interpretive work.The metaphor of clinical work as textual explication, however, creates the expectation that there is a text somewhere to be found. Such an expectation invites doctors and patients to search for the text and runs the (...) risk of conceptualizing patients as more static than they are. If one is to use the textual metaphor, one must appreciate the radical extent to which the clinical encounter is a mutually produced and shifting entity. The qualities of mutuality and indeterminacy are not those one usually associates with texts. One might ultimately be better served by a different metaphor based more directly on uncertainty. (shrink)

In this essay, I argue that traditional medical views of illness systematically exclude intuitive knowledge from their description of disease and thus result in a functionally impressive but humanly ungrounded medicine. Physicians trained in a technologized anatomico-pathologic view of disease find themselves cut off from much of what they knew about illness when they began their training. Not only do they lack a rigorous or formal way to confront the non-technical aspects of medical practice, but many have even lost sight (...) of the motives for medicine. I argue here for an intuitively based humanly grounded ontology of illness. Such an ontology begins in an understanding of the experience of the sick person rather than in an "objective" description of pathology. It is only through a science of illness-as-lived that one may achieve a truly humanistic medicine. CiteULike Connotea Del.icio.us What's this? (shrink)

Book reviewed in this article: Ethics and the Clinical Encounter. By Richard Zaner.