Look who's not talking: Recovering the patient's voice in the clinique

Abstract

Almost everyone agrees that doctors' handwriting is not the only indecipherable and alienating communication practice in healthcare. The oral communication between doctors and patients is equally problematic. Few scholars in the field of rhetoric have attempted to analyze why and how these discursive practices have come about. Equally absent from the medical and rhetorical fields are alternative models that construct a better discourse between doctors and patients. My dissertation, Look Who's Not Talking: Recovering the Patient's Voice in the Clinique, not only examines how doctors talk to patients, but also begins an effort to change present discursive practices in healthcare. Michel Foucault began an academic conversation in The Birth of the Clinic and in Power/Knowledge that deconstructed certain institutionalized discourses. While his study went a long way toward analyzing the discourse of medicine, his language and theories have not moved into medical journals or patient rooms. My dissertation acts as a bridge between "high" rhetorical theory and the "marketplace" of medicine (an unfortunately apt metaphor for healthcare in this country). Foucault supplies one of the lenses I use to look at the discourse. Other lenses include those of Kenneth Burke and Lloyd Bitzer. One underlying assumption in the dissertation is that practices are more easily changed once they have been analyzed. I place the analysis within history and within current contexts. This strategy enacts a model opposing the usual acontextualized, ahistoric doctor/patient discourse. Both chapters 3 and 4 look at how doctor/patient discourse was constructed in Europe and America. In addition to making a contribution to the medical field, this dissertation breaks new ground within rhetoric and lays the basis for further explorations. Because of my extensive work in the healthcare field as cardio-pulmonary technician and special procedures nurse, I was able to draw on my own experience to use as examples of the particular problems within the discourse I isolate and propose alternatives to. The fifth chapter features a two-semester course I designed for first-year medical students. This course is rhetorically based and teaches doctors-to-be why the language they use with patients is important and how to effectively address patients.