The Rhetorical Nature of Medicine   3 comments

This week’s discussions of medical authority and rhetoric have indeed been fascinating.  I especially liked Segal’s definition of disease as “a pronouncement of someone authorized to make such a pronouncement” (80).  Indeed, It is the dominant medical paradigm that possesses the authority to define what is and isn’t relevant.  Further, “Diagnosis is a particular kind of speech act requiring a particular kind of speaker.”  Here I envision someone in a white labcoat saying, “Well we have your lab results back, and you have [insert ominous-sounding disease name here].”  Both disease and diagnosis, then, are at least partially socially constructed and legitimated.

This dominance that medical professionals retain is also demonstrated in Lay’s statement, “Today, pregnant women often identify the first time at which they began to fully sense their babies as that moment when their physicians or technicians share with them an ultrasound image” (23).  This testifies to the power that medical practitioners wield in our society.  Only when women are told or shown by someone in a position of authority that they carry a baby can they identify as mothers, as if they won’t believe or acknowledge it until someone in a position of power allows them to see inside their own bodies.

Again I feel compelled to discuss my mother’s experience as an OB/GYN nurse practitioner, related especially to this topic as it is.  At her practice (4 doctors, 3 certified nurse midwives, and a nurse practitioner), both the midwives and my mother work under the purview of one of the doctors who is ultimately, hierarchically, the caregiver in charge and is responsible for anything that could go wrong.  Both my mother and the certified nurse midwives (CNMs) have gone through the Master’s level of graduate education to receive certification and official sanction from the medical community.  The CNMs do not carry out home births; all of their deliveries take place at a hospital, though they may not perform surgical procedures such as C-sections.

On the other hand, licensed midwives have completed an exam that allows them to assist mothers who choose to deliver at home.  A caveat for what follows: based on our experiences and backgrounds, my family — which includes myself, my father, and my mother — strongly adheres to the modern medical paradigm.  My mother tells me of terrible tragedies she has witnessed in emergency rooms as a result of licensed midwives who have delivered babies at home and have missed vital indications of hemorrhage, cranial injuries, and other problems that probably could have been avoided if carried out in a hospital by a doctor or CNM.  In her own words, she is “appalled” that licensed midwives are allowed to operate in Florida without thorough medical training or education.  I will be the first to note here that obviously she possesses a strong bias towards the current medical profession as she has been an adherent of it since her early days as an ER nurse in San Diego.

How bad is it for us to put our trust in the dominant paradigm?  Any paradigm is going to have its downfalls and undergo change.  It should be the goal of any contemporaneous paradigm to improve upon what is known to be lacking.  Interestingly enough, this talk of paradigms reminds me of Thomas Kuhn’s Structure of Scientific Revolutions, wherein, every so often, the body of knowledge in a field experiences a change that both builds upon and reassembles the previous knowledge.  Is viewing the medical profession similarly to a scientific paradigm an appropriate comparison?   I think we can benefit from the mechanistic machine-view of modern medical science as long as we recognize its shortcomings and seek to reconcile them with a healthy dose of rhetorical awareness.

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Posted September 13, 2010 by wdorner in Uncategorized

3 responses to “The Rhetorical Nature of Medicine

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  1. Will asked: How bad is it for us to put our trust in the dominant paradigm?

    Food for thought, Will! I appreciate your sharing of your mother’s experience. But, to take a stab at answering your question, first we have to consider how those dominant paradigms are formed? Are they formed under the auspices racism, homophobia and sexism? Do they operate under assumptions regarding what kind of knowledge is valuable and eschew alternative ways of knowing? I think both Segal and Lay inform us about these questions.

    Is the “default” setting always the best one, or does it depend on your personal goals, values, even aptitudes?

  2. Thanks for the comment, Jen, and I agree: we need to be mindful of the influences behind a system instead of blindly accepting it.

  3. Rebell against the paradigm! Revolt! 🙂

    Well, no, really, there must be that happy balance. For instance, UCLA’s East-West Medical Center likes to find balance.

    It’s very hard to escape the paradigm within the tightfisted control of a hospital’s beaucracy. But there have been innovations towards finding a balance.

    —Genevieve

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