1 .Doctor–Patient Communication
2 .Medical Language and Discourse Genres
French writer Julien Green once observed that while thought
flies, words walk. Jammal (1988) comments similarly that science flies and its
terminology walks – typically at a pace that lags far behind scientific
advances. There is less literature than one might expect on medical language,
the occupa- tional register of a tribe of white-coated speakers that gets
passed from one genera- tion of physicians to the next through the highly
ritualized institutions of medical education. It is widely recognized as what
sociolinguistics would call an “in-group dialect,” i.e. largely opaque outside
the medical “confraternity.”
2.1 Spoken and written genres
The literature on medical language tends to
concentrate in two areas: doctor–patient communication (section 1 above and
Ainsworth-Vaughn, this volume), where the focus is on spoken discourse, and the
language of particular genres of medical dis- course. The latter are primarily
written humanitarian values or a service orientation.
2.2 The lexicon and semantics of medicine
From a statistical study of 100,000 words from
medical English texts, Salager (1983) distills “the core lexis of medicine”
across specialties, while Jammal (1988) looks at how and why (mainly how) the
technical vocabularies of medical specialties come to be constituted. Based on
his experience compiling a dictionary of epidemiology, he offers a practical
guide to the creation of terminology for fields of specialization. Since the
dictionary he worked on was bilingual (French–English), he pays particular
attention to problems of translation from English, the international language
of medi- cine (see Maher 1986).
Depersonalization, i.e. the separation of biological
processes from the individual.
See the opening
sentence of the excerpt above; throughout this excerpt the woman is referred to
as “the patient” or “she,” no name, and ellipted altogether from statements of
the physician’s observations (“positive for. . . ,” “remarkable (only) for . .
.”). 2 Omission of agents, e.g. through existential “there was. . .”
constructions and agentless passives. These have the effect of emphasizing what
was done rather than who did it let alone why a decision was made to engage in
a given course of action.18 3 Treating medical technology as the agent (“The CT
scan revealed . . . ,” “Angiography showed . . .”). These formulations carry
the process of objectification a step further than the passive voice: not only
do the writers fail to mention the person(s) who performed the diagnostic
procedures, but they also omit mention of the often complex processes by which
angiograms and CT scans are interpreted. In treating medical technology as if
it were the agent, such formulations support a view of knowledge in which
instruments rather than people create the “data.” 4 The use of non-factive
predicators such as “states,” “reports,” and “denies” (Anspach calls these
“account markers”), which emphasize the subjectivity of the patient’s accounts.
3.1 Narrative in medicine
Narratologists who have studied (nonfictional) narrative are
keenly aware that what storytellers provide is not a verbal icon of a
pre-existing structure of real-world experience. Rather, they cull from, and
configure, the experiential database from which the story is constructed,
notably in ways that support “the point” they wish to make in telling the story
(see, e.g. Labov 1972; Fleischman 1990: section 4.1). This commonplace of
narratology comes as “news” to at least some researchers who have undertaken to
analyze medical case histories from a narrative point of view.
3.2 Narrative “voice” and point of view
Literary narratology insists on a distinction
between “narrative voice” (who is speak- ing?) and “point of view” (whose
perception orients the report of information?).23 Since narrators commonly
undertake to tell what other individuals have seen or experienced (this is
standard in the medical chart or case history, where the patient’s words and
experiences are entered into the record using the physician’s language), it is
necessary to keep these two notions distinct at the theoretical level. In
theliterature on medical discourse the two notions are often conflated and the
terms used inter- changeably. Poirier et al.’s discussion of “the absent voice
of the patient” (1992: 7–9) is really about the absence from the chart of the
patient’s point of view (they mention
3.3 Pathography
Narratives about an experience of illness have proliferated
in America over the past several decades, notably in the form of biographies
and autobiographies oftenreferred
The nominalization of disease
Warner’s most interesting remarks concern lexical
categorization and grammar. The use of nouns instead of verbs to express the
idea of illness (he has cancer/hypertension
