Suzanne Poirier

The voices of the medical record

The medical record, as a managerial, historic, and legal document, serves many purposes. Although its form may be well established and many of the cases documented in it ‘routine’ in medical experience, what is written in the medical record nevertheless records decisions and actions of individuals. Viewed as an interpretive ‘text’, it can itself become the object of interpretation. This essay applies literary theory and methodology to the structure, content, and writing style(s) of an actual medical record for the purpose of exploring the relationship between the forms and language of medical discourse and the daily decisions surrounding medical treatment. The medical record is shown to document not only the absence of a consistent treatment plan for the patient studied but also a breakdown in communication between different health professionals caring for that patient. The paper raises questions about the kind of education being given to house staff in this instance. The essay concludes with a consideration of how such situations might be more generally avoided.

Charting the Chart—An Exercise in Interpretation(s)

The multiauthored article is standard in the medical sciences, where the politics of the laboratory and the academy often loom larger than the singularity of the argument or grace of its execution. The following paper, however, depends upon the singularity of each of its authors and hails the individual grace of their arguments. Although collaborative, this paper is primarily collective, composed of unique readings of the same document. In its array of individual viewpoints and interpretations, it underscores the collective nature of the entries that constitute the single entity identified as the chart. As the record of one patients hospitalization is really a diverse collection of individual voices as well as professional interactions or viewpoints, so the responses of these readers are unique to each ones personal and professional backgrounds.1 —Suzanne Poirier, Ph.D., Literature2

Exploring (un)common ground: Communication and literature in a health care setting

In this article, a claim is made for the usefulness of integrating communicative and literary analysis as a way of studying the symbolic and pragmatic aspects of human relationships. Using this interdisciplinary approach, a course has been designed to teach practitioner‐patient communication to students in the health professions through the application of theory to literary “case studies.”; The major communication concepts emphasized are content and relationship, symmetrical and complementary interchanges, and rhetorical sensitivity. Literary concepts which are highlighted include narration, symbolism, and the reader‐text relationship. An analysis of a scene from The Elephant Man demonstrates this pedagogical approach. Conceptual and methodological implications for each discipline which grow out of this collaboration are explored.

Moral reasoning and Alzheimer's care: Exploring complex weavings through narrative

Abstract This article reports on selected results of an inquiry-guided study in which we used literature and autobiography to challenge current rationalist perspectives on the use of formal services by caregivers of Alzheimers sufferers. Starting with Gilligan s concepts of two basic forms of moral reasoning—justice versus care-based—we interpreted the moral reasoning about caregiving expressed in four novels: Diary of a Good Neighbor, Memory Board, Memento Mori, and The Other Side. Although we found Gilligans dichotomous framework not directly applicable, we did find ample evidence of the salience of moral reasoning to questions of who should care and on what basis. We also found that stories, as they are woven from threads of family history, social position and mores, as well as ideas about intimate love, religion, and autonomy, reveal the interconnectedness of so-called private choices to the social ideologies that constrain and shape these choices.

Difference and Identity: A Special Issue of Literature and Medicine

In an increasingly diverse society, it is essential that medicine be aware of matters of difference. Medical humanities programs promote awareness of the social aspects of medicine, and the Association of American Medical Colleges has recently instituted cultural competencies for clinical interaction for the training of medical students. Yet these efforts to impart understanding of the cross-cultural aspects of medicine are still hindered by a significant limitation: within a medical system whose currency is diagnosis, difference is primarily defined through disease. This special issue of Literature and Medicine focuses on difference and identity in the context of disease and disability. The articles collected here explore the complex ways in which notions of disease, disability, and difference are related and in which bodies marked by gender, race, disability, sexuality, and ethnic identities experience disease in specific ways. The essays take a humanities-based approach to the subject and emphasize an awareness and sensitivity to difference through forms of symbolic representation such as metaphor and narrative. This volume provides a heuristic lens through which relationships between individual expressions of identity and communal experiences of difference can be considered. Each article speaks to the process whereby individual stories and strategies shape, and are in turn shaped by, the institutions they seek to transform. Literature and Medicine is devoted to exploring interfaces between literary and medical knowledge and understanding. The journal showcases the creative and critical work of renowned physician-writers, leading literary scholars, and medical humanists.

Stories of Family caregiving: Case studies in moral reasoning

Family relationships are complex, interdependent, multifactorial, cultural, and sociopolitical. In instances of family caregiving, the dynamics of these relationships influence the well-being of all members. This paper will address one dynamic of family relationships, moral reasoning, as set forth in the theories of Carol Gilligan. Gilligans theories about two patterns of reasoning, based on the ethics of justice and care, will be examined within “stories” from fiction and interviews with family caregivers. This examination will raise issues about Gilligans theories as well as about the literary works themselves and will suggest new ways for health professionals to work with family caregivers.

Stories of Family Caregiving: Reconsiderations of Theory, Literature, and Life

between trained teachers who wcre ot wcre not nurses. Perhaps we were part of the grass roo^ efbrt but not identified. More research may be needed. Dr. Morgen has untangled complar group relationships and wena char shaped the womens health movement during an era marM by rapid social change. This is a useful organizational history based on sound documenration and a strong feminisr perspective. Her analysis of rht changing values and priorities of the national government during this era was enlightening and is worthy of serious consideration hr he nurse historian doing research on the late twentieth century.

Emma Goldman, Ben Reitman, and Reitman's wives: A study in relationships

Emma Goldman — Voltarine [l]e Cleyre — Louise Michels — Women Rebels — Angela Balabanoff — Anna Bessant — Maria Breshkovski — Margaret Fuller — Frances Wright — Blatavsky — Florence Nightingale — Madame Curie — Mary Baker Eddy1

A Physician's Metamorphosis

clearly suggests that a comprehensive account cannot fail to assess selfexperimentation. Difficulties in Veatchs analysis suggest that universal priorities cannot be profitably set at the level of principles. Following the National Commission, Levine endorses the most promising theoretical approach of seeking a sensitive balance among the various moral considerations implicated in the conduct of clinical research.