An Annotated Bibliography of Literature on the Rhetoric of Health and Medicine

2001-2005

• Britt, Elizabeth. Conceiving Normalcy: Rhetoric, Law, and the Double Binds of Infertility. Tuscaloosa: University of Alabama Press, 2001. Print. This rhetorical study examines “how we define infertility families, and parents” and how law itself acts as a technology with the power to define normalcy and frame our everyday experiences (3). Based on eighteen months of ethnographic research, Britt argues that the 1987 Massachusetts mandate for reproductive insurance coverage acts as a technology that “sustains rather than resolves, the tensions between the normal and the abnormal” (2). As a form of what Foucault calls “biopower,” the mandate stratifies reproduction by encouraging some groups to reproduce and not others. It also medicalizes involuntary childlessness as “infertility,” locating the phenomena within the body as an object to be fixed, rather than a complex set of over-determined social factors. The ultimate problem, however, is that the mandate creates a double bind of both control and constraint for those who are encouraged to reproduce who are labeled as medically “infertile,” offering biotechnologies as both a hope and a responsibility for appropriate inclusion.
  Gender, STS
• Keränen, Lisa. “The Hippocratic Oath as Epideictic Rhetoric: Reanimating Medicine’s Past for its Future.” Journal of Medical Humanities, 22 (2001): 55—68. Print. Lisa Keränen examines the often epideictic nature of medical rhetoric; that is, its ability to display and perpetuate communal values and practices. She specifically discusses the Hippocratic Oath’s history as an epideictic piece, pointing out how various versions of the oath throughout history promote different ethical values. She stresses the need for the oath’s modification to fit modern-day clinical ethics so that the past may be “reanimated” for medicine’s future.
  Doctoring, Classical/Canonical Rhetoric
• Lyne, John, ed.  “Contours of Intervention: How Rhetoric Matters to Biomedicine.” Journal of Medical Humanities, Special Issue on Rhetoric and Biomedicine 22.1 (2001). Print. Lyne focuses on rhetoric as a decision-making art with the power to help negotiate the current medical pressures of time constraints, competing values, and human limitations (3). His term, “bio-rhetorics” refers to patterns of medical persuasion that “cut across disciplinary lines and draw from a pool of generally shared meanings” (narratives, metaphors, associations) (4). Using genome discourse as an example, Lyne traces the ways that metaphors in particular have impacted policy, shaped subjective identities, defined ideological arguments, and influenced medical practice. He argues that a metaphor can act not only as a discrete linguistic organism with a determined meaning and effect but also as an environment, providing the necessary conditions for new persuasive appeals, discursive patterns, and metaphors to emerge (9). He specifically calls for rhetoricians to take an active role in the language of bioethics in order to carefully position people toward an increasingly technologically driven world. This special issue also includes an article by Michael J. Hyde contesting Leon Kass’ definition of human dignity in the Euthanasia debate; an article by Mitchell and Happe about the difficulty of defining the subject when seeking participant consent for DNA research; an article by Celeste M. Condit and Deirdre M. Condit on gendered metaphors in genetics; an article by David Depew on tendencies of reductionism in contemporary Darwinian rhetoric; and an article by Keränen on the epideictic nature of the Hippocratic Oath (annotated above). The following issue, 22.2 (June 2001), also contains an article by Jonathan Sterne on the acoustic culture of medicine, which would be of interest to medical rhetoricians studying the rhetoric of listening.
  Ethics, Policy, Public Discourse
• Wilson, James, and Cynthia Lewiecki-Wilson, eds.  Embodied Rhetorics: Disability in Language and Culture. Carbondale:  Southern Illinois University Press, 2001. Print. This collection approaches disability studies from a specifically rhetorical standpoint, employing critical theory to consider “how the language of institutional discourse systems determines material practices in ways that can work to the advantage—and disadvantage—of the disabled person” (11). The contributors cover substantial scholarly ground, providing historical, cultural, economic, educational, legislative, medical, literary, and rhetorical analyses of disability from feudal times until today. Their chief concern is to articulate, interrogate, and challenge how the disabled and disability are and should be rhetorically constructed: not solely as a medical condition, or pitiful product of poor parenting, or individual affliction, or educational ineptitude. Rather, they should be constructed as “a more complex social construct, . . . a dynamic set of representations that are deeply embedded in historical and cultural contexts” (Barton 169)—as a socio-political construct for which all are responsible to confront. And, in her contribution, Pendergrass champions a rhetoric that the “disabled themselves will have the greatest part in crafting” (59). The book is an exemplary case of rhetorical, cultural analysis.
  Disabilities Studies, Policy, Public Discourse
• Brodkin, L. C. Rhetorical Training for Physician Assistants: Reuniting the Science of Medical Care and the Art of Medical Rhetoric. Diss. New Mexico SU, 2002. Print. Brodkin argues that rhetorical training for physician’s assistants—particularly those who work in family medicine clinics—would help bridge the gap between objectivist medical and subjectivist patient-centered care. While rhetorical situations in hospitals tend to be fast paced and difficult to navigate, family clinics are known for long-term report with patients, and for prevention education more so than intervention. Because of this, family care providers and PA’s particularly who are trained in rhetorical strategies of communication, could make all the difference in successful patient-centered care in the medical clinic.
  Doctoring, HCP-Patient Com, Pedagogy
• Mol, Annemarie. The Body Multiple: Ontology in Medical Practice. Durham, NC: Duke UP, 2002. Print. Although not a rhetorical project, Annemarie Mol’s work in ethnographic sociology has much to offer rhetoricians. Mol argues that theorists should shift their focus away from arguments about epistemological construction and focus instead on the material practices that make up how medicine is done. Her ethnography is not of a hospital, patient, or doctor but rather of a disease—atherosclerosis—and the way various people within various settings enact atherosclerosis. Using methods borrowed from actor network theory and science and technology studies, Mol observes both the discursive and empirical interactions that make up the disease and reports on patterns of operation. This includes a good bit of rhetorical analysis and linguistic theory. Chapter 6 may be the most useful in this regard. In it, Mol tackles the issue of medical deliberation arguing that, while gathering information and choosing a plan of action, the doctor allows the messiness of practice to remain in the foreground of his thought. Then, once he has made a decision about treatment, the practical nature of science is bracketed, and the diagnosis is thought of as a “fact,” until, that is, something causes the doctor to question his past decision, at which time he retraces his steps and allows doubt to enter the picture once again, in order to test whether there was any place where he might have gone wrong. This is a practical process, but it is also a rhetorical one. Mol describes the criticisms she sometimes receives from doctors, for stubbornly choosing to speak of all medical practice as uncertain rather than certain—she chooses to make a scientific reality visible (or audible) by rhetorically insisting upon it. In this chapter, Mol also critiques the American mentality and rhetoric of “choice” in medical care, arguing that the commercial healthcare system constructs an illusion of choice for patients who are in fact constrained by the options presented to them by advertisers and unable to make fully informed decisions about their health.
  Doctoring, Drugs/Pharmacy, STS
• Schryer, C.F., Lorelie Lingard, Marlee Spafford and Kim Garwood. “Structure and Agency in Medical Case Presentations.” Writing Selves/Writing Societies. Ed. Charles Bazerman and David Russell. Fort Collins, CO: The WAC Clearinghouse and Mind, Culture, and Activity, 2003. Print. Setting out to examine “the interactions of agents and their social contexts” through “structuration theory and activity theory” (65), the authors of this article analyze the transcripts of 16 oral case presentations performed by third year medical students. The (oral) case presentation is both a way for doctors to communicate information about their patients to peers and a teaching genre that allows students to demonstrate and collectively practice their clinical decision-making and problem solving skills. Schryer, Lingard, Spafford, and Garwood see the case study as a medical workplace genre that dialectically mediates between neophyte’s individual agency and their need to become part of the discipline’s social “habitus,” ideologically interpolating them into the system, while also allowing them to gain agency within it. They do this by the following: providing a time/space and structure necessary for students to make and insert choices; facilitating improvisation; offering a wide spectrum of (rhetorical/decision-making) strategies for students to choose from based on their activity systems and personal preferences; providing a hybrid location overlapping educational and professional space in which students may establish their authority; and by teaching students to “see the world from the perspective of that genre’s characteristic structure, register and syntax”—a perspective that may help or hinder future communication with patients (91).
  Doctoring, Pedagogy, PTWC
• Scott, J. Blake. “Extending Rhetorical-Cultural Analysis: Transformation of Home HIV Testing.” College English 65.4 (2003): 349—67. Print. In this article, Scott argues that one of the rhetoric of science’s primary goals should be to “map the connections and power relations among science’s heterogeneous actors,” what Vincent Leitch calls “the protocol of entanglement” (qtd. in Blake 355). By “elucidating” such entanglements, Scott suggests that rhetoricians may imbue power to those within socio-political, scientific, and especially medical discourse. In a way, Scott extends the call of Herndl in the rhetoric of science (1993), and Longo in technical writing (2000), to incorporate critical cultural studies into the rhetorical fields of English, and here, of medicine.
  Policy, PTWC, STS
• Scott, J. Blake. Risky Rhetoric: AIDS and the Cultural Practices of HIV Testing. Carbondale: Southern Illinois UP, 2003. Print. Using a “rhetorical-cultural approach,” Scott conducts a study of AIDS culture and HIV testing practices, focusing on how various parties—doctors, policy makers, corporations, AIDS patients, “risky” or at-risk patients, and the general public—engaged in deliberation and the practice of healthcare amidst the AIDS epidemic in America. Specifically, he considers problematic constructions of “risk” in AIDS testing materials as they varied across cultural strata. He argues that HIV testing “is a disciplinary diagnostic” that requires active, ethical intervention in order to provide just constructions of power within the AIDS community (9). In addition to its cultural studies approach, Scott’s work is strongly grounded in science and technology studies, giving attention to material and empirical practices, closely examining popular artifacts and providing diagrams of deliberative schemes driving systems of communication.
  Gender, Policy, STS
• Zerbe, Michael. “What’s Up, Doc? Approaching Medicine as a Cultural Institution in the Technical Communication Classroom by Studying the Discourses of Standard and Alternative Cancer Treatments.” Innovative Approaches to Technical Communication. Eds. Tracy Bridgeford, Karla Kitalong, and Dickie Self. Logan: Utah State University Press, 2004.  183-196. Print. Responding to a call for more critically and culturally aware studies of technical communication, Zerbe provides a pedagogical model for applying a cultural studies lens to scientific technical communication and/or medical writing courses. First, he offers strategies for persuading students that “medicine operates as a discursively governed cultural institution” (185), such as analyzing the rhetoric of medical debates, referencing current, well known medical research endeavors (his example is the genome project), and pointing to cultural artifacts that clearly convey the meaning/significance culture places on such projects (his example is the film Gattaca). Second, Zerbe provides a research assignment for students that highlights the discursive differences between mainstream and alternative medicine. He asked students in his technical and scientific editing course to compare two different cancer treatment websites: one by the National Cancer Institute and the other by a Chinese based “alternative” medicine group. Students analyzed pages based on four questions: “1. Which of the sites do you find more credible? 2. What specific features of the sites . . . contribute to your conclusion? 3. What other . . . life experiences . . . help you reach this conclusion? 4. What would you do to the sites as a Web editor to boost their credibility?” (191). Zerbe describes his own class’s response to the assignment, modeling how teachers can lead students through the analysis.
  Pedagogy, PTWC
• Barton, Ellen, ed. “Introduction to the Special Issue: The Discourse of Medicine.” Special Issue of Journal of Business and Technical Communication 19.3 (2005): 245—48. Print. In this special issue of JBTC, Barton selects articles that represent the interdisciplinary contributions that TPC is making to medical discourse, exemplifying the theoretical, methodological, and overall research and results being generated at the time. Schryer and Spoel suggest genre theory as an interdisciplinary approach to medical discourse that produces results valuable to those in technical communication as well as medicine. Popham (reviewed below) considers standard office forms as boundary objects between the interdisciplinary workings of medicine, science, and business. Koerber applies critical theory to medical standards of breastfeeding and the rhetorical role of metaphors in bodily discourse. Similarly, Turner offers a critical perspective of the two junctures in genetic medicine, arguing that the representational shifts in gene data, screening and application are crucial sites of inquiry for medical rhetoric. Ryan utilizes a combination of fieldwork and textual analysis to analyze the editorial choices of MAMM magazine, as the editors negotiate medical and popular rhetorics about breast cancer.
  Gender, Genre, PTWC
• Bates, Benjamin R. “Senator Bill Frist and the Medical Jeremiad.” Journal of Medical Humanities 26.4 (2005): 259—72. Print. Bates conducts a rhetorical analysis of Senator Bill Frist’s 2001 address to the American Society of Thoracic Surgeons. He argues that the speech constitutes a “medical jeremiad”calling physicians to take up their traditional post as a priestly order in society, with nostalgic appeals to pathos that prophetically interpolate the audience as a “chosen people” (263). Frist invokes physicians’ rights and responsibility, as leading members of society, to take an active role in reforming healthcare, not just as “medical entrepreneurs” but as “involved member[s] of a community” (261). Bates sees Frist’s call as a rhetorical response to the growing negative views in America toward physicians and the biomedical system as a whole and as an attempt to combat this historical suspicion by reconstructing collective physician ethos.
  Classical/Canonical Rhetoric, Doctoring, Public Discourse
• Montgomery, Kathryn.  How Doctors Think: Clinical Judgment and the Practice of Medicine. New York: Oxford University Press, 2005. Print. As an English Ph.D. who has taught medical students for several decades, Montgomery offers a wealth of insight into the epistemological training of physicians. Drawing from Aristotle’s definitions of knowledge, she argues against the myth that medicine is a science, demonstrating instead that it is a science-using practice, or phronesis reasoning, grounded in contextual experience. Her book is a critically informed look at clinical judgment, how it plays out in the various settings and scenarios physicians are faced with on a daily basis, and the ways that socio-cultural expectations of scientific mastery clash with the reality of medical uncertainty. This book is in fact a follow up to her 1991 book Doctor’s Stories, but it is written for an academic and general public rather than for medical practitioners.
  Classical/Canonical Rhetoric, Doctoring
• Heifferon, Barbara. Writing in the Health Professions. New York: Allyn & Bacon/Longman, 2005. Print. This text is part of the Allyn and Bacon Series in Technical Communication, edited by Sam Dragga out of Texas Tech University. The series and Heifferon’s text are meant to “meet the continuing education needs of” PTCs and students at the graduate and undergraduate level (xiii). This volume covers the basics of copyright, document design, HIPAA, and various medical genres such as patient charts, exam records, reports, and educational materials. It also provides guidelines for carrying out a public health campaign and applying for grants. Finally, it ends with an entire section considering the ramifications of multicultural and international communication, visual communication, and electronic medical writing.
  Genre, PTWC
• Pender, Stephen. “Between Medicine and Rhetoric.” Early Science and Medicine 10.1 (2005): 37—64. Print. Stephen Pender’s 2005 article in Early Science and Medicine traces the classical association between medicine and symboleutic rhetoric, from Ancient Greek through early modern England. As the philosopher Cabanis pointed out in the eighteenth century, both rhetoricians and doctors must come to decisions by constructing universal conclusions from a few subjective and uncertain reports—an impossible task. Also, both practitioners are “pragmatic interventionists” in society. Pender argues, with Cabanis, that “rhetorised logic” can offer clinicians in our highly scientized world models of reasoning which would balance the general with the particular in order to offer “practical intervention devoted . . . comfort, or cure” (39, 41).
  Classical/Canonical Rhetoric, Doctoring, History
• Popham, Susan. “Forms as Boundary Genres in Medicine, Business, and Science.” Journal of Business and Technical Communication 19.3 (2005): 279-303. Print. Starting from the understanding that medicine is an interdisciplinary practice, Popham considers the ways that patient forms constitute boundary objects or boundary genres between medicine, business, and science. Specifically, she considers the patient examination form, patient visit form, diagnosis form, insurance form, and the billing claim. She looks for rhetorical patterns that reveal the constructed nature of particular fields sharing the genre. By analyzing examples of reflexion, translation, and distillation in this genre ecology, Popham identifies key tensions between business, medicine, and science, which in turn help us better understand conflicts between these fields in the world at large.
  Genre, PTWC
• Preda, Alex. AIDS, Rhetoric, and Medical Knowledge. New York: Cambridge UP, 2005. Print. Preda conducts a rhetorical analysis of medical journal articles on Acquired Immunodeficiency Syndrome from 1981 to 1989 published in the top five prestigious journals, which have been involved in the conversation from the first year of the virus’ emergence until now. Preda investigates how rhetorical metaphors and narratives of “risk” relate to scientific hypotheses about transmission and infection of AIDS, and, in turn, how these rhetorical patterns effect research funding, prevention, and advocacy. Preda relies heavily on the rhetoric of science, actor network theory, and speech act theory to conduct his analysis.
  Gender, Medical Research, Policy
• Segal, Judy Z. Health and the Rhetoric of Medicine. Carbondale: Southern Illinois UP, 2005. Print. Segal builds on classical rhetorical theory, Burke, and Foucault in order to conduct her investigation of the persuasive elements of clinical and public medical discourse. After providing a genealogy of medical rhetoric in the introduction, Segal uses chapter 1 to “re-re-present” the recent history of medicine (1800-present) in light of kairotic, rhetorical shifts (17). Chapter 2 considers the physician’s construction of a patient with invisible pain symptoms vs. perceptible ones and how these differences impact the doctor-patient interaction, treatment, and outcomes. Chapter 3 argues that illness narratives or pathology publication rhetoric is epideictic and outlines several tropes that define the values of this genre. Chapter 4 uses Burke’s Grammar of Motives to analyze the persuasive components of hypochondria. Chapter 5 describes the difficulties that arise from the incommensurable narratives of death held by doctors on the one hand (death as failure) and patients on the other (death-as-part-of-life). Chapter 6 elaborates on Segal’s 1997 article about medical metaphors (health-diagnosis, medicine-war, body-machines, medicine-business, person-genes) and how they shape/constrain healthcare discourse and policy. Chapter 7 considers the imperative of ethos construction on the part of physicians in order to successfully persuade patients regarding treatment decisions. Segal concludes with an argument for what rhetoric has to offer medical practice, that is, insight into everyday success and failure of healthcare endeavors.
  Classical/Canonical Rhetoric, HCP-Patient Com, Public Discourse