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

2006-2011

• Charon, Rita.  Narrative Medicine: Honoring the Stories of Illness. New York: Oxford, 2006. Print. Award-winning and highly acclaimed doctor, literature PhD, and professor at Columbia University College of Physicians and Surgeons, Rita Charon has played an instrumental role in founding, theorizing, and professionalizing narrative medicine as a clinical field. In this, one of her landmark works, Charon outlines the theoretical basis for narrative medicine and its practice based on its roots in “literary studies, narrative theory, general internal medicine, and bioethics” (x). The book is a primer for those coming into the field and a manual for those teaching the subject, particularly in medical contexts. She offers four types of divides between patients and health care professionals, five narrative features of medicine, five close reading strategies, and three movements of narrative medicine: attention, representation, and affiliation. “A clinical cousin of literature-and-medicine and a literary cousin of relationship-centered care, narrative medicine provides health care professionals with practical wisdom in comprehending what patients endure in illness and what they themselves undergo in the care of the sick” (vii). The book is broken up into four parts: 1) “What is Narrative Medicine?” a theoretical and practical introduction; 2) “Narratives of Illness,” considering our own and others’ stories of life and the body; 3) “Developing Narrative Competence,” which covers reading strategies, movements and pedagogical practices; and 4) “Dividends of Narrative Medicine,” which looks at the ways that the field impacts patient care, bioethics, and the future of health care.
  HCP-Patient Com, Narrative, Pedagogy
• Koerber, Amy. “From Folklore to Fact: The Rhetorical History of Breastfeeding and Immunity, 1950-1997.” Journal of Medical Humanities 27 (2006): 151—166. Print. This article in JMH discusses the use of metaphors in medical immunological journals disputing breastfeeding as a source of infant immunity to disease. Although popular “lore” among women said that breastfeeding was beneficial to the baby, and although these assertions were backed by certain nineteenth-century medical studies, it was not until one particular scientist, Lars Hanson, translated these theories into the dominant medical discourse of the twentieth century that the idea became accepted. The major factor involved in this translation was a metaphor: scientists believed immunity was carried through blood (only). So, Hanson chose to describe the bios carrying the immunity to the baby as “gamma-globulins of milk” to imply a relationship between blood and breast milk that would seem intuitive to readers. Koerber takes a science studies approach to this case, performing a mixture of textual analysis; political, historical, and cultural research; and employing Latour and Woolgar’s theory of networks, as well as feminist theories of knowledge and social values.
  Gender, Medical Research, STS
• Scott, J. Blake.  “Kairos as Indeterminate Risk Management:  The Pharmaceutical Industry’s Response to Bioterrorism.” Quarterly Journal of Speech 92 (2006): 115-143. Print. Scott analyzes the outcomes of Project BioShield—pharmaceutical companies’ partnership with the government to produce a biodefense industry—in order to propose a new conceptualization of kairos. Modernist conceptions of kairos, which assume rhetoric’s agentive control of risk, are inaccurate and incomplete. Such models do not take into account the “cultural-political dynamics . . . rearticulations and unintended, undesired effects” that can transpire when one seizes the “opportune moment” (116). Invoking Carolyn Miller’s concept of agency and the “contagion” metaphor of rhetoric, Scott offers a postmodern concept of kairos that recognizes “the interdependency and distribution of rhetorical agency” which, instead of seeking to avoid or insure against risk, finds ways to adjust and mutate in response to it (136).
  Classical/Canonical Rhetoric, Policy, Pharmacy
• Keller, Eve. Generating Bodies and Gendered Selves: The Rhetoric of Reproduction in Early Modern England. Seattle: U of Washington P, 2007. Print. Situated in cultural studies, medical history, and literature, Keller performs close readings of vernacular medical literature from the seventeenth century, side-by-side with historical and political scholarship of the time. In doing so, she considers how medical “knowledge” of the female body has impacted the agency of women and their place in society. Chapters 4 and 5 in particular examine the birth of modern obstetrics and embryology, interrogating how patriarchy impacted the formulation of subjects in these fields. Keller invokes Latour in her claim that the inscription of the early modern body is a “matter of concern”that has impacted the formation of the modern, liberal, gendered subject (18).
  Gender, History
• Keränen, Lisa. “‘Cause Someday We All Die’: Rhetoric, Agency, and the Case of the ‘Patient’ Preference Worksheet.” Quarterly Journal of Speech93.2 (2007): 179—210. Print. In this article, Keränen analyzes “the dense tangle of legal, ethical, spiritual, and communicative tensions that typify code status determination,” in order to investigate “the present state of death and dying in American hospitals” (180). To do this, she examines a “Patients’ Preferences Worksheet”—an end-of-life decision-making form at a large, urban, acute care facility—and how it is used through extensive observations and interviews there. Her results reveal that the mixture of vernacular, technical, and intuitional rhetorics composing end-of-life genres create “the illusion of choice amidst a prescribed array of technological interventions which often, in the final moments of life, come to be viewed by participants as unduly sustaining corporeal presence” in “heartrending” ways. Ultimately she finds that the inhuman rhetoric of the worksheet has the potential to either curtail patient autonomy or to promote a humane end of life. Either way, we must continue in the process of what John Lyne calls “moralizing the life sciences” through our rhetorical construction of death and dying (202).
  Ethics, Genre, HCP-Patient Com
• Lingard, Lorelei. “The Rhetorical ‘Tern’ in Medical Education: What Have We Learned and Where are We Going?” Advanced Health Science Education Theory and Practice 12 (2007): 121—133. Print. After writing her 1998 argument for rhetorical education in medical schools, Lingard went on to become a professor of medical communication at the University of Toronto. In this article, Lingard presents a critical reflection of her rhetorical teaching practices working with medical students, identifying strengths and weaknesses of the approach. She and her associates found that the rhetorical lens was most effective for teaching standardized professional genres of communication, for highlighting the social nature of clinical teamwork, and for making pedagogical connections between “communication patterns and patient safety” (124) (see Whyte 2009). On the other hand, difficulties that Lingard and her associates are still trying to bridge into their rhetorical training of medical students include “the material dimensions of communication,” the distributed nature of medical team education, and the difficulty of measuring rhetorical outcomes for institutional purposes. Lingard is now a professor at the Department of Medicine University of Western Ontario (UWO).
  HCP-Patient Com, Pedagogy, PTWC
• Heifferon, Barbara, and Stuart C. Brown, eds. The Rhetoric of Healthcare: Essays Toward a New Disciplinary Inquiry. Cresskill, NJ: Hampton P, 2008. Print. Birthed out of TCQ’s 2000 special issue on medical rhetoric, this collection lays the foundation for a corpus of research for the field, as it is the first edited collection specifically dedicated to the rhetoric of healthcare. Contributors include major scholars such as Judy Z. Segal, Michael Zerbe and Rhetoric of Science scholar Steven B. Katz, all of whom explore “a multitude of complex information systems and our place within those systems” considering healthcare to be “both a rewarding site for rhetorical investigation and an opportunity to enhance medical practice” (2). Indeed, many of the articles contribute knowledge, not only to rhetoric but also to fields of medical practice.
  PTWC
• Ariail, Jennie, and Thomas G. Smith. “Concept Analysis: Using an Academic Nursing Genre for Writing Instruction in Nursing.” Heifferon and Brown 243—64. Ariail and Smith (chapter 13) offer pedagogical perspectives gleaned from research they conducted as associate writing professors of a program “funded by and housed within a freestanding medical university” (243). The authors work with faculty to develop composition pedagogy, presentations, workshops, and a writing center (243). Their chapter focuses largely on the importance of helping students develop an interpersonal relationship with their instructors. This relationship in turn enables instructors to more clearly explain the purpose and exigence of various healthcare genres to which novices in the field have not yet been exposed. Ariail and Smith argue for a writing pedagogy of “helping” which emphasizes relationship building and partnering with students to achieve their goals. Their work is a perfect example of the types of interdisciplinary opportunities rhetoricians and professional communicators are being offered in the academic setting.
  Pedagogy, PTWC
• Barton, Ellen, and Richard Marback. “The Rhetoric of Hope in the Genre of Prognosis.” Heifferon and Brown 15—32. Out of the traditional tripartite of medicine—diagnosis, treatment, prognosis—prognosis remains the most resistant to scientific control. Barton and Marback (chapter 1) explain why prognosis is also the most intrinsically rhetorical in nature, because the physician must persuade the patient both of the prognosis’ accuracy and to accept the physician’s suggestion for treatment. At the end of life, a “poor” prognosis often calls for the withdrawal of treatment; however, physicians must also try to maintain a rhetoric of hope for the patient, as they persuade them to come off of life support. Barton and Marback analyze end-of-life consultations, sketching out the genre’s attributes and the way that hope operates within the four phases of the genre. In a successful consultation, physicians persuade patients to translate their hope into agentive decisions about end-of-life care. In a failed consultation, patients continue to cling to a hope for a future of life, without moving forward in a decision-making process. It is in these failed attempts at persuasion that “the rhetorical exigencies of modern medical prognosis are most dramatically exposed” (22).
  Doctoring, Genre, HCP-Patient Com
• Bernick, Philip, Stephen A. Bernhardt, and Gregory Cuppan. “The Genre of the Clinical Study Report in Drug Development.” Heifferon and Brown 115—32. Bernick, Bernhardt, and Cuppan (chapter 6) draw from their many years experience as writers in the pharmaceutical industry to describe the way authors navigate complex rhetorical audiences, purposes, and composition constraints in their development of the Clinical Study Report (CSR). The authors walk readers through the whole process of clinical tests and FDA approval, highlighting the rhetorical difficulties inherent in this crucially persuasive document written by multiple teams of authors, over a long span of time, with strict regulatory oversight. The study is a helpful guide for anyone writing for the sciences, or studying PTWC.
  Genre, Pharmacy, PTWC
• Detweiler, Jane. “To Design a Doctor(ate): Negotiating Professional Identities in a Mew Clinical-Doctoral Program.” Heifferon amd Brown 221—42. Jane Detweiler (chapter 12) provides a narrative description of one new Occupational Therapy program’s efforts to compose a Doctoral program with few other models to choose from. Like many budding healthcare fields trying to establish a professional identity and expert-level training, the program had to grapple with what they wanted their students to be equipped for, and how they could construct writing activities that would encourage and measure those outcomes. Questions about differing levels of expertise, pedagogical philosophy, and academic leanings all played a part in the team’s efforts to “design a Doctorate.” Pedagogy, PTWC
• Dinolfo, John. “Seeing and Re-Viewing the Human Body: Reflections on the Rhetoric of Medical Videography.” Heifferon and Brown 181—202. Dinolfo (chapter 10) provides a media-rich analysis of the benefits, strategies, and purposes of medical videography. His survey, based on many years as a professional medical videographer, demonstrates how this form of composition is used to teach, train, engage and inform healthcare professionals and patients alike in the academic and popular world. As a workplace genre, medical videos have the ability to model challenging rhetorical situations, to immerse viewers in clinical learning situations and lived clinical experiences, to make visible the invisible physical world, and to provide access to complex skill training. Videos are also used by continuing education programs to engage HCPs in the medical discourse community and in the latest conversations about effective clinical care. Videography also benefits patients by providing an educated interlocutor “who bridges the gap between clinician and patient” more effectively than is possible in many clinical settings (193).
  Genre, HCP-Patient Com, PTW/C
• Emmons, Kimberly. “‘All on the List’: Uptake in Talk About Depression.” Heifferon and Brown 159—80. Based on interviews and textual analysis of commercial pharmaceutical websites, Emmons argues that direct-to-consumer advertising for depression drugs has been largely successful through their combination of two already grounded genres: the women’s popular magazine quiz and the DSM medical checklist (DSM stands for Diagnostics and Statistical Manual of Mental Disorders). By linking the two genres, pharmaceutical companies successfully target women consumers, persuading them to identify themselves as gendered victims of a disease (depression) and to ask their doctors about the advertised drug.
  Gender, Genre, Pharmacy
• Heifferon, Barbara A. “Pandemics or Pandemonium: Preparing for Avian Flue.” Heifferon and Brown 51—76. Heifferon (chapter 3) considers a Center for Disease Control (CDC) podcast about ethical community planning for pandemics, in order to identify rhetorical strategies for promoting compliance (or adherence) in community members with varying beliefs and values. Specifically, she promotes Harvey Kayman’s model for community deliberation in the midst of crisis, which trains various community leaders and news media personnel in advance to use logos-centered rhetoric to maximize effective action and minimize pathos-driven chaos. Heifferon also makes an argument for how rhetoricians can contribute to public health decisions, recognizing that the ongoing changes regarding our nation’s health-care system offer increasing opportunities for communicators specializing in policy, business, and legal writing, as well as medical rhetoric.
  Policy, PTWC, Public Discourse
• Martins, David S. “Diabetes Management, the Complexities of Embodiment and Rhetorical Analysis.” Heifferon and Brown 75—90. Martins (chapter 4) works from a patient-centered perspective to analyze the effectiveness of Diabetes education and management. Drawing from a broad range of rhetorical theory, he proposes an embodiment model which takes into account the daily habits, ideologies, and values of individual patients in an effort to understand and tailor information and technology literacy education to patients’ specific needs and existing literacy skills.
  Doctoring, HCP-patient com
• Mebust, Michelle R., and Steven B. Katz. “Rhetorical Assumptions, Rhetorical Risk: Communication Models in Genetic Couseling.” Heifferon and Brown 91—114. Mebust and Katz provide a textual analysis of educational literature created for genetics counselors, focusing on the complex and often conflicting social and epistemic roles such counselors are expected to play, and the difficulty this poses to communication. The pamphlets reflect these complexities, asking counselors to act as both “objective” advisors to patients in their decision-making process, as well as compassionate, psychological counselors to families struggling to process difficult information about their potential future. Mebust and Katz demonstrate the way that medical communication is often complicated by healthcare professionals’ multi-layered social roles, and the difficulties this poses to their rhetorical choices and professional relationships.
  Doctoring, HCP-Patient Com, PTWC
• Popham, Susan L. “As if Good Writing Mattered: A Rhetoric of Pragmatism in Health Care Business Letters.” Heifferon and Brown 133—48. Writing from a workplace communication standpoint, Susan Popham (chapter 7) studies business letters written from a medical office to insurance companies, requesting patient coverage. Popham demonstrates how rhetorical purposes are often achieved primarily through knowledge of workplace culture, and not necessarily because of traditional, “strong writing skills.” Although the letters demanding coverage for children and cancer patients propounded with obvious grammatical errors and are rarely “clear” in their style, the writer was nonetheless able to secure funds necessary for her patients, based on rhetorical leverage defined by the particular communication practices within her industry.
  Genre, PTWC
• Reynolds, J. Fred. “The Rhetoric of Mental Health Care.” Heifferon and Brown 149—59. Reynolds (chapter 8) meditates on the fragile epistemological nature of “The Rhetoric of Mental Health Care,” highlighting the problems that come with attempting to define and scientize socially constructed categories of behavior. Providing some history regarding the spread of mental “diseases” over the last century, Reynolds questions the rhetorical assumptions often propagated by psychiatric medicine. He argues that the categories created by National Institute of Mental Health do not constitute truths but rather help construct truths for social, business, research, and professional purposes.
  Medical Research, Policy, Public Discourse
• Segal, Judy Z. “‘Female Sexual Dysfunction’ and a Rhetoric of Values.” Heifferon and Brown 33—50. Segal (chapter 2) provides a clinical, cultural, and popular analysis of epideictic values embedded in the rhetoric of female sexual dysfunction. Seeking places of intervention, Segal asks, “what are the contemporary commonplaces of goodness and pleasure” which shape our judgments of women and female sexuality as honorable or dishonorable (35)? She finds that, in medical discourse, a woman is more valued when her particular complaints “cleave to the model” physicians are familiar with, and when her complaint is more about a dysfunction than about desiring to gain pleasure for its own sake. Similarly, in public discourse, motives are important to sexual dysfunction and moral weight is attached to the woman’s desire for pleasure. A woman should be seeking to support her social connection before seeking to please herself. In literary discourse, more possibilities stand open for questioning what pleasure is and how it should be attained. Segal also discusses the implications of the trend for young girls to offer oral sex; she wonders whether their choice not to receive pleasure is a form of agentive empowerment or yet another form of female performance expectation.
  Classical/Canonical Rhet, Gender, Public Discourse
• Zerbe, Michael J. “From the Frontiers of IMRAD: Non-Traditional Medical Research in Two Cancer Journals.” Heifferon 2008 203—20. Zerbe (chapter 11) investigates whether or not medical journal research reflects healthcare’s growing emphasis on patient-centered care and holistic medicine. To do this, Zerbe surveyed hundreds of IMRAD (Introduction, Methods, Results, and Discussion) articles published in two top-tier medical journals between 1983 and 2004. Specifically, he compared three, 3-year spans of articles in The Journal of the National Cancer Institute (JNCI) and the Journal of Clinical Oncology (JCO) to see if research questions in the field have changed over time. His data shows that more and more, journals are including IMRAD studies which “consider human beings as a whole, rather than solely a disease that happens to be carried by a human being”—studies which consider factors such as quality of life, the impact of disease on extended family, perceptions and attitudes toward disease, doctor-patient communication, effective information dissemination, and cost-benefit analysis (207). These results seem to imply that empirical studies have grown to include more holistic, patient-centered inquiries into health and wellness.
  Genre, History, Medical Research
• Hyde, Michael.  The Call of Conscience: Heidegger and Levinas, Rhetoric and the Euthanasia Debate. Columbia: U of South Carolina P, 2008. Print. Hyde provides a careful examination of the philosophy of conscience based on Heidegger’s and Levinas’s respective interpretations of how we hear our conscious and how we should then act on it: “The act of listening is as important to the truth of conscience as is its own evocative voice; the call of conscience is consummated only in the hearing and the understanding for what it has to say” (8). According to Heidegger, the call is grounded in the realization of “the temporality of Being” and the self’s drive to become better. Levinas, by contrast, is more aware of the call as is it comes through the face of the other, and our awareness of a being “‘otherwise than Being’: God” (8). Both views, says Hyde, are important for “understanding who and how we are as human beings inhabiting a world” (10). Hyde applies these theories, and those of classical rhetoric, to a close reading of public discourse surrounding the euthanasia debate. He provides rhetorical analysis of personal stories as well as specific, historic examples—such as the 1988 JAMA publication, “It’s Over, Debbie,” which sparked vehement controversy. Essentially, Hyde actively engages in a current, deliberative rhetoric. To do so, he employs critical analysis and ethical philosophy to persuade his audience to respond to the call of its own conscience and to the call of those suffering. The discussion is framed by Hyde’s own story of his father’s death and concludes by imagining a better ending for his father’s life. Hyde also discusses these issues in articles published for the Quarterly Journal of Speech 79 (1993) and for the special issue of the Journal of Medical Humanities 22.1 (2001).
  Classical/Canonical Rhetoric, Ethics, Public Discourse
• Japp, Phyllis M. Narratives, Health, and Healing: Communication Theory, Research and Practice. Mahwah, NJ: Erlbaum, 2008. Print. The collection provides a helpful overview of the field of narrative health as it has developed over the past two decades and of its current areas of inquiry. According to Arthur W. Frank, the growth of biomedicine and technoscience has led to an “increasing separation of health from illness, bringing about a new species of health stories,” which he differentiates from illness stories (xi). The patient is constantly bombarded with stories of what health and the body should and shouldn’t be, and must choose which stories will become his or her own. The stories that become most accepted by society constitute a “pedagogy”; this pedagogy teaches people what they ought to want, expect, do, and be in their bodies. The rather extensive collection is broken into four sections. Part 1 provides an “Overview of Narrative and Health Communication Theorizing,” which can serve as an excellent introduction to the field. Part 2 looks at “Personal Narratives and Public Dialogues.” Part 3 has a professional communication focus, as it considers “Narrating and Organizing Health Care Events and Resources.” The final section, Part 4, regards “Narrative Sense-Making About Self and Other.” The collection considers everything from the ethos of Biomedically Invisible Illness (BII) patients (Japp and Japp) and “safe sex” in India (Singhal, Chitnis, Sengupta) to workplace education (Ragan, Mindt, Wittenberg-Lyles) and alternative medicine (Sharf).
  Doctoring, Narrative, PTWC
• Koerber, Amy, E., Jonathan Arnett, and Tamra Cumbie. “Distortion and the Politics of Pain Relief: A Habermasian Analysis of Medicine in the Media.” Journal of Business and Technical Communication 22.3 (2008) 364—91. Print. This article might be called a specimen of modern forensic rhetoric; it investigates the controversy surrounding a 2005 study by Wong et al. published in The New England Journal of Medicine regarding the timing of epidurals during labor. Koerber, Arnett and Cumbie evaluate public allegations made against the Wong et al. as well as the media, of purposefully misrepresenting the study’s research data to the public. In particular, a notable Canadian physician named Dr. M.C. Klien published several articles arguing that the research methods and composition practices of Wong et al. “failed to meet their ethical obligation to facilitate public understanding for their research findings” (366). Koerber, Arnett, and Cumbie find that, although the media did play a role in distorting the message of the journal article (a practice often decried by the public), Dr. Klein’s allegations, that the very design and presentation of the study were misleading, may have been correct. Thus, not only the media, but researchers themselves are accountable for how the public perceives scientific knowledge. Koerber, Arnett, and Cumbi employ Habermas’s concept of the ideal speech situation to “expose the ways in which scientific or medical research can be designed and reported from the beginning to either foster or hinder accurate media coverage and, as such, to either facilitate or preclude public debate and understanding of complex issues” (386).
  Ethics, Medical Research, Public Discourse
• Koerber, Amy, and Brian Still. “Guest Editors’ Introduction: Online Health Communication.” Technical Communication Quarterly 17.3 (July 2008): 259—63. Print. This issue of TCQ acknowledges the growing need and opportunity for technical and professional communicators to partner with research healthcare communication as it expands electronically. The articles represent three ways in which TPCs can do this. First, TPCs can apply traditional rhetorical analysis to online health communities; this is exemplified by Spoel, who considers two Canadian midwifery websites. Second, TPCs can offer their skills as subject-matter experts to better construct materials for various online audiences; Tomlin argues that since 1997, PWs in the pharmaceutical industry have transformed from “medical writers” to “communication specialists” as they better articulate complex rhetorical purposes for drug companies. Similarly, Willerton describes the rhetorical process of composing expert subject-matter material for online health sites like WebMD®. Finally, according to Koerber, TPCs can partner with interdisciplinary teams researching and developing healthcare materials as subject-matter experts in communication. Dim, Young, Neimeyer, Baker, and Barfield model this process by reporting on their involvement in work at St. Jude’s Research Hospital to develop handheld informed-consent technologies, and how they worked to resolve usability, communications, and ethical dilemmas innate to the device meant for parents of child cancer patients. Mirel, Barton, and Ackerman, in turn, report on their development research in telemedical technologies, which they conducted with a team of health-care professionals to improve both the interface itself, as well as the research design. They suggest that TPCs consider modifying their research methodology and practices in order to contribute to interdisciplinary fields like medicine in a way that will be acknowledged.
  Classical/Canonical Rhet, Medical Research, PTWC
• Rundbald, Gabriella. “Impersonal, General, and Social: The Use of Metonymy versus Passive Voice in Medical Discourse.” Written Communication24.3 (2007): 250-277. Print. Rundbald conducts an award winning quantitative analysis of nine medical research articles’ methods sections to determine the rhetorical uses of passive voice and metonymy, comparing her results to norms in other scientific genres. Results show polarized author representation, being either completely visible or completely hidden, with visible authors being active, and hidden authors being passive through possessive/causative metonyms. Participants in the studies, although faceless and genderless, are nevertheless portrayed as active, while researchers referenced outside of the study are completely dehumanized as “recent audits and systems” so that “the degree of impersonalization is greater for the nonauthorial professionals than for the authors” (272—73). Representational/locative metonyms also serve as a rhetorical “socialization” strategy, “confirm[ing] group membership by exhibiting their associations with research and health organizations” (273). This article won the 2007 NCTE Award for Best Article Reporting Qualitative or Quantitative Research in Technical or Scientific Communication.
  Classical/Canonical Rhet, Genre, Medical Research
• Bennett, Jeffrey A. Banning Queer Blood: Rhetorics of Citizenship, Contagion, and Resistance. Tuscaloosa: U of Alabama P, 2009. Print. Bennett takes a close look at the history of and rhetoric surrounding the ongoing FDA ban which prohibits queer men from donating blood, excluding them from a meaningful and much needed performance of civic identity. Bennett exposes the public, scientific, and political rhetorics sustaining the ban; the economic and phobic motives driving them; and how queer men have responded to and resisted their exclusion. The study makes use of textual as well as qualitative research, reporting on interviews with twenty-one men affected by the ban.
  Gender, Policy, Public Discourse
• Ding, Huiling. “Rhetorics of Alternative Media in an Emerging Epidemic: SARS, Censorship, and Extra-Institutional Risk Communication.” Technical Communication Quarterly 18.4 (2009): 327—350. Print. Ding researches the SARS epidemic in China, which took place between November 2002 and March 2003 in the Guangdong Province, demonstrating how “alternative media can function as extra-institutional channels to challenge and contradict official media and to communicate imminent risk to the public” (329). Despite the fact that official Communist Party of China news sources remained silent about the outbreak, independent, overseas Chinese web sites, as well as “guerrilla media” such as text messaging and word-of-mouth, helped spread the word about SARS and triggered two mass panic buying waves. These waves ultimately prompted the only official press conference on the issue. Ding also considers the “costs, dangers, and implications” for technical communicators who go against official orders in order to warn the public through alternative media, attempting to map the ethical obligations of PTCs in such situations (344).
  Ethics, PTWC, Public Discourse
• Graham, S. Scott. “Agency and the Rhetoric of Medicine: Biomedical Brain Scans and the Ontology of Fibromyalgia.” Technical Communication Quarterly 18 (2009): 376-404. Print. Using the recent shift in professional medical opinions about fibromyalgia (FM) as a case study, Graham explores how change occurs within the “often strict and authoritarian structures of Western biomedicine” (378). Constructing what he calls “an object-centered agency narrative,” Graham demonstrates how new PET brain scanning and the images it produced were key to shifting perceptions of FM and may even have been instrumental in the FDA’s approval of the drug Lyrica as a form of FM treatment. PET, as a black box, gained quick legitimating through its coordination with previously legitimized technologies like X-rays (387-88). Additionally, the cartography metaphor as an epistemological concept was already familiar and accepted by the biomedical community when PET appeared (389). From a rhetorical standpoint, the medical community was so frustrated with the epistemological uncertainty of FM that “any data, no matter how preliminary or problematic, [were] likely to be greeted with enthusiasm” (393). Connections like these led to a quick acceptance of PET evidence of FM, which in turn allowed the FDA to recognize and legitimize the ontological existence of FM with their approval of Lyrica.
  Medical Research, Policy, STS
• Hass, Christina, ed. “Writing and Medicine” Special Issue of Written Communication 26.3 (July 2009): 115—211. Print. Although no special introduction is given to this issue, perhaps because there were no guest editors, Written Communication dedicated one of their twenty-fifth anniversary issues to “Writing and Medicine.” At the start of the year, the journal planned to print only three articles and a review piece; however, when the special issue was released in July—later than expected—there were in fact six rigorous research articles (see “Editor’s Introduction” to Written Communication 26.1 (Jan 2009)); a testament to the field’s productivity.
  PTWC
• Barton, Ellen, and Susan Eggly. “Ethical or Unethical Persuasion?: The Rhetoric of Offers to Participate in Clinical Trials.” Hass 295—319. In this study, the authors conduct qualitative and quantitative analyses of 22 instances in which physicians offer patients the chance to participate in clinical trials. The 22 encounters were selected as a representative sample out of a database consisting of 42 video-taped encounters. The researchers’ goal was to survey how physicians rhetorically couched these offers, and whether their framing of the offers were ethical or not. Their results showed that the physicians in their study regularly mentioned purpose, benefits, and risks of the trial to patients (>85% of the time). Secondly, physicians regularly presented purposes, benefits and risks with a “positive valence”—that is, in positive rhetorical terms (≥60% of the time). And lastly, physicians’ positive valencing was “often in terms of clinical care of the individual patient (≥78% of the time), via either implied direct benefits or minimized side effects” (310). Evaluating these results, Barton and Eggly found that doctor’s positive valencing was motivated by the “best-option principle”: the belief that individual patients really will benefit most from the trial intervention. This belief is reflected in their rhetoric. However, doctors ethically balance their positive rhetorical valance of the trial’s benefits with a more neutral rhetorical valance when describing the general purpose of the test (to find out if and how it is beneficial or harmful to patients).
  Ethics, Genre, HCP-Patient Com
• Newman, Sara. “Gestural Enthymemes: Delivering Movement in 18th-and19th-Century Medical Images.” Hass 273—94. Newman examines medical texts, illustrations, and photographs of medical writers at a time when “the elocutionists were reviving delivery for their rhetorical pursuits” and “medical researchers and practitioners were shifting their efforts from dissecting lifeless cadavers to observing living bodies” (275). These two moves prompted medical writers to develop a vocabulary which allowed them to capture the motions and movements they were observing. The results of these rhetorical developments are what Newman calls “gestural enthymemes”: visual arguments that employ a kinetic movement of ideas, a form of pictorial delivery which parallels linguistic style. Particularly, she identifies three patterns of enthymematic arguments: climax, anadiplosis, and catacomesis. She then considers the way that these devices were translated from medical drawings into the age of medical photography, examining the relationship of rhetoric and technology to the past and present.
  Classical/Canonical Rhet, Genre, History
• Owens, Kim Hensley. “Confronting Rhetorical Disability: A Critical Analysis of Women’s Birth Plans.” Hass 247—72. Owens argues that birth plans (unofficial, advanced directives about what women do and don’t want to happen during their hospital birth) are women’s attempt to rectify or compensate for the (perceived?) “rhetorical disability” that comes during childbirth—a condition induced by their physical and authoritative lack of power largely supplanted by/relinquished to technological expertise. Based on surveys, five birth plans, and over 100 online birth narratives from five different parenting Web sites, Owens concludes that, while birth plans do not necessarily “enable women to resist particular interventions, control their births, or overcome rhetorical disability,” they nevertheless holds value as an educational catalyst for mothers, who “write themselves into birth” and “into particular understandings of their relation to knowledge medicine and society” (268).
  Gender, Genre, HCP-Patient Com
• Schryer, Catherine F., Elena Afros, Marcellina Mian, Marlee Spafford, and Lorelei Lingard. “The Trial of the Expert Witness: Negotiating Credibility in Child Abuse Correspondence.” Hass 215—246. This team of researchers analyzed 72 forensic letters by physicians responsible for identifying and describing potential instances of child abuse. The rhetorical situation is complex, however, because of the legal ramification innate to the “expert witness,” a figure being challenged in the time and place of this study. Through analyzing the letters and interviewing both writers and readers of the letters, Schreyer et al. found that specific adjectives and adverbs were used strategically by writers, to “allow for a range of interpretations and [to constrain] those interpretations at the same time” (215). These strategies also allowed physicians to rhetorically navigate dangerous legal waters.
  Ethics, Genre, Policy
• Teston, Christa B. “A Grounded Investigation of Genred Guidelines in Cancer Care Deliberations.” Hass 320-348. Teston conducts an elaborate analysis of how Standard of Care documents (national guidelines intended to standardize treatment of each known cancer) rhetorically and materially impact medical deliberation and decision making in the face of uncertainty. Teston observed Tumor Board meetings where treatment decisions are discussed and by undertook textual analysis of complex, online Standard of Care documents. In doing so, she finds that although the documents have authoritative purpose, they do not explicitly link patients’ individual experiences to expectations for physician intervention. She also proposes an updated model of Toulminian analysis which takes into account the non-linguistic rhetorical appeals so fundamental to digital texts, investigating the relationship between claim and evidence in these documents and their role in structuring activity group genres.
  Classical/Canonical Rhet, Genre, Policy
• Whyte, Sarah, Carrie Cartmill, Fauzia Gardezi, Richard Reznick, Beverley A. Orser, Diane Doran, and Lorelei Lingard. “Uptake of a Team Briefing in the Operating Theatre: a Burkean Dramatistic Analysis.” Social Science in Medicine 69.12 (2009): 1757—66. Print. Sarah Whyte et al. report findings from a study in which they used the Burkean dramatistic method to analyze the rhetorical successes and failures of 756 preoperative surgery debriefings. By considering the motives, attitudes, and behaviors of the HCP’s conducting the surgeries (surgeons, physician’s assistants, nurses, technicians, etc.), researchers were able to map the relationship between the perceived purposes and goals of the participants, and the participants’ perceived success of the debriefings. Researchers were also attentive to how the practitioners adapted to change in the operating room during surgery when events did not transpire according to plans, necessitating new biomedical action. The research was headed by Lorelei Lingard, a professor in medical communication who argues for rhetorical training of medical students. This study demonstrates that verbal rhetorical communication plays an essential role, not only in personal or humanitarian practice of medicine, but also in the clinical out-workings of the science of medicine and what it considers “medical knowledge.”
  Classical/Canonical Rhet, Doctoring, PTWC
• Davis, Lennard, ed.  The Disability Studies Reader. 3rd ed.  New York: Routledge, 2010. Print. Recently published in its third edition, this text is essential to those interested in disabilities healthcare. Grounded in critical and cultural studies, the collection includes perspectives from a wide variety of fields, including history, sociology, anthropology, gender and race studies, art, and literature. Originally published in 1997, each edition has added further landmark essays in the field, so as to constitute a now 656 page anthology used in many different graduate programs. This edition is broken up into seven sections: Part I: Historical Perspectives, Part II: the Politics of Disability, Part III: Stigma and Illness, Part IV: Theorizing Disability, Part V: Identities and Intersectionalities, Part VI: Disability and Culture, Part VII: Fiction, Memoir, and Poetry. For those studying medical rhetoric, the essays follow several themes of interest. Susan Sontag and Georgina Kleege deal with the role of metaphor in constructing disabled subjectivities. Douglas Baynton looks at the nineteenth century debates about the validity of American Sign Language vs. oral education literacy. James C. Wilson considers the disabled body as a flawed edition of a genetic text. Simi Linton specifically considers the role of language in oppressing people with disabilities. David Michelle and Sharon Snyder, as well as Thomas Couser analyze the role of narrative in shaping the disabled life. Many authors investigate complex visual rhetorics, such as the rhetoric of prosthetics (Gillingham, Mullins, Barney and Smith), photographic rhetorics (David Hevey), and the rhetoric of “beholding” (Rosemarie Garland-Thomson). These are just a few examples of selections that would be of use to medical rhetoricians.
  Disabilities Studies, Narrative, Public Discourse
• Gibson, Scott C., Jason J. Ham, Julie Apker, Larry A. Mallak, and Neil A. Johnson. “Communication, Communication, Communication: The Art of the Handoff.” Annals of Emergency Medicine 55.2 (February 2010): 181-183. Print. This study, written for a medical audience, considers the importance of patient transfer: “Handoff communication is best understood as a dialogue between health professionals—an interaction that fosters empathy, equity, and common ground, in addition to transferring necessary information” (181). Handoffs can occur from physician to physicians, between teams of HCPs, and between or within services and specialties. In each instance, the length and content of the handoff communication will vary. For example, the authors studied transfers from emergency physicians to hospitalists, looking for the variables which determine appropriate types of handoff communication. While emergency physicians are usually attuned to “acute interventions and admission criteria,” internists are usually looking for broader patient information, a difference which can make the handoff more difficult. In order to strike a balance, the researchers suggest ongoing strategies which individual teams can use to develop safer and more efficient transitions. The authors promote interdisciplinary research teams with both academic and clinical doctors working together, suggest particular tools of analysis provided by other emergency medicine researchers, and encourage emergency medicine to lead the process of developing “well-designed tools, procedures, and communication” which will improve handoffs for all HCPs (182).
  Doctoring, Genre, PTWC
• Segal, Judy Z. “Internet Health and the 21st-Century Patient: A Rhetorical View.” Written Communication26.4 (Oct. 2009): 351—69. Print. While most research about online health advice critiques the rhetor’s (lack of) credibility, Segal considers “all parts of the rhetorical triangle,” taking into account the audience and complex subject matter of Internet health communication. Her article provides a thorough review of the literature on Internet health to date, a rhetorical view of the situation, and suggestions about where research and scholarship need to go. In particular, she argues that current research “isolates the use of health-information Web sites from the contexts of that use—from, for example, personal contexts . . . contexts of health and medicine . . . and cultural contexts” and suggest that rhetoricians are particularly equipped to study these complexities in concert (365).
  Classical/Canonical Rhetoric, Public Discourse
• Keränen, Lisa. Scientific Characters: Rhetoric, Politics, and Trust in Breast Cancer Research. Tuscaloosa, AL: U of Alabama P, 2010. Print. Keränen’s book is a study of the rhetoric surrounding the 1990s “NSABP Datagate” scandal, in which it was discovered that a highly influential breast cancer researcher had falsified data, impacting the life and death treatment of hundreds of thousands of women. Keränen particularly focuses on the construction of character in these debates and how the perceived characters of researchers impacts the collective character of science and biomedicine: “I demonstrate how various participants in science-based controversies . . . make sense of scientific claims based on whom and what they find trustworthy, and how rhetorical processes can foster or undermine trust and thereby shape scientific institutions and practices” (3). Theoretically, Keränen suggests that character can be detailed in three parts: ethos, persona, and voice. She uses this method to track the competing characters concocted by the public and assigned to people involved with Datagate.
  Ethics, Medical Research, Public Discourse
• Graham, Scott S., and Carl G. Herndl. “Talking Off-Label: The Role of Stasis in Transforming the DiscursiveFormation of Pain Science.” Rhetoric Society Quarterly41.2 (2011): 145-167. Print. From ethnographic data collected while observing the Midwestern Pain Group (MPG), Graham and Herndl use Foucault’s enunciative analysis to describe the “disciplinary inculcation and practitioners’ experience in the highly regulated practice of pain management” (149). Although the theories and practices defining the group are highly rigid and resistant to change, the authors argue that classical stases theory has the ability to extend Foucault’s model by “mak[ing] visible both the means and the obstacles to discursive transformations . . . allow[ing] us to understand some of the concrete and messy rhetorical work of invention involved in attempting to change a discursive formation” (164). Using Prelli’s matrix of higher and lower stases, Graham and Herndl identify three points of stasis which have allowed the interdisciplinary MPG to recognize and discuss the changes they want to take place in current pain discourse and treatment.
  Classical/Canonical Rhetoric, Doctoring, STS
• Leach, Joan, and Deborah Dysart-Gale. Rhetorical Questions of Health and Medicine. Lanham, MD: Lexington Books, 2011. Print. Leach and Dysart-Gale offer the rhetorical question as a tool for analyzing the “duel functions of rhetorical criticism”: to “prob[e] the terms of belief systems” and to “examin[e] the functions of discourse and the formal resonances and mismatches that produce rhetorical effects” (2). Their edited collection rhetorically questions two commonplace and unchallenged social assumptions about health and medicine. The first is the assumption that good health care relies on scientific evidence. The second regards particular self-imagined subjectivities which medicine asks people to take on in their relationship to health services—identities which pave the way for specific medical arguments. The authors use the example of “at risk” populations to illustrate this second commonplace. Leach and Dysart-Gale identify and describe eight different classifications of rhetorical question: erotema, anacoenosis, anthypophora, dianoea, aporia, psyma, ratiocination, epiplexis, exuscitatio. They suggest that these questions provide rhetorical structure to various health-related genres (such as IMRAD research), and that by analyzing the use of questions we can better understand the work of medical inquiry, the construction of medical knowledge, how it travels, and how it has transformed in recent years. The ultimate goal of the collection is to use rhetorical theory to investigate “the ways in which pressing questions” in health and medicine “are posed, debated and answered” (7).
  Classical Rhetoric, Medical Research, Public Discourse
• Cwiartka, Monika. “How Do Mice Mean? The Rhetoric of Measurement in the Medical Laboratory.” Leach 33—58. Cwiartka investigates the relationship between material laboratory practices, textual reports, and narrative rhetoric, specifically surrounding experiments with mice. Scientists use “knockout mice” to research what happens when particular genetic material is removed or modified in a mammal. Often, data about mice and humans are woven together in reified (oversimplified) stories, in order to tell a deterministic tale about the power of genes over human behavior. Rather than simply argue against this premise, Cwiartka considers the specific constraints which make knockout mice experiments necessary and productive, as well as how data produced in said experiments is rhetorically presented for persuasive means. She also suggests ways for improving the material and composition practices of research so as to allow for well-interpreted results. Cwiartka develops an “action-attention-language triad model” of analysis which considers both the phenomenological and material aspects of laboratory work. The model holds much potential for future scientific rhetorical analysis, since it connects linguistics, rhetorical situation, and material practice in one, broader rhetorical triangle. The triad considers everything from spatio-temporal constraints of research, to “attention cognition,” and the process of rhetorically reifying data into “facts” over time through language. While much rhetorical analysis is focused on the subjective/phenomenological, Cwiartka’s model places a strong focus on “doability”—the pragmatic process of narrowing experimental focus, material interaction, practical judgment, identification, re-identification, and interpretation.
  Medical Research, STS
• Derkatch, Colleen. “Does Biomedicine Control for Rhetoric? Configuring Practitioner-Patient Interaction.” Leach 129—53. Derkatch provides a detailed analysis of why standard biomedical research methods prove incompatible with complementary and alternative medicine (CAM), such as chiropractic and acupuncture therapy. CAM interventions qualify as, what the UK Medical Research Council calls, complex interventions in health care. Complex medical interventions “comprise a number of separate elements which seem essential to the proper functioning of the intervention although the ‘active ingredient’ of the intervention that is effective is difficult to specify” (130). Such interventions rely heavily on communication practices with the patient, as well as complex physical treatments. As such, complex CAM interventions do not easily fit the three tenets of traditional clinical trial research primarily used to test drugs: a clear definition, control of outside factors, and standardized intervention (132). The personalized communication and treatment of CAM interventions are hard to control, and developing a placebo is also impractical when researchers are not working with a specifically defined “active ingredient.” Therefore, “CAM consequently sponsors a model of health care at odds with both the rhetorical conditions governing clinical practice and the guiding philosophies of CAM practices themselves” (131). Derkatch provides an excellent history of evidence based medicine (EBM) and patient centered care’s (PCC) development and their impact on research trends. She suggests that, although EBM’s research models do not fit CAM’s purposes, CAM has successfully used randomized control clinical trials to bring more discussion and attention to CAM, and to question the epistemology governing biomedicine. Additionally, she argues that PCC has not and cannot be adapted to the biomedical model of enacted practice, as proponents claim that it can.
  Genre, Medical Research
• Dysart-Gale, Deborah. “How Do Children Learn about Illness and Death? Managing Suffering and Sickness.” Leach 155—80. Dysart-Gale provides a historical survey of children’s literature about death and dying from the 17th century to the end of the 20th century. Her purpose is to identify the rhetorical strategies and cultural values embedded in these texts. These, in turn, reveal adults’ understandings of death and what they consider necessary information for coping with it at various points in history. She finds that books are heavily shaped by any given epoch’s epidemiological and medical state (156). In the seventeenth century, when infant mortality was high and one in four children died before the age of ten, texts like Janeway and Mather’s A Token for Children are focused on preparing children spiritually to face death with faith and courage, that they may be received into heaven according to Calvinist values. In the eighteenth century and even early twentieth century, books are more concerned with preparing and comforting those who survive the death of a child. Additionally, physicians figure more prominently and medical procedures are depicted in greater detail. After the creation of the Salk polio vaccine in the 1950s, when child deaths became significantly less common, children’s books dealing with death focused not on disease but accidents, the emotions of those bereaved, and normalizing responses to death. Once the AIDS epidemic hit in the 1980s and andazidothymidine (AZT) was being used as a successful treatment for children, children’s books focused on the social acceptance of kids with AIDS or the death of adult family members with AIDS. Books rarely depicted children actually dying of AIDS. When they did, they returned to seventeenth century tropes of saintly children dying bravely and going to heaven. This pattern reveals an ongoing reliance on narrative structures to communicate difficult concepts about life.
  Ethics, Genre, History
• Keränen, Lisa. “How Does a Pathogen Become a Terrorist? The Collective Transformation of Risk into Bio(in)security.” Leach 77-96. Keränen analyzes the rhetorics of the United States TOPOFF (“top official”) exercises: large-scale government simulations of bioterrorist attacks meant to improve high level officials’ decision making and communication. She finds that the collective rhetorics of these elaborate exercises perpetuate autopoiesis, or self-reproducing rhetorics of risk which help strengthen the biodefense industry. They do this through three rhetorical maneuvers. First, they transform “uncertainty into spectacular risk”; second, they “blur reality and simulation into visions of chaos and casualty”; and third, they exploit the tensions between reassurance and concern (83-84). The study describes the history of these activities, their textual rhetorics, and how the test results have been used to perpetuate and secure further funds and research for military biodefense. Keränen questions the actual need for such exercises and the rhetorics which support them, arguing that funds would be better directed toward problems with proven statistical threat, rather than speculative ones.
  Policy, Public Discourse
• Leach, Joan. “How Do You Talk to a Patient? A Question of Decorum.” Leach 181—93. Leach calls for rhetorical research into the decorum (rules of conduct) of physician-patient communication. She traces the discursive history of medical manners from classical times to today, demonstrating that communication, ethics, and etiquette have been aligned in different ways throughout time. Currently, the American Medical Association sees communication as an ethical issue. However, a counter rhetoric is forming which suggests that etiquette may be a more “common sense” approach to teaching physicians how to communicate and care for patients. Humanists would most likely claim that etiquette is a mere surface performance, while ethics is a deep-level, empathetic concern for patients; however, people such as Michael W. Kahn and Atul Gawande argue that proper care for patients cannot take place unless physicians have a base-level list of criteria for interacting with and treating patients. Kahn in particular offers a six-point list of manners which he says will make for a “good enough” physician, even if (realistically) perfect empathy and emotional understanding are not always achievable. Leach argues that although it may be tempting for rhetoricians to rally with the humanist cause against Kahn and Gawande’s checklist manifesto, a more productive stance might be to “incorporate rhetorical sensibilities about prudence and decorum into the checklist” (191). Indeed, Kahn even leaves room on his list for this very contribution by qualifying particular directives with, “if appropriate.” Phrases like this imply that, although some aspects of medicine are indeed a science, knowing when particular behaviors are appropriate is still an art. Leach also calls rhetoricians to investigate what patients want from their physicians, in terms of decorum, and what patients’ own rhetorical strategies are for interacting with physicians.
  Classical/Canonical Rhet, Doctoring, HCP-Patient Com
• Segal, Judy Z. “What, in Addition to Drugs, Do Pharmaceutical Ads Sell? The Rhetoric of Pleasure in Direct-to-Consumer Advertising for Prescription Pharmaceuticals.” Leach 9—32. While research shows that direct-to-consumer advertising for prescription pharmaceuticals (DTCA) has been strongly present for centuries, Segal is interested in identifying what current DTCA is attempting to persuade consumers of. Building on her assertion (made in her past publications) that DTCA rhetoric is epideictic, Segal outlines the moral structure, or “pleasure economy” which these advertisements compose. To do this, Segal employs the structural theories of Perlman and Olbrechts-Tyteca (1969) which state that rhetors build their arguments based on negative/positive binary pairs. In the case of DTCA, pharmaceutical companies have to a) demonstrate that their products are associated with a “good” (or, real) kind of pleasure, and b) dissociate (distance, de-articulate, redefine) that “good pleasure” as different from the kind of pleasure commonly associated with illicit drugs. Thus, binary pairs are invoked which distinguish between the bad/unacceptable pleasure of illicit drugs, and the good/permissible pleasure of pharmaceuticals. Some examples include immediate/delayed, solitary/social, unnatural/natural, unproductive/productive. This pleasure economy is illustrated in examples of migraine rhetoric, a malady often treated with narcotics. As Segal points out, the migraine sufferer is often suspected of moral weakness, and it is not the drugs she is prescribed, but rather her use of those drugs which is seen as licit or illicit; is she using the narcotic to stop pain, or induce (bad) pleasure? To avoid the moral suspicions associated with such drugs, pharmaceutical companies must advertise their drugs as promoting good or real forms of pleasure: sociability, authenticity, and productivity—pleasures that help others rather than simply the female self.
  Classical/Canonical Rhet, Gender, Pharmacy
• Spoel, Philippa. “How Do Midwives Talk with Women? The Rhetorical Genre of Informed Choice in Midwifery.” Leach 97—128. Spoel investigates the relationship between micro- and macro-level medical discourses and the hybrids they create. She does this by examining an emerging speech genre in Canada’s budding midwifery practice: the informed choice consultation. One of midwifery’s three main principles, informed choice, Spoel argues, is both ideological and rhetorical in nature, drawing from biomedical models of “informed consent,” but placing a religious emphasis on the equality and autonomy of the patient. Using discourse analysis, Spoel compares two conversations between two different midwives and their patients, as they discuss diabetes screening. The conversations reveal varying levels of discursive hybridity, in that they manifest both mainstream and alternative models of medical communication. Her first conversation excerpt, between a midwifery student and patient, contains stronger resonances of the biomedical, professional-expert model of communication, in which the doctor provides informed authority. Spoel’s second excerpt, between a practicing midwife and her patient, displays a more dialogical and cooperative model of communication. Spoel concludes that both excerpts reflect macro-level ideological tensions surrounding informed choice; however, they also point to the flexibility of local genres within situated rhetorical practices.
  Gender, Genre, HCP-Patient Com