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Rethinking Diagnosis: The Many Texts of Medicine

Rethinking Diagnosis: The Many Texts of Medicine

(p.87) 6 Rethinking Diagnosis: The Many Texts of Medicine
The Distressed Body
Drew Leder
University of Chicago Press

Using tools from Continental philosophy, this chapter suggests that clinical diagnosis can best be understood not as a purified science but as a hermeneutical enterprise: that is, as involved with the interpretation of texts. Like the literary critic reading a novel, or the judge asked to apply a law, the physician must interpret the “text” presented by the ill person. Or “texts” really: four in turn are examined. These include the “experiential text” of illness as lived out by the patient; the “narrative text” constituted during history-taking; the “physical text” of the patient’s body as objectively examined; and the “instrumental text” constructed by diagnostic technologies. Harmonizing these proves to be no easy matter. Criteria of coherence, collaboration, and clinical effectiveness must all be employed. However, certain flaws in modern medicine arise from its refusal to face up to its hermeneutical nature. Medicine instead pursues a dream of objective truth gained by technologies which will yield a purified vision or mathematics of disease. Yet in seeking to escape interpretive subjectivity, medicine may both impair clinical judgment and lose sight of its primary subject — the living, experiencing patient.

Keywords:   diagnosis, hermeneutics, physician, patient, illness, technology, medicine

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