Volume 37, Issue 1

Rhetoric in medicine refers to various acts and actors: the patients speech; the doctors speech; the resulting narratives - for instance the medical history; the patients biography; the narration of the doctor-patient relationship; the cultural history of doctor, patient and illness.

The discourse analysis of medical communication as a special case of institutional communication has made enormous progress in the past decades but has largely concentrated on the empirical analysis of corpora of current doctor- patient discourse, while other areas of medical communication as well as their historical dimension came out of focus. Therefore, the following contribution attempts to firstly provide the reader with a conceptual and terminological framework, in order to emphasize the relevance of rhetorical knowledge for a successful understanding between (medical) experts and lay people (patients). Secondly, addressing the less specialized reader, it gives an outline of the traditional rhetorical lines of medical communication from antiquity to the present. Against this background, the pragmatic conditions of this specific type of speech constellation can be described more precisely. On such a conceptual basis and within such a rhetorical and pragmatic framework, founded both historically and systematically, the entirety of discursive phenomena of institutional communication in health care institutions can be examined more closely. At the same time, this provides a more differentiated approach (compared to traditional literary approaches) to the interpretation of forms of ›aesthetic problematization‹ of medical communication in selected examples of fictional literature.

Since 1987, the year of birth of the first child conceived outside the womb, experiments with human life have been leading to an intense public debate about the benefits, chances and risks of research in reproductive medicine. For what had formerly existed in fictional worlds only, be it the alchemical mind game, the homunculus- recipe of Paracelsus or the breeding centre of Aldous Huxley’s Brave New World, was now happening in reality. With in vitro fertilization becoming a feasible alternative to creating offspring, the literary forms of representation for those technologies changed, too. This will be analysed in three exemplary 1980s novels with regard to topical focus, modifications in genre poetics and specific rhetoricity. It becomes apparent that in the age of human reproductive technology, the old motif of life from the lab has long lost its fictitious status and now manifests itself in diverse, sometimes bizarre ways as a part of social reality. As a result, authors now focus on the specific ethical and social problems of reproductive medicine. However, for fictional elaboration and rhetorical ornamentation of dystopias, bio-genetics and nanotechnology are mostly consulted because these sciences offer means of seemingly creating perfected and custom-made descendants.

Using an understanding of rhetoric as a method of communicative reasoning capable of providing grounds for conviction in those to whom it is addressed, this article argues that the formation of medical diagnoses shares a structure with Aristotle’s account of the rhetorical syllogism (the enthymeme). Here the argument itself (logos), together with characterological elements (ethos) and emotions (pathos), are welded together so that each affects the operation of the others. In the initial three sections of the paper, we contend, first, that diagnoses, as verdictive performatives, differ from scientific claims in being irreducibly personal and context-dependent; secondly, that they fit the structure of voluntary action as analysed by Aristotle and Aquinas; thirdly, that as practical syllogisms they differ from theoretical syllogisms, for example in taking effect in action, being ›addressed‹, and being intrinsically embedded in wider contexts of medical communication and practices. In the remaining sections we apply this account to textual evidence about diagnosis, drawing on work by the brain surgeon Henry Marsh. A rhetorical analysis of his observations on the formation of diagnostic opinions in situ illuminates how moral, social and emotional features are fused with the cognitive aspects of medical judgement, making or marring how diagnoses and treatment are enacted. In other words, a philosophical- rhetorical account of diagnosis can help us to appreciate how medical diagnosis takes effect. We briefly conclude with some implications of our work for how diagnostic processes could in practice be better supported.

The notion of therapeutic communication was spread mainly by Paul Watzlawick. He is building on antique roots and argues that the working principles are known since the antique and were wide spread in the art of healing. The famous statement of the sophist Antiphon from Athena »I can heal the sick with words« Watzlawick explains in the context of rhetoric and he refers explicitly to the »somatic rhetoric« of Quinitilian and his Instituto Oratoria. For a better understanding of this statement the Socratic art of speech will be introduced practically, which shows itself in contrast to the rhetoric of sophism: as talk room of truth in opposition to a talk room of method. Even the giving of a remedy is indispensably connected with the dialog between the physician and the patient and only in this combination a catharsis is enabled. The working principles of the therapeutic communication relate to all areas of rhetoric, that means not only inventio, dispositio and elocutio but also actio and pronuntatio as well as the whole context of speech.

Psychotherapy talk is characterized by epistemic, emotional and professional asymmetries of knowledge, which are continuously adjusted to by the participants in joint process of negotiation. Adjustment is based on structural features of communication: the fundamental sequentiality of verbal interaction, i.e. interrelated succession of utterances of at least two interlocutors, provides for and guarantees the achievement of intersubjectivity and therapeutic efficiency. Solution-oriented questions as a rhetorical practice serve to produce forward-looking awareness, expansion of knowledge and reorganization of knowledge on the patient’s side as well as an increased ability to act. These processes become apparent not only locally in the immediate context of solution-oriented questions but also globally in the course of the interaction as a whole. The data for this research consists of psychodiagnostic interviews conducted according to the concept and manual of the Operationalized Psychodynamic Diagnostics (OPD Task Force 2009).

Doctor-patient communication is a condensed and solution-oriented interaction. Repairs of what is said and what isn‘t processed properly are especially in these - usually very short - interactions important to get to a common level of knowledge. This is not only crucial for the implementation of the common and targeted interaction, but also for a successful therapy following it. In addition, in some cases repairs are extremely delicate. In this article we will discuss which rhetorical devices the participants use for repair and how these repairs are processed. Not only rhetorical devices differ, but also processing of the repairs in individual interactions. Data are based on various corpora of medical communication with dyadic and triadic structure of general practitioners, internists, urologists and pediatricians from Germany and Korea.

This article discusses how patients consent to medical treatment. More specifically, we shall look at how doctors prompt patients to sign consent forms. The analysis of consent forms and transcripts from authentic doctor-patient interactions shows that physicians treat the act of signing the form as a mere routine that is only loosely connected to the act of consenting to the proposed treatment. The use of the irrealis mode creates a distance between the here and now of the interaction and the request to sign the form. Thus, the institutional significance of the signature becomes blurred. We shall call the rhetorical procedures used in this process a »camouflage « to highlight the fact that the institutional and juridical value of the signature is minimized.

In this chapter, we present a new method for the medical field, which can contribute to patient-oriented care, especially in shared decision making. The mental models and conceptions of patients about their illness and the expected care determines their perception, decision and use of the care system - and thus they also influence the adherence. If the illness-health-model as part of the health literacy of the patients is known and recognized by the doctors throughout the decision-relevant processes, this facilitates a working patient-doctor relationship not only on a level of general kind communication. It helps doctors to better understand why patients decide in a certain way and why. By using the computer-linguistic methodology and software presented in this chapter, it is possible to automatically and objectively analyse, aggregate and cluster large data sets of written mental models and beliefs based on the patientsʼ models to create a comprehensive overview of common belief clusters. The results can be visualized on comprehensive knowledge maps and then used by the treating physicians. The knowledge maps are disease-specific and can - after a successful instruction and training - be used by physicians to improve the factual understanding of patient concerns.

Using the question of ›overweight and nutrition‹ as an example, the article examines the rhetoric of knowledge transfer in public health communication and shows how individual texts from a wide variety of oral and written media combine on a meta-textual level to form a textual network and thus become a constitutive component of a public discourse in health communication. The occasion and starting point is the Swiss Nutrition Report, whose 5th issue on the topic of »Nutrition and obesity« has triggered a nationwide flood of follow-up publications on the subject. In addition to the scientific report, the resulting text network includes its popular scientific short version, specialist presentations, leaflets and flyers, brochures, newspaper interviews, news and commentaries, talk shows, Internet forums and interpersonal nutrition counselling discussions, each of them following their own rhetorical rules and patterns.