Texts, Authoring and Reading in Medical Education

Abstract

Despite William Osler’s referring, over a century ago, to the patient as a ‘text’ and key work since (Daniel 1986, 1990; Leder 1990), the notion may be new to some medical educators and needs to be carefully explained and explored. At first sight, the word ‘text’ may seem a demeaning or reductive way to describe a patient’s presence, but doctors are familiar with descriptions of patients as ‘cases,’ presented in various ways with colleagues, such as grand rounds. A case is one form of a text. We should then not baulk at the notion of patient as text and the activities of talking with and writing about the patient as textual practices, since doctors already speak informally about reading the patient’s symptoms, body language or social background in the consultation. Although they may sometimes do this unsystematically and instinctively, this ‘close reading’ is a key skill within the consultation and enables doctors to relate to the patient better, to exchange information in a way that will ensure its reception, and ultimately to arrive at a diagnosis and treatment plan for the patient’s illness. We have also shown earlier how it is possible to ‘read’ educational relationships between patients, students and medical and health-care experts in various theoretical lights.