| What lets doctors see patients so briefly and yet know so much about them? What are residents doing all day in the hospital, since relatively little of their time is face-to-face with the patient? The work of the face-to-face encounter extends to well before and after the actual moment of interaction. The resident must situate a patient and her overwhelming host of facts. Physicians make sense of circumstances, information, and interaction through a particular kind of storytelling that enlists what the physician already knows about patients, diseases, treatment, and outcomes. In settling on the story of a patient-with-disease, a patient story trajectory with an imputed past and future, a physician draws on narrative templates that condense within them a systematic approach to diagnosis, a set of ideas about what patients are like, notions of biomedical disease, and institutional habits. These templates are at once cognitive and practical, and allow residents to identify the sort of problem, the kind of patient, and the nature of the disease, often at a glance. Based on a set of overlapping narrative templates, the resident can build the story of this patient-with-disease on the scaffolding of the stories he already knows, the things he already knows how to do, and the routes he knows how to follow. In the medical encounter, the narrative storytelling that residents do is a conveyance that moves a patient through a hospitalization by making the problem visible as such, by pointing the resident to what is relevant information, and by directing his line of questioning to pursue that relevant information. Residents are learning to locate patients within a story that situates them relative to an imputed past and imputed future. Patient story trajectories are densely-woven ropes of actants that come together to form a story that situates the patient's illness. These actants are things, circumstances, events, and routines that are taken up to shape the story of the patient-with-disease. "Facts" do not take on their meaning except in relation to other facts in the story of a patient-with-disease. |
