| This qualitative descriptive study examines how various members of a certain discourse community of academic physicians have constructed patients on paper over time--with emphasis on the classical concept of pathos, or its modern equivalent, empathy. The most pertinent lexical and syntactic choices made with (dis)regard to patients are delineated in five editions of the New England Journal of Medicine (NEJM), spaced 30 years apart--March 25, 1828; March 25, 1858; March 29, 1888; March 28, 1918; and March 25, 1948.;My cross-disciplinary viewpoint as a particular reader-scholar-editor is steeped in three intertwining premises: (1) Language matters: words have deeper meanings that both reflect and shape the underlying power structure. (2) The effect of allegedly harmful linguistic choices--however untentional, however minor in isolation--is cumulative. (3) There is a place for individuals' perceptions in what counts as useful knowledge.;What I found was an increasing tendency to objectify patients in the sometimes sterile, allegedly scientific glare of the "anatomo-clinical gaze," to use Foucault's term. Trends include decreasing attention to the names, personalities, and voices of patients; increasing use of words that, in effect, blame patients for their conditions; increasingly harsh vocabulary for patients; and increasing displacement of patients as mere receptacles. In all five editions, patients are often distanced from their own body parts, constructed on the receiving end of physicians' work, and buried in awkward phrases.;For example, the case reports of 1828, replete with patients' last names and direct quotations, have given way at times to overt discounting of their largely now-anonymous stories. The metonymous equation of patients with "cases" does not predominate until 1918 and 1948. The 1918 edition transmogrifies patients into everything from "loathsome objects" to "derelict fragments." The 1948 edition in particular overuses "perform" for procedures that physicians do, usually "on" or "to" (rather than "for") patients, often rendered as numbered and capitalized cases. It also introduces "problem" patients as something to "manage" (rather than "care for"). |
