Doctor/Patient encounters

[Jim Wilce]

For Sam Hopwood:

Whether they are cross-cultural or not I don't know, but doctor-patient 
encounters are typically unequal and often represent a cross-class or 
interethnic relationship.

This has been documented in medical encounters…
… in Bangladesh:

Wilce, James M
1995 "I Can't Tell You All My Troubles":  Conflict, Resistance, and 
Metacommunication in Bangladeshi Illness Interactions. American 
Ethnologist 22:927-952.
	1997 Discourse, power, and the diagnosis of weakness: Encountering 
practitioners in Bangladesh. Medical Anthropology Quarterly 
11(3):352-374.

in submission Madness, fear, and control in Bangladesh: Clashing bodies 
of knowledge-power. Medical Anthropology Quarterly (special issue on 
Illness and Illusions of Control).

… in South Africa:
Swartz, Leslie
1991 The Politics of Black Patients' Identity:  Ward-Rounds on the 
`Black Side' of a South African Psychiatric Hospital. Culture, Medicine 
and Psychiatry 15:217-244.

Comaroff, Jean
1994 The diseased heart of Africa. In Knowledge, power, and practice:  
The anthropology of medicine and everyday life. S. Lindenbaum and M. 
Lock, eds. Pp. 305-329. Berkely and Los Angeles: University of 
California Press.

and in the US
Ainsworth-Vaughn, Nancy
1998 Claiming power in doctor-patient talk. New York: Oxford University 
Press.

Many of us working in this field, including the citations above, 
critique simple models of domination and resistance in such encounters.

Sachs, Lisbeth
1989 Misunderstanding as therapy: Doctors, patients and medicines in a 
rural clinic in Sri Lanka. Culture, Medicine, and Psychiatry 
13::355-349.

Also, the literature on medical discourse has shifted from an 
interactionist focus on one-to-one encounters (doctor-patient) to an 
investigation of broader processes, including colonialism:


Anderson, Warwick
1992 "Where Every Prospect Pleases and Only Man Is Vile": Laboratory 
Medicine as Colonial Discourse. Critical Inquiry 18(3):506-529.

and contextualization and entextualization in medicine:
Kuipers, Joel C.
1989 "Medical discourse" in anthropological context: Views of language 
and power. Medical Anthropology Quarterly 3(2):99-123.

Cicourel, Aaron V.
1992 The interpenetration of communicative contexts:  Examples from 
medical encounters. In Rethinking Context:  Language as an Interactive 
Phenomenon. A. Duranti and C. Goodwin, eds. Pp. 291-310. Studies in the 
Social and Cultural Foundations of Language, Vol. 11. Cambridge: 
Cambridge University Press.

with an increasing focus on discourse among doctors that 
recontextualizes whatever occurs between doctor and patient:
(Cicourel 1992)

Erickson, Frederick
1999 Appropriation of voice and presentation of self as a fellow 
physician: Aspects of a discourse of apprenticeship in medicine. In 
Talk, Work and Institutional Order: Discourse in Medical, Mediation and 
Management Settings. S. Sarangi and C. Roberts, eds. Pp. 109-144. 
Berlin: Mouton de Gruyter.

(in the same collection there are several other excellent pieces).

Best,

Jim

Jim Wilce, Associate Professor of Anthropology
Northern Arizona University
PO Box 15200
Flagstaff AZ 86011-5200
Office phone: 928-523-2729
email: jim.wilce at nau.edu
Home page: http://jan.ucc.nau.edu/~jmw22

New! You can now order Jim's 2003 edited volume, Social and Cultural 
Lives of Immune Systems, from Routledge. See 
http://www.routledge-ny.com/books.cfm?isbn=0415310040.
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