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Searching for the Patient’s Presence in Medical Case Reports


Magdalena Zabielska

The book addresses the issue of the patient’s presence in specialist medical publications in the context of a patient-centered approach to medical practice. The author combines both quantitative and qualitative approaches in order to analyze the discourse about the patient in one of the oldest medical genres, case reports. She traces textual references to patients throughout the reports to show that their nature and frequency depend both on the structure of the genre and the context of the production of these texts. The author touches upon the topical issue that although specialist communication may seem to exclude patients, it does not mean it does not concern them. Indeed, they are written about and it appears critical how this is done.
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Chapter One: Theoretical background


Drawing on a useful classification of various approaches to discourse analysis proposed by Nelson Phillips and Cynthia Hardy (2002), the present work is located in the area of social linguistic analysis which can be characterized as being constructivist and text-based in nature. According to the above authors, the aim of this framework is “to undertake a close reading of the text to provide insight into its organization and construction, and also to understand how texts work to organize and construct other phenomena” (Phillips and Hardy 2002: 22). This methodological choice excludes critical discourse analysis with its ideological commitment, which will be reflected in the decision of how the term discourse is understood in the present work. Moreover, it is constructivist in that it views the texts as shaped in the course of the history of the development of medicine. At this point a distinction should be made between distal and proximate contexts of the production of the texts. Distally, the evolution of the case report genre against the background of the history of medicine is taken into consideration. Proximately, the focus falls on the present context in which case reports are written, i.e., the current model of medical practice with its methodologies and modes of reasoning. The reflection of these factors in contemporary case reports will be demonstrated in the empirical part of the work where the linguistic selections used to write about patient diagnosis and treatment have been analyzed. Additionally, these choices have been investigated in the light of...

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