From a complaint through therapy to recovery: Patient indexicality in medical case reports

Abstract

In the present paper, the issue of patient indexicality in professional medical texts has been addressed. To this aim a corpus of medical case reports has been compiled to examine both direct and indirect references to the patients described there. The studied tokens have been investigated from two perspectives. First, the focus has fallen on patient textual presence/absence as conditioned by the aims of the respective text-parts. Second, the analysis of patient reference in the sections of the case reports has been discussed with respect to some of the facts from the history of the development of medicine. The form and content of the texts under study may also be influenced by the currently practiced model of medicine, i.e. the biomedical model. Furthermore, the analysis has drawn on the hierarchical levels of medical description as well as on two models of disease presentation which also help to explain the choice of modes of writing about patients and diseases they suffer from. The study reveals that as the texts progress, they become more patient-evacuated and focus on his/her progressively smaller body parts. In other words, patient reference changes from direct indexicality to indirect references to his/her body parts or to the textual absence of the treated. This effect is achieved not only by the type of information imparted but also by the lexical and grammatical resources used to describe it. Consequently, the mode of writing as testified in the case reports at hand contributes to the presentation of mental/bodily experience, disease and treatment in abstraction from the patient.