Doctors' Stories: The Narrative Structure of Medical Knowledge (review)

Book Reviews 321 figure is performing miracles. The Christianity of The Brothers Karamazov evinces a profound understanding of the human need for healing and consolation. What the Inquisitor offers is not miracle, mystery, and authority , but magic, mystification, and tyranny. In Ught of Dostoevsky's primary literary source for "The Grand Inquisitor," the biblical book of Revelation, it is the Inquisitor who is "the false prophet." Keep the people guessing for their own good—and ours. Only so can we retain the power to do what is best for those who are unhappy in freedom. Or in Brody's transliteration, "in sickness." Howard Brody's book brims with evidence in support of his argument that viewing the doctor-patient relationship through the lens of power will yield fresh insight into that relationship. Instead of discussing that evidence, I have elected to take issue with the literary formulation of the book's main ideas because of its impUcations for the author's subsequent philosophical inquiry into the nature of healing. The Chief of Medicine tells his silent listener that doctors must be priests of a sort, by which he means ministers of magic and guardians of the unsharable secret that Aesculapian power is a sham. It is with this view that Brody disagrees. He believes, instead, that power, in its Aesculapian, charismatic , and social forms, inheres in the practice of medicine and that the responsible thing to do is to acknowledge that fact and share the power. My reading of the import for medical ethics of Dostoevsky's "Grand Inquisitor" is different. It is that the salient feature of power in its priestly modes is neither magic nor inherence, but vicariousness. Doctors do not possess power; that way Ues either tyranny or noblesse oblige. They are more Uke vicars than sorcerers or autocrats, or should aspire to be if they mean to heal without harming or patronizing patients. —Ronald A. Carson University of Texas Medical Branch at Galveston Kathryn Montgomery Hunter, Doctors' Stories: The Narrative Structure of Medical Knowledge. Princeton, N.J.: Princeton University Press, 1991. xxiii + 205 pp. Clothbound, $24.95. When people ask my wife how her father died, she will reply either "of a heart attack" or "on vacation." Both answers are appropriate and literally true; either is acceptable to almost any questioner. Yet each deals 322 BOOK REVIEWS with a quite different aspect of his death and locates the event in a radically different trajectory of human purpose. And each has a different resonance of comfort, anxiety, significance, and meaning for her and for her questioner. Which stories should doctors be listening for? Which stories should doctors be telling? How does one know? Reading Kathryn Montgomery Hunter's Doctors' Stories: The Narrative Structure of Medical Knowledge, I find myself reflecting on these questions in a complex, textured way that enriches the work of medical practice. Hunter is to be congratulated for having articulated a framework of medical activity in which these questions—far from the traditional view of what we doctors think we need to worry about—become decisive issues for responsible , effective, and rewarding practice. There is good medicine for doctors in this book. Hunter describes her method in her preface and introduction: She was an outsider, an English professor at a medical school, trying to bring a humanities perspective to traditional medical education, and she had the good fortune to do so at Morehouse when it was creating its own medical school. She taught in the first two preclinical years and, just as the clinical faculty was arriving, moved on to the University of Rochester, her first contact with an established, fully matured clinical faculty. She tried to understand this new territory by becoming a participant-observer and using what she calls the "ethnographic method" in the clinical context —on work rounds, in conferences, in grand rounds—all of the settings in which clinical medicine is taught. Where she was expecting hard science and cold facts, she found something very different: people told stories. The facts varied from case to case, the conventions of storytelUng varied a little from work rounds to grand rounds, but the activity of narration appeared to remain as a constant...