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CHAPTER 3 Producing the Good Patient To Dr. D.'s delight S. turned out to be a very good patient. She listened carefully to everything he said, taking copious notes at every appointment . She accepted his diagnoses of her conditions and readily adopted his changing interpretations of her new symptoms. Shefollowed his treatment orders to the letter, changing this drug and that, this dose and that, all with scarcely a word of protest. She worked hard to make the best of an often bad situation and covered her discouragement with a brave smile. Moreover, she became actively involvedin her own treatment, eagerly searching out information on her conditions and askinginformed questions. Carefully observingher own life, she offered observations and hypotheses that fit into and filled out the doctor's interpretive framework . On top of all that, S. was an engaging person (he told her that one day), fun to talk to and fun to see. This is the kind of patient that doctors dream of. This chapter explains how S.came to be such a good patient. By"good patient" I mean what Dr. D. meant: a patient who remained in treatment (that is, who was a patient), followed the doctor's orders (was "compliant "), and trusted her doctor's judgment,abilities, and promises to make her better ("had a good attitude").1 Whether S.would be a good patient was always an open question. It was in doubt because, as we have seen, after treatment began she experienced a rash of new symptoms. How was it that S. not only held on and followed orders, but did so in such an upbeat, trustful way? S.'s medical diary revealsthat her positive response to her doctor was in good part coaxed into beingby the doctor himself. In the last two chapters we saw how the discourses and practices of biomedicine secured a powerful grip on S.'s body and mind. In this chapter we look at the work done by the rhetorics of biomedicine, disclosing how the doctor's active attempts to persuade his patient to believe his story, follow his orders, and trust in him had the effect of turning a skeptical patient into an adoring one. In discussing the doctor's persuasive skills I speak of rhetorical 113 114 / Doing Biomedicine tactics. Bycalling these verbal maneuvers tactical I mean to signal that, although the process remained unconscious, the rhetorics were formulated and deployed to produce specific effects. That the doctor's words could be unconsciously chosen for particular persuasive purposes is not surprising. The process had to be unconscious, because his biomedical mind-set did not allow him to seehis work as anything but pure science. And the connection between specific verbal practices and specific effects is simply the product of years of clinical experience in which the doctor had faced problems of patient creation again and again. Over time he had worked out conversational gambits that would transform various unhelpful attitudes into helpful ones, with the effect of converting cautious or doubtful or resistant patients into good ones. The doctor's rhetorics worked so well because they were based on the discourses, the powerful and well-known "truths," of biomedicine, which were then embellished for persuasive effect. The listener not attuned to the conversational use of rhetoric would think she was hearing "the truth," when in fact the truth had been subtly stretched. The doctor 's claims were not false, they were just exaggerated for effect. The reader should keep in mind that Dr. D. was following accepted practice here. As noted in the Problematique, doctors must sometimes resort to such language to get recalcitrant patients to comply with their orders. S. was nothing if not recalcitrant, at least initially. In S.'s case we can identify three phases of good-patient construction, or three sets of rhetorical maneuvers, each addressed to a different patient problem. In the first two weeks of treatment, when the patient remained skeptical of her doctor's ability to help her, he painted a potent mix of frightening and hope-inspiring images to keep her in treatment. Then, when the patient appeared on the verge of dropping the drug treatment , the doctor brought out heavy linguistic guns to overpower her resistance . Finally, when the medications began to work, he marked and encouraged his patient's new attitude of trust with declarations of patient benefit and physician victory over entrenched bodily foes. These rhetorical maneuvers produced remarkable effects. Within six weeks the patient...


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