| Description |
Physicians are routinely exposed to dying patients and death, although some encounters are emotionally and existentially problematic, creating problems on two levels. Individuals are taught through medicine's hidden curriculum to detach from patients at the end-of-life, which can conflict with their personal values and result in moral distress. Institutionally, medical discourse does not officially encompass personal reflective writing, although it has been cited as potential remediation. This study uses discourse analysis, narrative discourse analysis, and rhetorical genre theory to critically investigate 126 physicians' personal articles recounting experiences from their postgraduate training with dying patients, which have been published in 14 general medical journals over 47 years. Findings disclose six rich discoursal features that distinguish physicians' personal discourse as rhetorical: repetition, metadiscourse, emotive language, euphemisms, metaphors, and narrative. Analysis of narrative, the dominant feature, reveals that physician authors consistently use personal writing to resist the hidden curriculum. Recurring themes--challenges to medical enculturation, counter-cultural medical practices at the end of life, and reincorporation of humanistic values--represent genre knowledge critical to an ethical practice of medicine. Therefore, physicians' personal discourse warrants rhetorical recognition as another genre of medical discourse, which I provisionally call perspective writing. Texts that focus on dying and death constitute the subgenre necrography. Findings from analysis of necrography using a combined method of material rhetoric, critical rhetoric, and phenomenology further reveal that narrative enables physician-authors to relate to the corpse in terms of kairos. They reconceptualize death as a critical time in which they can reconnect to the human body of the dead person and to their own mortality, humanizing the patient and themselves. I propose this representation of the corpse as the kairotic body, a theoretical model that expands upon other theories of the power of the unruly body. Rhetorical recognition of the genre of perspective writing, and by extension necrography, would substantiate the value of an existing body of medical writing as a significant and beneficial corrective to moral distress. Necrography especially provides new, crucial perspectives on dying that may contribute to the demedicalization of death in the medical profession and ultimately, in American society-at-large. |
