HEARING THE PATIENTS VOICE - TOWARD A SOCIAL POETICS IN DIAGNOSTIC INTERVIEWS

In this article we introduce a special practice that we have called th e practice of a ''social poetics'', and explore its nature. The settin g is a Primary Care Clinic at a large urban teaching hospital in the n ortheast of the U.S. As we describe it, the practice is at first condu cted by a third person who occupies the position of a ''cultural go-be tween'' and who mediates between doctors and their patients in diagnos tic interviews. Her task is to be open to being 'arrested', or 'moved' by, certain fleeting, momentary occurrences in what patients do or sa y. For sometimes in such moments, in our responding to the unfolding m otions of their whole body and voice-as they respond to the circumstan ces in which they find themselves-we can begin to sense that the uniqu e nature of their 'inner world of pain and suffering' is like for them . The practice of a social poetics entails a new, relational attitude to the patient's use of words, an attitude that invites a creative, po etic sensibility, as well as a 'boundary crossing' stance that creates comparisons useful in relating what patients say to the rest of their lives. In elucidating the nature of such a practice further, we draw on the work of Wittgenstein, Bachelard, and Bakhtin. Together, these c an lead to a new diagnostic practice that enables those involved in it to create, within the practice itself, both ways of talking that draw attention to the new possibilities for interaction the practice itsel f momentarily makes available, and ways of talking relevant to realizi ng these possibilities. Copyright (C) 1996 Elsevier Science Ltd