DOCTOR TALK AND DIABETES - TOWARDS AN ANALYSIS OF THE CLINICAL CONSTRUCTION OF CHRONIC ILLNESS

During the last two decades the illness narrative has emerged as a pop ular North American literary form. Through poignant stories. well-educ ated patients have recounted their struggle with disabling diseases as well as with the hospitals and health care bureaucracies From whom th ey seek service. However. much less has been written about the doctor' s narrative construction of chronic diseases either in the process of learning medicine or through diagnosing, treating and counseling chron ically ill patients. Indeed, following Kleinman's lead, the physician' s narrative has;been narrowly viewed as a discourse on the verifiable manifestations of pathophysiology. Drawing on contemporary theories of storytelling - including the conception of narrative as conversationa l interaction - the present paper argues that doctor narratives are eq ually complex if quite different than patient stories; Indeed, through an analysis of doctor talk centering on diabetes mellitus collected i n several distinct venues - case presentations, narrative interviews a nd medical consultations - ii is argued that physician stories not onl y employ very evocative tropes, but that these stories combine didacti c, rhetorical and soterological elements in the telling. The research was conducted at two, urban family practice training sites in Chicago. (C) 1998 Elsevier Science Ltd. All rights reserved.