Trajectories of Persons and Practices: Sociohistoric Perspectives of Disciplinary Development. The Case Study of Terri Ulmer

Chapter 6 | Learning to See Patients:
Resituating the Development of Professional Vision in Healthcare

Textual Mediation in Healthcare Activities

The centrality of texts in learning to see as—to, indeed, be—a health care professional has been the focus of a number of analyses. Close analyses of professional practice have prompted researchers to conclude that developing professional vision as a health care practitioner is a matter of engaging with professional texts. Based on his analysis of social workers’ writing and recordkeeping, for example, Paré (2001) argued that “this erasure of the self—or more accurate, perhaps—transformation of the self into a ‘professional’ locates the learner anonymously within the institution’s naturalized ideology. It is a transformation realized through participation in workplace genres” (p. 68).

Those analyses have examined a wide vareity of specific texts, from McCarthy (1991) and her co-author’s (McCarthy & Gerring, 1994) examinations of the Diagnostic and Statistical Manual of Mental Disorders, one of psychiatric health care’s charter documents, to Bawarshi’s study (Devitt, Bawarshi, & Reiff, 2003) of the functions of the patient medical history form, to Teston’s (2012) recent examination of how visual displays of medical images “make present,” in Perelman and Olbrechts-Tyteca’s (1969, p. 117) sense, the material characteristics of disease and thus shape deliberations about treatment. Catherine Schryer and her various co-authors have examined the rhetorical function of a wealth of health care genres, including case presentations (Schryer, Lingard, & Spafford, 2005), electronic patient records (Varpio, Schryer, Lehoux, & Lingard, 2008), the dignity interview (Schryer, McDougal, Tait, & Lingard, 2012), referral letters, forensic reports, treatment forms, medical consultations, and physicians’ talk with and about patients (Hildebrand, Spafford, & Schryer, 2008).

Scholars have argued for the need to extend those analyses by approaching health care and the charter texts readily associated with it not as already made actions and texts that persons simply enter into but as activities that are continually in-the-making. Engestrom’s (1993) work in Finnish medical clinics offered a heterogeneous account of meaning-making in health care settings, one that included patient voices and the histories of health care professionals. Bellwoar (2012) offered a recent case study of Meagan that examined the self-directed trajectory of texts—including ultrasounds and other official medical texts with various “unofficial” texts including tradebooks about pregnancy, information from Wikipedia, products at Toys "R" Us—she uses to understand and manage her health care.

We present here a documented narrative (Becker, 2000; Prior, 1998) that partially traces the sociohistoric and semiotic trajectories of Terri’s seeing of patients as it is repurposed and remediated across diverse multiple activities and representational media over a span of multiple years. In assembling and presenting our analyses in this narrative form, our goal is to present the historical pathways of Terri’s seeing of patients in a coherent fashion without flattening out the richness, complexity, and dynamics of how literate action is continually taken up, transformed, re-combined, and re-coordinated across space, time, and media. The documented narrative that follows partially traces the developmental pathway of Terri’s seeing of patients as it is remediated across a number of nexus mediating her everyday literate engagements: poetry, science fiction, religious worship, her autobiographical memoir, and a family video.

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