Hermeneutics and Modern Medicine


Last month’s column discussed phenomenology and explained that the term hermeneutics often is used in conjunction or even in confusion with the term phenomenology. This column will define and provide a background of hermeneutics. The relationship that hermeneutics has with phenomenology also will be reviewed. The column will conclude with a discussion of critical hermeneutics and its research implications. DEFINITION AND BACKGROUND A simple definition of hermeneutics is textual interpretation, or, in other words, finding meaning in the written word. Two embedded assumptions of hermeneutics are that humans experience the world through language and this language provides both understanding and knowledge. The term hermeneutics was derived from two words–the Greek verb hermeneuein, meaning to interpret, and the noun hermeneia, meaning interpretation.(1) This method of textual analysis emphasizes the sociocultural and historic influences on qualitative interpretation. . . .

The body plays a central role in shaping our experience of the world. Why, then, are we so frequently oblivious to our own bodies? We gaze at the world, but rarely see our own eyes. We may be unable to explain how we perform the simplest of acts. We are even less aware of our internal organs and the physiological processes that keep us alive. In this fascinating work, Drew Leder examines all the ways in which the body is absent—forgotten, alien, uncontrollable, obscured. In part 1, Leder explores a wide range of bodily functions with an eye to structures of concealment and alienation. He discusses not only perception and movement, skills and tools, but a variety of “bodies” that philosophers tend to overlook: the inner body with its anonymous rhythms; the sleeping body into which we nightly lapse; the prenatal body from which we first came to be. Leder thereby seeks to challenge “primacy of perception.” . . .


Narrative medicine has emerged in response to a commodified health care system that places corporate and bureaucratic concerns over the needs of the patient. Generated from a confluence of sources including humanities and medicine, primary care medicine, narratology, and the study of doctor-patient relationships, narrative medicine is medicine practiced with the competence to recognize, absorb, interpret, and be moved by the stories of illness. By placing events in temporal order, with beginnings, middles, and ends, and by establishing connections among things using metaphor and figural language, narrative medicine helps doctors to recognize patients and diseases, convey knowledge, accompany patients through the ordeals of illness–and according to Rita Charon, can ultimately lead to more humane, ethical, and effective health care. Trained in medicine and in literary studies, Rita Charon is a pioneer of and authority on the emerging field of narrative medicine. In this important and long-awaited book she provides a comprehensive and systematic introduction to the conceptual principles underlying narrative medicine, as well as a practical guide for implementing narrative methods in health care. A true milestone in the field, it will interest general readers, and experts in medicine and humanities, and literary theory.

Surgeon and MacArthur fellow Gawande applies his gift for prose to medical and ethical dilemmas in this collection of 12 original and previously published essays adapted from the New England Journal of Medicine and the New Yorker. If his 2002 collection, Complications, addressed the unfathomable intractability of the body, this is largely about how we erect barriers to seamless and thorough care. Doctors know they should wash their hands more often to avoid bacterial transfer in the ward, but once a minute does seem extreme. Using chaperones for breast exams seems a fine idea, but it does make situations awkward. “The social dimension turns out to be as essential as the scientific,” Gawande writes—a conclusion that could serve as a thumbnail summary of his entire output. The heart of the book are the chapters “What Doctors Owe,” about the U.S.’s blinkered malpractice system, and “Piecework,” about what doctors earn. Cheerier, paradoxically, are the chapters involving polio and cystic fibrosis, featuring Dr. Pankaj Bhatnagar and Dr. Warren Warwick, two remarkable men who have been able to catapult their humanity into their work rather than constantly stumble over it. Indeed, one suspects that once we cure the ills of the health care system, we’ll look back and see that Gawande’s writings were part of the story.


“This is a book that will be read with pleasure by anyone interested in how medicine is done and it is a book that should be required reading for all students starting their clinical training.” –Journal of the Royal Society of Medicine

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