Narrative, Historical, and Ethical Perspectives on the Medical Report

This project explores the narrativity, history and ethics of the medical report (‘discharge letter’), a standardized, epistemic genre that organizes written medical communication worldwide. Every day, physicians produce and study this kind of document countless times: for every patient released from hospital, physicians write a discharge letter to summarize the course of illness. The project pursues three main, interconnected goals. We will examine:

1. how physicians reason using narrative in this genre, which can be considered to be a very specific type of factual storytelling (literary studies)

2. how the discharge letter has developed historically in relation to both the patient’s file and medical concepts of the body, and how it has shaped medical institutionalization and standardization in the 20th c. (history of medicine)

3. how this genre, both historically and in the present, negotiates fundamental ethical conflicts relating to medical paternalism, the use of technology, and the very principles of medical ethics – especially dignity and autonomy (medical ethics).

Given that the discharge letter has not yet been subjected to scholarly investigation in the humanities, our project establishes the first state of the art in this field. Our archival sources, ca.180 discharge letters/reports and 160 patient’s files, indicate that the genre gradually develops during the 20th c. In the first part of the century, when letters from physicians to colleagues sporadically appear in medical files, illnesses are described in a rather subjective, narrative, even literary manner. After mid century, the discharge report becomes more and more formalized and a necessary element of the patient file; it seems to reflect developments in clinical medicine towards pluralism and specialization and of course the rapid technical development – and it rises ethical questions about patients’ experiences in hospitals and about medical communication in general.