Waitzkin H, Britt T
University of California, Irvine North Orange County Community Clinic, Anaheim 92801.
Int J Health Serv. 1989;19(4):577-97. doi: 10.2190/L84U-N4MQ-9YAC-D4PP.
Criticism of social context does not generally appear in medical encounters. When contextual issues arise in medical discourse, messages of ideology and social control may become apparent, usually without the conscious awareness of the participants. By easing the physical or psychological impact of contextual difficulties, or by encouraging patients' conformity to mainstream expectations of desirable behavior, encounters with doctors can help win patients' consent to troubling social conditions. Seen in this light, doctor-patient encounters become micropolitical situations that do not typically encourage explicit statements or actions by health professionals to change contextual sources of their patients' difficulties. A critical theory influenced by structuralism suggests that the surface meanings of signs in medical discourse prove less important than their structural relationships. In addition, a theoretical approach adopting elements of post-structuralism and Marxist literary criticism emphasizes the marginal, absent, or excluded elements of medical discourse. Contextual features that shape a text include social class, sex, age, and race. Through the underlying structure of medical discourse, contextual problems are expressed, marginalized, and managed.
