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 popular North American literary form. Through poignant stories, well-educated patients have recounted their struggle with disabling diseases as well as with the hospitals and health care bureaucracies from whom they 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 chronically 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 conversational interaction — the present paper argues that doctor narratives are equally complex if quite different than patient stories. Indeed, through an analysis of doctor talk centering on diabetes mellitus collected in several distinct venues — case presentations, narrative interviews and medical consultations — it is argued that physician stories not only employ very evocative tropes, but that these stories combine didactic, rhetorical and soterological elements in the telling. The research was conducted at two, urban family practice training sites in Chicago.