MEDICAL SLANG 683
Cad . Saúd e Púb lic a, Rio d e Jane iro , 14(4):671-699, o ut-d e z, 1998
The so cial co n structio n o f m edical m etapho r
Dr. Ch r ist o p h e r Pe t e r so n’s a r t ic le o n m e d ic a l sla n g is a n in sigh t fu l a n a lysis o f t h e wa ys in wh ic h p h ysic ia n s a n d o t h e r m e d ic a l st a ff u se c re a t ive la n gu a ge t o c o n st r u c t a re sp o n se t o co n tem p o ra r y crises in th e h ea lth ca re system . I fou n d little in Dr. Peterso n’s a rticle with wh ich t o a rgu e, a n d in d e e d , o n ly wish t h a t I h a d h a d a ccess to h is wo rk wh en I a d d ressed sim ila r issu e s a s t h e y e m e r ge in m a n y o f t h e a u t o b io -gra p h ica l wr it in gs o f p h ysicia n s in t h e Un it e d St a t e s. My co m m e n t a r y is le ss a crit iq u e o f h is a r t ic le t h a n a ve r y t e n t a t ive c o n sid e ra t io n o f so m e o f th e im p lica tio n s o f h is co n clu sio n s.
On e o f t h e fir st p o in t s t h a t m a y st r ike t h e re a d e r in th e Un ite d Sta te s a b o u t th e Bra zilia n m e d ic a l sla n g t h a t Dr. Pe t e r so n d isc u sse s is th a t it p rovid es a fa scin a tin g p ersp ective on in -stitu tio n s a s m u ch a s o n p a tien ts. As Dr. Peterso n n o t e s, m u ch o f t h e wo rk d o n e in t h e Un it -e d St a t -e s o n m -e d ic a l sla n g, b y D a vid Go rd o n a n d o t h e r s, fo c u se s o n t h e t yp ific a t io n o f p a -tien ts th rou gh wh a t is som etim es referred to a s ‘go m e r’ t a lk. Th is fo r m o f m e d ica l sla n g co m -p rises a rich voca b u la r y of d ero ga to ry term s fo r p a tien ts ra th er th a n in stitu tio n s. Th e sym b o lic co re o f th is sem a n tic field is th e u rb a n h o sp ita l em ergen cy ro o m , wh ich in d igen t a n d p o o r p a-tien ts u se fo r th eir p rim a ry ca re, o ften p resen t-in g wit h m t-in o r m e d ica l p ro b le m s, o r wit h t h e co m p lica tio n s o f ‘self-in d u ced’ co n d itio n s sec-on d ary to d ru g an d alcoh ol u se, cigarette sm o k-in g, a n d p o o r d iet. Even ‘go o d’ p a tien ts m a y b e sp oken of in a m ild ly d ero ga to ry wa y, for exa m -p le with th e te rm ‘YAVIS’ o r “yo u n g, a ttra ctive, ve r b a l, in t e llige n t , su c c e ssfu l”. Th e st r in g o f p o sit ive la b e ls ca n n o t q u it e h id e t h e n e ga t ive to n e im p lied in th e u se o f a stereo typ in g la b el. Dr. Peterso n’s a rticle m a kes two su ggestion s t h a t co u ld b e t u r n e d b a ck o n m e d ica l sla n g in t h e Un it e d St a t e d ve r y p r o d u c t ive ly. Fir st , h e su ggests th a t Bra zilia n m ed ica l sla n g en cod es a rela tion sh ip b etween h ea lth ca re p rovid ers a n d in stitu tio n s, a n d in d e e d with th e la rge r Bra zil-ia n p olitica l econ om y. Secon d , h e su ggests th a t t h e ch a n ge s in h e a lt h ca re t h a t ge n e ra t e su ch p ersp ectives a re m o st p ro d u ctively co n sid ered to b e Web eria n ra th er th a n Ma rxia n in n a tu re.
Debate sobre o artigo de Christopher Peterson
De b ate o n the p ap e r b y Christo p he r Pe te rso n
Dep a rt m en t of An t h rop ology St a t e Un iv ersit y of N ew York a t Bu ffa lo
Bu ffa lo, U SA.
Don a ld Pollock
Alt h o u gh Dr. Pe t e rso n is cr it ica l o f Go rd o n a n d o th e rs fo r fo cu sin g e xclu sive ly o n m e d ica l sla n g fo r p a t ie n t s a n d ign o r in g sla n g fo r in st i-t u i-t io n s, I a m n o i-t c e r i-t a in i-t h a i-t , in i-t h e Un ii-t e d St a t e s wh e re Go rd o n d id h is re se a rc h , p h ysicia n s h a ve d evelop ed a sign ifica n t sla n g vo ca b -u la r y fo r m e d ic a l in st it -u t io n s. Th e o n e p e r t in e in t e xa m p le t h a t o ccu rre d t o m e wh ile re a d -in g Dr. Peterso n’s a rticle wa s th e p h ra se ‘d o c -in a b ox’, referrin g to sm a ll clin ics, o ften a sso cia t-ed with la rger h o sp ita ls o r h ea lth m a in ten a n ce o rga n iza tio n s, th a t p rovid e a wid e ra n ge o f p ri-m a r y c a re se r vic e s t o ri-m u lt ip le zo n e s wit h in a n d a r o u n d a n u r b a n a re a , like b ra n c h e s o f a b a n k. Th e cr it ica l m e a n in gs e m b e d d e d in t h e p h ra se a llu d e t o t h e (im p re ssio n o f ) st r ip p e d -d own , lowe r- q u a lit y o f ca re p rovi-d e -d b y t h e se fa c ilit ie s, wit h t h e im a ge o f a q u ic k c o n su lt a -t io n fro m wh ich e ve r p h ysicia n h a p p e n s -t o b e st a ffin g t h e ‘b o x’ a t t h a t t im e, c o m b in e d wit h t h e n o t io n o f a c h e a p c o m m o d it y so ld in a ge n e r ic b o x in la r ge n u m b e r s. Bu t a p a r t fr o m t h is e xa m p le I a m n o t fa m ilia r wit h a n y m o re co m p le x sla n g vo ca b u la r y o f t h e r ich n e ss t h a t Dr. Peterson u n covers in Rio d e Ja n eiro, th ou gh th is m a y rep resen t m y own m yo p ia .
ysi-PETERSO N, C. 684
Cad . Saúd e Púb lic a, Rio d e Jane iro , 14(4):671-699, o ut-d e z, 1998
Pe t e rso n p re se n t s co m p e llin g e xa m p le s o f t h e m ean in g an d th e con stru ction s of m ed ical sla n g in Rio d e Ja n eiro, a n d d escrib es th e n ew m ea n -in gs p h ysic ia n s c re a t e fo r (a n d c o m m u n ic a t e a b o u t ) t h e ir h e a lt h c a re syst e m t h ro u gh t h e ir u se o f m ed ica l sla n g. Bu t h e m a kes u n co n vin c-in g a t t e m p t s t o d iffe re n t ia t e h is st u d y fr o m o t h e rs (p a rt icu la rly a st u d y b y Go rd o n in Ca lifo r n ia ), a n d so m e t im e s m ove s t o o q u ickly b e -twe e n d e scrip tio n s o f m e ta p h o r, sla n g, ja rgo n , p rove r b s, p u n s, a n d jo ke s. Th is is a t o n c e a p le a sin g a n d p ro b le m a tic p a p e r, e sp e cia lly fo r a m e d ica l a n t h ro p o lo gist wit h lit t le fo rm a l so -cio lin gu istic tra in in g.
Pe t e r so n co n t r a st s su b st it u t ive, co m p a ra -tive, a n d in tera ctive exp la n a tio n s o f m eta p h o r, a n d m a ke s a co n vin cin g ca se fo r t h e u t ilit y o f th e th ird ca tego r y. He p resen ts o n ly a sketch o f th e Bra zilia n h ea lth system cr isis, b u t h e m a kes a p p r o p r ia t e a n d c o n vin c in g re fe re n c e s t o a co n text o f h o rro r a n d m o ra l ch a llen ge, a n d th e d evelo p m en t a n d u se o f m ed ica l sla n g to m a n -ifest a n d co n fro n t (o r wo rsen ) th a t co n text. On t h e o t h e r h a n d , h is a t t e m p t s t o c o m p a re h is stu d y with on e from Californ ia on h osp ital jokes (Go rd o n , 1983) a re le ss co n vin cin g. He co n t ra st s h is b ro a d e r wit h Go rd o n’s n a r rowe r fo -cu s, t h o u gh it is n o t cle a r t h a t Go rd o n so u gh t t o re p re se n t a n yt h in g o t h e r t h a n o n e sp e cific t yp e o f jo ke. He a lso cr it iq u e s Go rd o n’s a t t e n -t io n -t o ra p p o r -t a m o n g p r o fe ssio n a ls a n d d is-ta n ce fro m p a tien ts, p referrin g in stea d h is own a tten tio n to th e crea tio n o f m ea n in g. Bu t wh ile Peterson d oes atten d to m ean in g, h e also p o sits a m ech a n ism of socia l cr itiq u e th a t lin ks a con -t e x-t o f h o r r o r -t o -t h e c re a -t io n a n d u se o f p u n s b y d o ct o r s. So is it t h a t Pe t e r so n d islike s Go r -d o n’s la ck o f a t t e n t io n t o m e a n in g, o r is it t h a t Go rd o n e m p loys a d iffe re n t fu n ct io n a l m o d e l? Or b o t h ? Pe t e r so n la t e r e xp la in s t h a t h e p a ys m o st a tte n tio n to th e th ird o f h is th re e th e m e s (m e d ica l sp e cia lt y, p a t ie n t s, h e a lt h ca re se r v-ic e s) b e c a u se t h is is a n a re a m o re re le va n t t o t h e c r isis. He c h o o se s h is own e xa m p le s fo r wh a t , a s m u ch a s h ow, t h e y co m m u n ica t e. Fi-n a lly, Peterso Fi-n writes th a t Go rd o Fi-n d ra ws “cu ri-ou s con clu sion s.” Th is cr it iq u e se e m s t o m e t o rest la rgely o n a m isrep resen ta tio n o f th e wo rd ‘c la im ,’ a s e q u iva le n t t o t h e ve r b ‘t o d e m a n d ’ ra t h e r t h a n t h e a lso a c c e p t a b le ‘t o re q u ire’ (co n tra ry to Peterso n’s con clu sion , in th is la tter se n se co m a t o se p a t ie n t s ca n re a d ily cla im a t -ten tio n ).
Bu t u n d e r n e a t h t h is I a m c o n fu se d a b o u t t h e r o le o f t h is c r it iq u e in t h e a r t ic le it se lf: with ou t d efen d in g Go rd on I won d ered wh y Pe-cia n s, ju st a s t h e re a re fo r p a t ie n t s, b u t h a rd ly
a n y a t a ll fo r in stitu tio n s.
I wa s th erefo re in terested to see th a t Dr. Peterson focu ses, correctly I th in k, on th e b u rea u -c ra t iza t io n o f h e a lt h -c a re, a n d re a d s m u -c h o f Ca r io ca m e d ica l sla n g t o b e a re sp o n se t o t h is p rocess. Th e a ltern a tive th a t h a s b een exp lored e xt e n sive ly b y p h ysic ia n s a n d m e d ic a l so c ia l scie n t ist s o f a m o re Ma r xist b e n t is t h e ‘p ro le -ta ria n iza tio n’ o f p h ysicia n s, a p ro cess in wh ich p h ysicia n s in cre a sin gly fin d t h e m se lve s se r v-in g as em p loyees of d e facto p rofit-m akv-in g h o s-p it a ls a n d ‘m a n a ge d ca re’ co rs-p o ra t io n s. In t h e m id - 1980s jo u r n a ls su ch a s Th e In t ern a t ion a l Jou rn a l of Hea lt h Serv ices Resea rch we re in -fla m ed with a n gr y a n a lyses o f Ma rxist sch o la rs wh o re a d in t o t h is p r o c e ss t h e c o m m o d ific a t io n o f ‘c a re’ t h e c o n ve r sio n o f a h u m a n re la -t io n sh ip in -t o a re ifie d ‘-t h in g’ -t h a -t is p ro d u ce d , m e a su re d , wit h h e ld , o r so ld in a st r ic t ly e c o -n o m ic m o d el.
Dr. Pe t e rso n su gge st s, a s I re a d h im , t h a t a m o re n u a n ced view o f th e recen t h isto ry o f th e p o lit ica l e co n o m y o f h e a lt h ca re is n e ce ssa r y. Aft e r a ll, p h ysic ia n s h a ve lo n g wo rke d a s e m -p loye e s o f in st it u t io n s, a n d t h e y a re st ill fa r fro m b e in g t re a t e d a s h o u r ly wa ge la b o re r s. Ra th er, wh a t h a s ch a n ged in th e circu m sta n ces o f p h ysicia n wo rk is t h e e xt ra o rd in a r y le ve l o f b u re a u cra t iza t io n it h a s u n d e rgo n e, a t le a st in t h e Un it e d St a t e s a n d , a p p a re n t ly, in Bra zil. I d o n ot h a ve th e sp a ce in a b r ief co m m en ta ry to d e ve lo p t h is p o in t in d e t a il, b u t sin ce it is n o t th e exp licit focu s of Dr. Peterso n’s a rticle I wa n t t o d ra w a t t e n t io n t o t h e re le va n ce o f h is a rgu -m en t fo r a n o n go in g d eb a te in th e so cio lo gy o f m e d icin e. Wh ile h is Bra zilia n e xa m p le h a s fa s-c in a t in g d iffe re n s-c e s fr o m t h e U S s-c a se s wit h wh ich I a m m o st fa m ilia r, t h e re a re im p o r t a n t sim ila r it ie s t h a t m a ke h is a r t ic le a sign ific a n t co n trib u tio n to th is d eb a te a s well.
I sh o u ld a lso n o t e t h a t t h is co m m e n t a r y is b e in g wr it t e n wh ile I a m t ra ve lin g, a n d d o n o t h a ve a c c e ss t o t h e u su a l sc h o la r ly m a t e r ia ls th a t I wo u ld wa n t to co n su lt; I a p o lo gize to Dr. Peterso n a n d o th er a u th o rs if m y m em o ry fa ils m e a t o n e o r t wo p o in t s in m y d is c u s s io n o f th eir wo rk.
