DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY
EDITORIAL
Medical rhetoric and rhetoric medicine Throughout its history, medicine has benefited from technological advances that have gradually but profoundly reshaped practice, leading to faster and more accurate diagnosis and management. These changes seem to operate to the detriment of clinical skills,1 resulting in a situation that has been termed ‘hyposkillia’ of clinicians. But on the contrary, increasingly complex technological approaches demand parallel refinement of clinical abilities. For example, recent improvements in DNA testing require careful assessment of the phenotype in order to indicate appropriate customised gene panel screening or effectively interpret the significance of the many variants inevitably identified through whole-exome sequencing.2 Technological development should therefore, hopefully, lead to renewed enhancement of clinical examination skills. Yet, such developments urgently call for the solidity of an even older pillar supporting medical practice alongside the clinical and paraclinical ones, namely excellence in reasoning and in communication with the patient, which in our field extends from the child to his or her family. This pillar is rhetoric. Because health care teaching has long forsaken humanistic education, many of us may not be aware that we constantly, if clumsily, utilise a range of devices that have been identified, classified and refined since Greek antiquity under the discipline of rhetoric. The most obvious aspect of rhetoric relates to persuasion, which is no less useful in health care practice when prescribing investigations or a management plan today than it was in Hippocrates’s time. It is also essential to this type of publication. Aristotle’s On Rhetoric presented persuasion as a form of demonstration that can be achieved by three different modes. The first of these, ethos, stems from the speaker’s personal credibility. In the case of DMCN, ethos is exemplified by the Journal’s reputation, Impact Factor, editorial board, etc. The second mode of persuasion, pathos, calls on the emotional effect on the hearer. In this Journal’s case, where the hearer corresponds to the readership, pathos may appear as occasional emphasis on shared ethical values, the odd passionate letter or claim that a matter is unjust. However, DMCN’s main asset is undoubtedly the third mode of persuasion, logos, providing arguments that prove a truth or an apparent truth. This is the very substance of the Journal, as contributing authors describe facts and figures that support original theses. It can be noted that the appeal of such logos in turn enhances
DMCN’s ethos. All three modes of persuasion have also been at play throughout the long history of the practitioner-patient relationship. In an extreme example, Plato ridiculed the indispensability of persuasive medical rhetoric by staging a contradictor of Socrates who boasted about talking to patients ‘who refused to take a drug or submit to surgery or cauterisation by the doctor, and though the doctor was unable to persuade [them, he] did, by means of no other craft than rhetoric’. Still, there is much more to rhetoric than the art of persuasion. The discipline’s emphasis on observable signs, facts and empirical data, and its commerce with incomplete knowledge, conjecture and situational judgement bear striking similarities with our own daily challenges. Ours too is a practical art that requires the practitioner to deal with contingencies, complexities, and singularities of individual cases. In both rhetoric and clinical practice, the practitioner is faced with uncertainty, yet he or she must aim for the best in every case while running the risk of failure because of reliance on practical judgement. While stretching the limits of knowledge, practitioners must learn from their own experience and others’, whether successful or not. Admittedly, medical application of the hypothetico-deductive method and Bayesian analysis has attracted increasing interest,3 but indeed all forms of inference, from deduction, induction and abduction to their variants, are actually involved in the diagnosis process, which lies at the basis of management planning in paediatric neurology and developmental medicine, as in all branches of health care practice. The enhanced possibilities afforded by technology have been recognised to result in increased responsibility of clinicians.4 This should prompt us to resume dialogue with the humanities in order to cultivate a modern, fertile field of interdisciplinarity, where medicine and allied disciplines, human and social sciences, such as anthropology, sociology, history, arts, philosophy, and of course rhetoric, meet in order to promote applications for improved teaching and practice of our professions. And also to further strengthen the development of this Journal.
BERNARD DAN Editor
doi: 10.1111/dmcn.12577
REFERENCES 1. Spence D. What is the point of doctors? BMJ 2013; 347: f7380. 2. Dan B, Baxter P. Paediatric neurology: a year of DNA technology. Lancet Neurol 2014; 13: 16–8.
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3. Loftus S. Rethinking clinical reasoning: time for a dialogical turn. Med Educ 2012; 46: 1174–8. 4. Ronen GM, Dan B. Ethical considerations in pediatric neurology. Handb Clin Neurol 2013; 111: 107–14.
© 2014 Mac Keith Press
EDITORIAL
Medical rhetoric and rhetoric medicine Throughout its history, medicine has benefited from technological advances that have gradually but profoundly reshaped practice, leading to faster and more accurate diagnosis and management. These changes seem to operate to the detriment of clinical skills,1 resulting in a situation that has been termed ‘hyposkillia’ of clinicians. But on the contrary, increasingly complex technological approaches demand parallel refinement of clinical abilities. For example, recent improvements in DNA testing require careful assessment of the phenotype in order to indicate appropriate customised gene panel screening or effectively interpret the significance of the many variants inevitably identified through whole-exome sequencing.2 Technological development should therefore, hopefully, lead to renewed enhancement of clinical examination skills. Yet, such developments urgently call for the solidity of an even older pillar supporting medical practice alongside the clinical and paraclinical ones, namely excellence in reasoning and in communication with the patient, which in our field extends from the child to his or her family. This pillar is rhetoric. Because health care teaching has long forsaken humanistic education, many of us may not be aware that we constantly, if clumsily, utilise a range of devices that have been identified, classified and refined since Greek antiquity under the discipline of rhetoric. The most obvious aspect of rhetoric relates to persuasion, which is no less useful in health care practice when prescribing investigations or a management plan today than it was in Hippocrates’s time. It is also essential to this type of publication. Aristotle’s On Rhetoric presented persuasion as a form of demonstration that can be achieved by three different modes. The first of these, ethos, stems from the speaker’s personal credibility. In the case of DMCN, ethos is exemplified by the Journal’s reputation, Impact Factor, editorial board, etc. The second mode of persuasion, pathos, calls on the emotional effect on the hearer. In this Journal’s case, where the hearer corresponds to the readership, pathos may appear as occasional emphasis on shared ethical values, the odd passionate letter or claim that a matter is unjust. However, DMCN’s main asset is undoubtedly the third mode of persuasion, logos, providing arguments that prove a truth or an apparent truth. This is the very substance of the Journal, as contributing authors describe facts and figures that support original theses. It can be noted that the appeal of such logos in turn enhances
DMCN’s ethos. All three modes of persuasion have also been at play throughout the long history of the practitioner-patient relationship. In an extreme example, Plato ridiculed the indispensability of persuasive medical rhetoric by staging a contradictor of Socrates who boasted about talking to patients ‘who refused to take a drug or submit to surgery or cauterisation by the doctor, and though the doctor was unable to persuade [them, he] did, by means of no other craft than rhetoric’. Still, there is much more to rhetoric than the art of persuasion. The discipline’s emphasis on observable signs, facts and empirical data, and its commerce with incomplete knowledge, conjecture and situational judgement bear striking similarities with our own daily challenges. Ours too is a practical art that requires the practitioner to deal with contingencies, complexities, and singularities of individual cases. In both rhetoric and clinical practice, the practitioner is faced with uncertainty, yet he or she must aim for the best in every case while running the risk of failure because of reliance on practical judgement. While stretching the limits of knowledge, practitioners must learn from their own experience and others’, whether successful or not. Admittedly, medical application of the hypothetico-deductive method and Bayesian analysis has attracted increasing interest,3 but indeed all forms of inference, from deduction, induction and abduction to their variants, are actually involved in the diagnosis process, which lies at the basis of management planning in paediatric neurology and developmental medicine, as in all branches of health care practice. The enhanced possibilities afforded by technology have been recognised to result in increased responsibility of clinicians.4 This should prompt us to resume dialogue with the humanities in order to cultivate a modern, fertile field of interdisciplinarity, where medicine and allied disciplines, human and social sciences, such as anthropology, sociology, history, arts, philosophy, and of course rhetoric, meet in order to promote applications for improved teaching and practice of our professions. And also to further strengthen the development of this Journal.
BERNARD DAN Editor
doi: 10.1111/dmcn.12577
REFERENCES 1. Spence D. What is the point of doctors? BMJ 2013; 347: f7380. 2. Dan B, Baxter P. Paediatric neurology: a year of DNA technology. Lancet Neurol 2014; 13: 16–8.
916
3. Loftus S. Rethinking clinical reasoning: time for a dialogical turn. Med Educ 2012; 46: 1174–8. 4. Ronen GM, Dan B. Ethical considerations in pediatric neurology. Handb Clin Neurol 2013; 111: 107–14.
© 2014 Mac Keith Press
