Patient’s unreliable narration in the modern cinematic discourse

Abstract

The present article analyzes the corpus of anamnestic data in terms of their narrative reliability. The material of the research is the American television medical drama House, M.D. In a number of episodes, the underlying diagnosis cannot be established either because patients lie about a possible source of the disease or do not disclose a particularly important fact. The unreliability of patient’s account can significantly obstruct the process of establishing diagnosis and treatment. The possible impedient factors of doctor-patient communication are as follows: the patient’s ignorance of the significance of earlier diseases, treatment or taken medicine; conscious concealment of certain information, e.g. alcohol abuse or infidelity; physical inability to provide the necessary information. In case when patient’s account cannot be relied on, the doctor must enhance his/her narrative proficiency in order to discern and detect the signs of fallibility. The patient’s fallible or biased perspective is deciphered via the application of Paul Grice’s principle of cooperation. The signs of deviant narration can be found when the patient violates the maxim of quality (the narrator lies or contradicts himself/herself), the maxim of quantity (the narrator provides excessive information or, on the contrary, fails to mention something), the maxim of manner (the order of narration is disrupted, or it contains ambiguity) or the maxim of relation (the narrator provides irrelevant information). The degree of compliance with Gricean conversational maxims discloses the underlying nature of doctor-patient communication and thus facilitates the process of diagnostics and treatment.