Rosalind Crocker discusses the panel ‘Relationality and Loss’ at the Northern Network for Medical Humanities Research (NNMHR) Congress, 21-23 April 2021
As a researcher in fictive doctor/patient relationships, the ‘Relationality and Loss’ panel at the NNMHR Annual Congress posed a number of key questions pertinent to my work. How are the problems of communication implicit in the diagnostic hierarchy to be countered in future practice? How can mortality, this year ever-present in the media and yet paradoxically hidden from the patient’s friends and relatives, be theorised in the context of COVID-19? How do we affirm the individuality of healthcare professionals in a system which consistently undervalues their work? The three speakers in this panel, Nishi Ravi, Dr Mohammad Hossein B. Jahromi, and Dr Linda Miller, presented papers which considered interweaving aspects of narrativity, visibility, and authority in the doctor/patient dyad, and highlighted concerns about the theme of ‘relationality and loss’ which speak pressingly to our current historical moment.
Nishi Ravi’s deeply personal presentation, titled ‘Communication, Culture and Affect in the Diagnostic Process’, discussed medicine as a “need-fuelled industry with power hierarchies”. She looked at possible ways to promote patient empowerment in a clinical model which prioritises the clinician’s superiority of knowledge, but does not presently give them the tools, time or resources to take protracted diagnostic appointments. Her experience of racial and economic biases in clinical encounters, in individual doctors and across the healthcare system more widely, joins a range of patient narratives which emphasise the particular limitations of a traditional clinical hierarchy, such as Porochista Khakpour’s Sick: A Memoir and Damon Tweedy’s Black Man in a White Coat, which looks at racism in medicine from a clinician’s perspective. Ravi’s presentation, like these memoirs, emphasised the importance of patient centrality in the clinical model, and offered narrative as a means of achieving a more effective diagnostic system.
As a doctor on the frontline of the COVID-19 pandemic, Dr Mohammad Hossein B. Jahromi’s presentation, ‘Multi-layered cadavers; Invisible griefs. Paradoxical logic of mortality during COVID’ offered a timely perspective on the clinical dyad in times of crisis. Like Ravi, Jahromi’s talk looked at modes of narration in illness, but focused on the abilities and agency lost by the ‘ICU body’, a body with which technology has irrevocably interfered. Through the theoretical lens of necropolitics, he explored how ‘irregular death’ is treated as a threat to the social order, and how a marginalized death – defined by Jahromi as one which takes place away from the usual recourses and rituals of mourning – is a traumatic, unexpectedly social, event. I was reminded here of author Michael Rosen’s experience of COVID, which was later discussed in the panel Q&A. His condition was presented to the public via his own Twitter page, which was taken over by his partner during his time in an induced coma.[1] The usual immediacy of social media was thus intercepted by a necessarily editorialising perspective, supporting Jahromi’s assertion that COVID has perhaps irrevocably altered the ways in which debilitating illness can be communicated beyond the clinic.
Reflecting too on the impact of COVID for our theorisation of the medical establishment, Dr Linda Miller’s presentation was titled, ‘Re-Facing the De-faced Doctor; Injustice and the Wounded Healer’, and looked at the idea of the ‘faceless’ healthcare force. She examined the fact that clinicians and other clinical staff have reported feeling ‘undervalued’ even before COVID, and linked this to the depictions of doctors, even in NHS materials, as faceless, anonymous figures. Affirming the heritage of ‘defacing’ as a means of symbolically removing power, for example in iconoclasms, Miller noted the ways in which clinicians are often only ‘re-faced’ when accused of wrongdoing or, particularly recently, when they have lost their lives in service. Continuing what was, for me, a key thematic concern of the panel, Miller also referred to ideas of narrativity and power, exploring the “testimonial injustices” of the healthcare profession, who are often retired before they feel they can freely express dissatisfaction with their working conditions.
The three speakers of this panel, though approaching the topic of ‘Relationality and Loss’ from varying perspectives, some patient-focused, some from the clinician’s point of view, shared a consistent emphasis on the importance of narrative in medicine. Through prioritising patient perspective where possible, and removing stigmatising language and biases, Ravi demonstrated the considerable practical applications of her research for clinical encounters, aiming to improve patient outcomes. This can, as she noted, only be possible by improving the material conditions of medical professionals, a theme shared with Miller. By refacing the doctor, a particularly potent phraseology in the context of COVID mask-wearing etc., clinicians may gain a greater sense of recognition and identification with the profession, as well as allowing them to share individualised grievances, recommendations, and ambitions. Jahromi’s presentation affirmed the difficulties of addressing these narrative limitations in our current circumstances, and the troubling implications of COVID for both patients’ and clinicians’ stories are certainly highlighted by the reading of his paper alongside Ravi’s and Miller’s. It is clear that the findings of these speakers will become ever-more pressing in the coming months and years, and that successful relationality and communication between public and clinic has never been more vital.
Rosalind Crocker is a PhD student at the University of Sheffield, looking at the figure of the ‘medical man’ in neo-Victorian fiction. Her research, also on contagion, resurrectionism and patient narratives, is funded by the AHRC through the White Rose Consortium. Twitter: @rosiecrocker98
[1] Alison Flood, “Michael Rosen returns to Twitter after long battle with coronavirus”, The Guardian, June 12th, 2020, accessed May 14th, 2021, https://www.theguardian.com/books/2020/jun/12/michael-rosen-returns-to-twitter-after-long-battle-with-coronavirus.