Restoring the patient's voice: the case of Gilda Radner.

In the past few years, the medical case report has been studied as a document that evidences the way the patient and, by extension, the experiential and subjective aspects of an illness tend to be marginalized in contemporary medical theory and practice. First-person narratives about illness, our popular "pathographies," may in part represent our attempt as a culture to respond to this problem of "the vanishing patient." A rich source of information about patient experience, pathographies can be useful to us in locating specific issues in the medical enterprise that need understanding and perhaps require correction. Gilda Radner's It's Always Something demonstrates how two important issues--both neglected in the conventional medical history--powerfully affect the medical enterprise: the hopes, expectations, and wishes of the experiencing patient, and the perceived attitudes and demeanor of the patient's physicians. The restoration of patient and physician to the "history" is important not only because it reminds us of the personal dimension of the medical enterprise, but also because it alerts us to problems of attitude and action that bear directly on diagnosis, course of treatment, and the therapeutic transaction.