Hearing the patient's 'voice': toward a social poetics in diagnostic interviews.

In this article we introduce a special practice that we have called the practice of a "social poetics", and explore its nature. The setting is a Primary Care Clinic at a large urban teaching hospital in the northeast of the U.S. As we describe it, the practice is at first conducted by a third person who occupies the position of a "cultural go-between" and who mediates between doctors and their patients in diagnostic interviews. Her task is to be open to being 'arrested', or 'moved' by, certain fleeting, momentary occurrences in what patients do or say. For sometimes in such moments, in our responding to the unfolding motions of their whole body and voice-as they respond to the circumstances in which they find themselves-we can begin to sense that the unique nature of their 'inner world of pain and suffering' is like for them. The practice of a social poetics entails a new relational attitude to the patient's use of words, an attitude that invites a creative, poetic sensibility, as well as a 'boundary crossing' stance that creates comparisons useful in relating what patients say to the rest of their lives. In elucidating the nature of such a practice further, we draw on the work of Wittgenstein, Bachelard, and Bakhtin. Together, these can lead to a new diagnostic practice that enables those involved in it to create, within the practice itself, both ways of talking that draw attention to the new possibilities for interaction the practice itself momentarily makes available, and ways of talking relevant to realizing these possibilities.