Dissertation Defense: Elisa Reverman
Candidate: Elisa Reverman
Major: Philosophy
Advisor: John Greco, Ph.D.
Testimonial Knowledge in Medical Discourse
At its core, this dissertation project brings concepts and tools from the epistemology of testimony to the medical interview. The epistemology of testimony is, at its broadest, concerned with the link between truth and testimony. Given that the medical interview is a particular kind of testimonial exchange, with all kinds of idiosyncrasies and specific epistemic goals, the tools from the epistemology of testimony are particularly well suited for illuminating new philosophical understandings of this kind of exchange.
While other disciplines have examined the medical interview, patient-provider communication, and medical discourse extensively, philosophical work on the topic is less abundant. Much of the philosophical attention on testimonial exchange in healthcare settings is focused on identifying different kinds of epistemic injustice, perhaps best demonstrated in Ian James Kidd and Havi Carel’s portfolio of work on the topic. However, there has not yet been a fine-grained philosophical investigation of the nature and uptake of patients’ testimonial knowledge in the medical context that utilizes the tools and concepts from the epistemology of testimony, and this project seeks to fill that gap.
In taking this approach, my dissertation introduces four novel epistemic dynamics within this scope of discourse. The first is the identification and role of narrative testimony in the medical interview. In this chapter, I argue that the medical interview is a unique exchange of testimonial knowledge, and that patients often make use of narrative structures in these exchanges. I then argue that narrative testimony is itself a distinct kind of testimonial knowledge with epistemically unique traits.
The second chapter discusses testimonial compression, a phenomenon best demonstrated in, but not limited to, the medical context. Here, I describe the different ways that specific formats of testimony can be enforced by an audience, and demonstrate instances of testimonial compression in several different examples of medical discourse. I then discuss the various effects that testimonial compression can have and show how compression can be negotiated.
In the third chapter, I argue that medical contexts assume an evidentialist approach to patient testimony. I identify the ways in which patient testimony is assessed as a kind of evidence in a way that mirrors the evidence-ranking system proposed in EBM and GRADE. I also describe the ways in which the assessment of patient testimony as evidence is different from EBM’s evidence-ranking model, and discuss various consequences of this approach.
Finally, my fourth chapter investigates the current and limited work on medical gaslighting. I point out that “medical gaslighting” is in fact used to describe a wide range of behaviors, and propose an account of medical gaslighting that is sensitive to the particularities of the medical context and medical discourse.
In introducing these concepts and epistemic dynamics, I aim to contribute to both the existing work on patient-provider communication and medical discourse as well as the epistemology of testimony.