Learning to argue like an expert
The role of topoi in internal medicine residency
Diana Lin Awad Scrocco | Youngstown State University
Many scholars have argued that practicing medicine requires sophisticated rhetorical prowess (Loftus 2012; Pender 2005; Segal 2005, 2007). Although rhetorical theory can explain how novices learn to argue like experts, much work in the subfield of medical learning only implicitly draws on rhetorical notions (e.g., Barton & Eggly 2009; Heritage & Maynard 2006). This study examines conversations between faculty physician preceptors and resident physician trainees in an internal medicine clinic to consider the role of persuasion in teaching novices to argue like experts. Using Aristotelian topoi, I reveal how the common lines of argument underlying medical teaching and learning help novice and expert physicians explain concepts, elicit interpretations, and initiate deliberation. As they synthesize and rationalize medical information, they use antecedent-and-consequence, possible-and-impossible, authority, and testimonial topoi. This study of professional enculturation elucidates a rarely examined area of medical communication, potentially enabling preceptors to teach their tacit reasoning more explicitly to residents.
Keywords: medical rhetoric, medical communication, medical learning, classical rhetoric, expert-novice communication
Published online: 12 February 2015
https://doi.org/10.1075/jaic.3.3.01scr
https://doi.org/10.1075/jaic.3.3.01scr
References
Aristotle
2007 On Rhetoric: A Theory of Civic Discourse (G. Kennedy, Trans.). Oxford: Oxford University Press.
Aronowitz, Robert A
1998 Making Sense of Illness: Science, Society, and Disease. Cambridge: Cambridge University Press.
Atkinson, Paul
1995 Medical Talk and Medical Work: The Liturgy of the Clinic. Thousand Oaks: Sage.
Barton, Ellen, and Susan Eggly
2009 “Ethical or Unethical Persuasion? The Rhetoric of Offers to Participate in Clinical Trials.” Written Communication 261: 295–319. 
Berg, Marc
1997 Rationalizing Medical Work: Decision-Support Techniques and Medical Practice. Cambridge, MA: MIT Press.
Corbett, Edward J., and Robert J. Conners
1999 Classical Rhetoric for the Modern Student (4th ed.). New York: Oxford University Press.
Fleiss, Joseph L., Bruce Levin, and Myunghee Cho Paik
2003 Statistical Methods for Rates and Proportions (3rd ed.). New York: John Wiley & Sons.
Frankel, Richard
1995 “Some Answers about Questions in Clinical Interviews.” In The Talk of the Clinic: Explorations in the Analysis of Medical and Therapeutic Discourse, ed. by G.H. Morris, and Ronald J. Chenail, 233–257. Hillsdale, NJ: Erlbaum.
Geisler, Cheryl
2003 Analyzing Streams of Language: Twelve Steps to the Systematic Coding of Text, Talk, and Other Verbal Data. New York: Pearson.
Grimaldi, William M.A
1998 “The Sources of Rhetorical Argumentation by Enthymeme.” In Landmark Essays on Aristotelian Rhetoric, ed. by Richard Leo Enos, and Lois Peters Agnew, 115–159. Mahwah, NJ: Lawrence Erlbaum Associates Publishers.
Gross, Alan G., Joseph E. Harmon, and Michael S. Reidy
2002 Communicating Science: The Scientific Article from the 17th Century to the Present. Oxford: Oxford University Press.
Hamm, Robert M
1988 “Clinical Intuition and Clinical Analysis: Expertise and the Cognitive Continuum.” In Professional Judgment: A Reader in Clinical Decision Making, ed. by Jack Dowie, and Arthur Elstein, 78–105. Cambridge: Cambridge University Press.
Heritage, John
2004 “Conversation Analysis and Institutional Talk: Analysing Data.” In Qualitative Research: Theory, Method and Practice, ed. by David Silverman, 222–245. London: Sage.
Heritage, John, and Douglas W. Maynard
2006 “Introduction: Analyzing Interaction Between Doctors and Patients in Primary Care Encounters.” In Communication in Medical Care: Interaction Between Primary Care Physicians and Patients, ed. by John Heritage, and Douglas W. Maynard, 1–21. New York: Cambridge University Press.
Hunter, Kathryn M
1991 Doctors’ Stories: The Narrative Structure of Medical Knowledge. Princeton, NJ: Princeton U
Jenicek, Milos, and David L. Hitchcock
2005 Evidence-Based Practice: Logic and Critical Thinking in Medicine. Chicago: American Medical Association Press.
Loftus, Stephen
2012 “Rethinking Clinical Reasoning: Time for a Dialogical Turn.” Medical Education 461: 1174–1178.
McBurney, James Howard
1936 “The Place of the Enthymeme in Rhetorical Theory.” Speech Monographs 31: 49–74.
Montgomery, Kathryn
2005 How Doctors Think: Clinical Judgment and the Practice of Medicine. Oxford: Oxford University Press
Newman, Sara
2009 “Gestural Enthymemes: Delivering Movement in 18th- and 19th-Century Medical Images.” Written Communication 261: 273–294.
Nordin, Ingemar
2000 “Expert and Non-expert Knowledge in Medical Practice.” Medicine, Health, Care and Philosophy 31: 297–304.
Pender, Stephen
2005 “Between Medicine and Rhetoric.” Early Science and Medicine 101: 36–64.
Rief, John J., Gordon R. Mitchell, Susan L. Zickmund, Tina D. Bhargava, Cindy L. Bryce, Gary S. Fischer, Rachel Hess, N. Randall Kolb, Laurey R. Simkin-Silverman, and Kathleen M. McTigue
2012 “Promoting Patient Phronesis: Communication Patterns in an Online Lifestyle Program Coordinated with Primary Care.” Health Education Behavior XX1: 1–12.
Rubinelli, Sara
2009 Ars Topica: The Classical Technique of Constructing Arguments from Aristotle to Cicero. New York: Springer Science+Business Media B. V.
Rubinelli, Sara, and Claudia Zanini
2012 “Teaching Argumentation Theory to Doctors: Why and What.” Journal of Argumentation in Context 11: 66–80.
Schryer, Catherine, Allan McDougall, Glendon R. Tait, and Lorelei Lingard
2012 “Creating Discursive Order at the End of Life: The Role of Genres in Palliative Care Settings.” Written Communication 291: 111–141.
Segal, Judy Z
2005 Health and the Rhetoric of Medicine. Carbondale, IL: Southern Illinois University Press.
2007 “Illness as Argumentation: A Prolegomenon to the Rhetorical Study of Contestable Complaints.” Health: An Interdisciplinary Journal for the Study of Health, Illness and Medicine 111: 227–244.
2009 “Internet Health and the 21st-Century Patient: A Rhetorical View.” Written Communication 261: 351–369.
Slomkowski, Paul
1997 Aristotle’s Topics. New York: Brill.
van Eemeren, Frans H., Rob Grootendorst, and A. Francisca Snoeck Henkemans
2002 Argumentation: Analysis, Evaluation, Presentation. Mahwah, New Jersey: Lawrence Erlbaum Associates.
Walton, Douglas, Chris Reed, and Fabrizio Macagno
2008 Argumentation Schemes. New York: Cambridge University Press.
Warnick, Barbara
2000 “Two Systems of Invention: The Topics in the Rhetoric and The New Rhetoric.” In Rereading Aristotle’s Rhetoric, ed. by Alan G. Gross, and Arthur Walzer, 107–129. Carbondale: Southern Illinois University Press.