Creating Conditions by Katie Featherstone Paul Atkinson

Author:Katie Featherstone, Paul Atkinson [Katie Featherstone, Paul Atkinson]
Language: eng
Format: epub
ISBN: 9781138019928
Barnesnoble:
Publisher: Taylor & Francis
Published: 2014-02-18T00:00:00+00:00

This suggests that ongoing contact with the genetics clinic serves to provide a wider role than simply that of providing a diagnosis. It is a role that parents value. Although obtaining a diagnosis can be very important to families, such contact beyond diagnosis can provide important support for the parents and may well be in direct contrast to the attitudes they encounter in other areas of their life.

Conclusion

In the course of this chapter we have followed Rett syndrome into the clinic. We have emphasized a number of related issues. Throughout, we have stressed the fact that the clinic retains its centrality and its distinctiveness even in the context of geneticized medicine.

It has been too easy for sociologists and other observers to claim or to imply that the clinic is of reduced significance in a world of technologically driven biomedicine. It is tempting, and indeed fashionable, to classify the history of medical knowledge in terms of distinct periods, and to attach distinctive modes of knowledge-production to them in turn. On that basis, we might expect laboratory-led developments such as genetic testing to have superseded ‘clinical’ modes of perception and inference. That is not the case.

As we have seen, the clinic retains its significance within the culture of hospital medicine. It remains a site for the display and inspection of patients, and for their transformation into ‘cases’. In this clinical mode of work, the senior clinician continues to enact her or his personal knowledge. Clinical expertise is legitimated in various ways. They include appeals to scientifically based clinical or fundamental research. But they also include appeals to personal authority. The clinical perception and interpretation of the manifestations of medical entities is not reducible to the enumeration of laboratory values, test results and the like.

Moreover, as we have also seen, the boundaries between clinical entities are not hard-and-fast. The experienced clinician retains the right to discriminate. The competence to create fine distinctions, and so to distinguish between similar syndromes and other conditions, is central to clinical expertise. Again, this is not coterminous with the results of laboratory tests, such as those of the new medical genetics. Equally, the clinician claims the expertise to judge whether a feature is diagnostically relevant or incidental to the case in hand.

While we do not wish to imply that expert clinicians are wilfully oblivious of other sources of evidence and legitimation, we do wish to emphasize that within the clinic – as a discursive space – there co-exist multiple sources of knowledge and legitimation. Consequently, rather than thinking of successive phases or stages of medical knowledge, and emphasizing the discontinuities between them, we need equally to recognize that there are multiple forms of knowledge in play in the clinic. Rather than identifying a succession of types of medical knowledge, we prefer to think of the clinic as a palimpsest, in which the longue durée of clinical understanding intersects with more recent forms of biomedical understanding.

Genetic conditions like Rett syndrome are especially relevant to our general understanding of this phenomenon.

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