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Rhetorical persuasion in the clinical setting

Maurer, Brian T. PA-C

Journal of the American Academy of PAs: October 2015 - Volume 28 - Issue 10 - p 62
doi: 10.1097/01.JAA.0000471488.61175.c0
The Art of Medicine
Free

Brian T. Maurer has practiced general pediatrics for more than 30 years. He is the author of Patients Are a Virtue and blogs at http://briantmaurer.wordpress.com. The author has disclosed no potential conflicts of interest, financial or otherwise.

Tanya Gregory, PhD, department editor

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It is Friday evening in the after-hours care center. All the scheduled patients have been processed. Each one has departed with a prescription in hand, their precious ticket to procuring a portion of the magic potion they imagine will make them better.

I sit with my feet up at my desk, pondering the business of medicine, this issue of buying and selling healthcare in the modern medical marketplace. Somehow it all sickens me. Sometimes I wonder if I might not have developed agoraphobia—fear of the marketplace itself.

Another car pulls into the parking lot outside the front window. A young man and his mother step out and enter the building. Soon they are escorted back to one of the examination rooms by the medical assistant. He pauses in the doorway of my office to hand me the stack of previous encounter forms on this patient.

When I glimpse the name, I already know the chief complaint and the diagnosis. I swing my feet off the desk, touch the stethoscope draped around my neck as though it were a talisman, and stroll the short distance down the hallway to where the patient and his mother sit, waiting.

“Alan!” I say, offering my hand in greeting. “What brings you here this evening? I haven't seen you all summer.”

Alan looks up at me from the chair. “Vomiting,” he says, matter-of-factly. His mother lounges in the chair beside him, tapping the screen of her smartphone. She doesn't look up.

“Ah, when did the vomiting start?” I ask.

“Last night, about 7:30 p.m.”

“How many times have you vomited since then?”

“Just that one time,” he says. “But I woke up this morning with stomach pain, so I stayed home from school today.”

“How is the bellyache now?”

“It's pretty much gone,” he says.

“Did you eat anything today?”

“I had a tuna fish sandwich for lunch and a glass of milk.”

“Hop up on the table and let's have a look at you,” I say.

Except for some mild facial acne, the examination is normal.

“How many days of school have you missed so far?” I ask him.

He rolls his eyes as though he were mentally factoring a quadratic equation. “Four,” he says.

I raise my eyebrows. “You've missed 4 days of school already? School just started 2 weeks ago.”

Alan nods his head.

“So how is school going this year?”

“My schedule was all screwed up,” he says. “They had me down for three English classes. I got them to drop one. I've pretty much completed the requirements for the residual class from last year. That leaves the AP English in critical discourse, AP history, AP physics, AP calculus, and gym.”

Alan is obviously an intelligent young man. His problem has always been that he doesn't see the value in attending class—or handing in homework assignments on time. Last year he barely squeaked by. Several teachers took pity on him and allowed him to complete a couple of special assignments so he could pass.

“What are you studying in critical discourse?” I ask him.

“Pathos, logos, ethos,” he says. “It's actually kind of cool. I like that class.”

“So you enjoy the persuasive arts,” I say. “Any idea what you want to study after high school?”

“Law, actuarial science, or statistics,” Alan says.

“You've got the makings of a lawyer,” I say. “Of course, you've got to have good grades to get into law school. That entails showing up for class, participating in class, completing homework assignments, handing them in on time, and keeping up with the information for testing time.”

“He gets 100s on nearly all of his tests,” his mother says, looking up from her smartphone. “No one understands how he can do that and not study.”

“He's naturally smart,” I say. “He just has to learn to show up for class and turn in his assignments. They count for at least one-third of the grade.”

“Do it right the first time and it's done,” I tell him. “That way you can put this behind you and move on with what you really want to do with your life.”

Alan nods his head. “I suppose that's a persuasive argument,” he says.

“Logos, ethos, pathos,” I say.

His mother laughs. “I'm lovin' this!” she says.

“Do your work,” I tell him. “Go to school.”

Alan nods his head. “Okay,” he says. Then he adds: “Can I have a note for an excused absence today?”

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