Responsible and responsive knowing in medical diagnosis: the medical gaze revisited

The medical gaze has long been privileged over the voice of the patient as the source of medical knowledge, in western societies. The ontology (that is, the very existence) of symptoms invisible to scientific observation will thus tend to be questioned by medical professionals. Yet any gaze, even the medical one, is refracted through the lenses both of social-cultural stereotypes and of gender, and its seeings are shaped by these refractions. In this article, two family physicians and an epistemologist examine certain "unexplained" disorders, in a conversation informed by a feminist perspective: they bring a feminist point of view to bear on these issues. Medically unexplained disorders, which occur most frequently in women, are disabling conditions for which objectively observable symptoms and/or scientific causal explanations are not available. The approach taken in this article makes some of the assumptions underlying clinical knowledge more clearly visible: the authors' conversation situates diagnostic activity in medicine as a gendered, power-infused social interaction within a cultural context where the gold standard of medical knowledge is very narrowly set. The participants propose responsible and responsive knowing as alternative strategies for knowing well. As they are presented here, these strategies incorporate an awareness of the inherent uncertainty of medical knowledge, raise questions about those to whom the knower is accountable, acknowledge the patient's experiences, and attend to the potentially oppressive effects of expert knowing.