When Gregory House MD makes another brilliant diagnosis accompanied by his trademark sardonic commentary, millions of people watch in fascination. Of course, it may be the appeal of Hugh Laurie in this most unlikely of roles, or the distractingly attractive supporting cast who play House's absurdly tolerant acolytes that prompts many to watch.
Nonetheless, House is a television drama that has diagnosis at its heart. Viewers understand that the quest for the diagnosis and the pursuit of an explanation is crucial: relationships, acceptance, resources and life itself depend on the diagnostic genius of Gregory House. The frustrations of misdiagnosis, the burden of symptoms without names, the suspicions of others towards those who do not have a diagnostic label to share, the effectiveness of diagnosis as a shortcut to welfare payments and the ways in which diagnosis can explain behaviour and give rise to legitimate claims for love and attention are evident in every episode.
Naturally, US television producers - for alas, Princeton Plains Hospital is a fictional creation - know how to turn diagnosis into a thrilling 40-minute roller coaster of deductive reasoning, blind alleys and romance. Nonetheless, the drama is right in placing diagnosis at the centre of what it means not only to be a doctor but to be a human being.
Annemarie Goldstein Jutel's book recognises the significance of diagnosis, both as part of the work of the medical profession (and it remains the case that diagnosis is largely a medical pursuit in clinical practice despite changes in professional boundaries and responsibilities) and also for those who seek, receive and sometimes contest diagnostic labels. Her work elucidates the concept of diagnosis and shows its embedded significance in the organisation and experience of illness and its treatment.
Of course, this is not the first time that diagnosis has been considered. As Jutel acknowledges, diagnosis has been an important part of work in the fields of medical sociology and anthropology, the history of medicine and the philosophy of bioscience. There is a rich literature on medical work and clinical interactions that have contributed considerably to our understanding of why and how doctors attach clinical labels while forming and negotiating professional norms. Throughout, she acknowledges the giants on whose shoulders she stands, although there are some surprising omissions, including Paul Atkinson, Phil Strong and Annemarie Mol, whose work demonstrates how diagnoses are negotiated through social interactions in the clinical environment.
Perhaps there will always be surprising omissions in a text that covers the breadth of material discussed here. The range of questions that Jutel raises and explores is vast and ambitious. Not only does she seek to cross - or, in her words, "to palliate" - the disciplinary difference that has led to discussions of diagnosis being dispersed between medical sociology, philosophy, anthropology and social history, but she also addresses large questions about the therapeutic relationship, the professionalisation of healthcare, health beliefs, the experience of illness and campaigning and advocacy in healthcare.
One of the merits of this text is that it goes beyond the more familiar clinical territories of mental health and psychiatry, where the contested nature of diagnosis and its social significance are already much discussed, to include consideration of diagnosis in genetic screening, fetal loss and obesity. The standard of the analysis is consistently high, but it is at its most engaging and thought-provoking when Jutel is forging new conceptual paths rather than when she is revisiting the familiar issues of the doctor-patient relationship and the medical profession. That is not to say that one would agree with all that she proposes, particularly in relation to the evolving diagnoses around weight and size, but as a stimulus to thought and debate, this book is an indubitable success.
For me, this book's greatest achievement is its engaging style and clear location of scholarly analysis in a clinical context. Jutel never lets the reader forget why diagnosis matters, and she is skilled at making the invisible visible as she explores the myriad ways in which the mysterious process of classifying and naming illness informs the provision of healthcare. This is a book that will have wide academic appeal. It also offers a thoughtful and realistic alternative to the beautiful people on House.
Putting a Name to It: Diagnosis in Contemporary Society
By Annemarie Goldstein Jutel
Johns Hopkins University Press 200pp, £23.50
Published 20 May 2011