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Austin Rahman Professor Leslie Wilcott ENC 1102-38 Genre Analysis Genre Analysis As a student that one day aspires to become a physician, I have chosen to my genre Analysis on the field of medicine. Genre's or text types in the medical field are extremely important, and one of the most important are case studies. According to Amy Devitt, a professor at Kansas university, "genre is a dynamic response to and construction of recurring situation, one that changes historically and in different social groups, that adapts and grows as the social context changes" (Devitt 580). In other words, Genre is a form of dynamic texts that comes from a repeated situation and the content at hand. Medicine like science, is a highly objective field that is very time sensitive, with new theories/procedures being developed every day; case studies allow us to gain valuable information on symptoms, medication, and illness. Anis Bawarshi, a English professor at the University of Washington, proposes that: " Analyzing genres within their lived contexts reveals to students, teachers, and researchers the material strength of those communities and their power over members and nonmembers alike" (Bawarshi 580). Thus, Doctors need case studies so that they are able to learn vital information on expanding their knowledge of medicine, and to allow for correct diagnoses.

Rahman 2 The three case studies that I will be analyzing are Case(s) #24,30,40. Case #24 is about a 38 year old male who overdosed on the new drug; bath salts(methcathione) and had severe paranoia. Case #30 overlooks a 19 year old boy diagnosed with Epstein-Barr virus causing him to have slurred speech. Finally, Case #40; a 38 year old man infected with a lympotrophic virus and leukemia which caused him to have an altered mental status. These case studies are unique, because the symptoms of the patients are not associated with the illnesses. To begin with, all three case studies were performed at The Massachusetts General Hospital and archived to the New England Journal of Medicine, a very prestigious and renowned medical journal, turned website, where doctors are able to peer review articles and studies from across the world. Only certain case studies are published, having to be qualified as " scientific accurate, nobel, and important"(NEJM). Case studies are known as clinical studies and are categorized according to specialty (neurology, ,pediatrics etc) , my case studies were found under Neurology. The website itself is subscription based, with a annual rate of $179.00. One specific detail, which makes this special discourse community separate itself from other "medical journals" is that upon subscribing, there is a drop down box that asks what occupation you are; Doctors, Residents, or undergraduate students in medicine. Only those Three can subscribe to the medical journal. Upon taking a closer look at the case studies, my subscription is provided by the "University Of Central Florida College Of Medicine". I believe that the NEJM(New England journal of medicine) wants to "separate" between what Devitt refers to as "Specialists" and "Non-specialists"(Devitt 545). This could be due to the fact that many non-specialists would have a rather hard time deciphering lexis and even reading the articles. As Devitt states: "Part of the difficulty when specialized communities write to nonspecialist users lies in technical language" (Devitt 545). Even as a pre-med student that does well in science courses, I had a

Rahman 3 very hard time trying to understand what many of the lexis were, specifically medications and or symptoms . For example, in Case Study 30, the subject also showed symptoms of Otalgia, and Ataxia; and was treated by various drugs such as azithromycin and ceftriaxone . To a doctor these words have a applied meaning to them, but to the outside world these words are very foreign .When I went to look up these words, I was directed to websites such as Rxlist or Medline plus, both websites that are medical knowledge bases for patients/doctors. Even though the Knowledge bases were "dumb downed" , I still had a very hard time interpreting what was read, due to the fact that I had no prior background knowledge, as the knowledge bases are meant only for references. Furthermore, there were countless similarities between the case studies at hand. Each case study was structured and formatted generally the same way. The case studies are titled with the case number, and the year of the occurrence, followed by the names of the doctors that were assigned to the case. The headers, I believe are put this way so that case studies can be found chronologically. The case studies start with a Presentation of the case; a highly detailed and thorough narrative of the patients symptoms and his experience leading up to his diagnosis, within the presentation are the medications given( and dosages), and any tests done to the patient, each case study has a Laboratory Data chart which lists the Bio-statistics(pH,blood type, urine analysis etc) of the patient, as well as other results/data of various tests depending on the case. Data synthesis depends on the case itself, normally lab data is collected over a span of examinations . This is the case for Case #30, where the patient had recurrent examinations, until finally the lab data fit like a puzzle, however this is not always the case; In Case #40, the patient was immediately put into the CC unit(Critical care unit), and all tests were done immediately. I speculate that doctors do this because they want to try and treat the illness with the very

Rahman 4 minimum precautions, before moving onto advanced treatment, possibly to avoid being sued for medical malpractice.One theory that I have about the presentation is that, by having a very thorough presentation, other doctors can actually "feel" like they are diagnosing the patient. Similar to how reading a book "plays a movie" in your head. Bawarshi is able to state this in his words as: "When we use genre analysis as ethnomethod-ological technique, we not only gain access into communities, but also begin to recognize how "lived textualities" interact with and transform "lived experiences." (Bawarshi 580) After the presentation of the case, there is a short paragraph(s) on differential diagnosis; the differential diagnosis is any other serious causes that would have put the patient in his/her current state, in Case #40, Dr Theodore Benzar states "it is important not dismiss other causes..", clearly it is important to look at all angles of the illness as a wrong diagnosis could prove fatal. The last main paragraph is discussion of management tied in to the final diagnosis; which is a open chat where various doctors give their advice, experience, and ask questions about the case study or subject. Upon further contemplation I think I can assume why the case studies are structured and formed this way. When articles are written with a scientific theme or background, unlike English articles, they are very straight to the point and specific, this is mainly to not cause ambiguity and confusion. The most interesting take on the case studies is the forum like chatting done in the discussion of management, doctors, and only doctors, from all over the world are able to participate and give their thoughts and opinions on the case studies, I believe this is done mainly on the idea of "two-heads are better than one". I believe the purpose of open discussion is that it can open up ideas and thoughts that may have previously been disregarded or not known. Such as, in case #19 where one doctor asked the primary physician of the patient on how he was able to acquire authentic methacathinone(bath salts) in his lab results. Bath salts are a synthetic

Rahman 5 and new drug, therefore in major drug screenings it can be undetected, making this case study a very prevalent article to inform doctors on what possible overdose symptoms are of the drug.

Based upon the conclusions that I was able to draw up from the case studies, I truly am able to understand the medical discourse community better. Doctors need case studies as a form of reference guide, by utilizing the case studies a doctor has a new "tool" to his examinations, he/she will be able to diagnose the illness a lot faster, or may be able to learn a differential diagnosis patient. Since my case studies dealt with neurology, which is a specialized branch in the study of the nervous system (both central and peripheral), I also know that the nervous system is a highly structured and complicated, therefore it is quite common for doctors to overlook other diagnoses. Another reason why case studies are important is because, since medicine is constantly evolving, doctors must "keep up" with the growing research, otherwise they could delay the proper treatment(s) for the patient. Without easy access to case studies, it would be very hard to diagnose and treat patients, and in some situation, time can be the difference between life and death. The way doctors communicate, to me, is very similar to the fact of globalization, now that case studies are online, each doctor can mutually benefit from one another with their experience and thoughts.

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Works cited Amir T. Fathi, M.D., Yi-Bin Chen, M.D., Brett W. Carter, M.D., and Russell J.H. Ryan, M.D."Case 24-2012 A 38-Year-Old Man with Abdominal Pain and Altered Mental Status."The New England Journal of Medicine. N.p., 9 Aug. 2012. Web. Devitt, Amy, Anis Bawarshi, and Mary Reiff. Materiality and Genre in the Study of Discourse Communities. 5th ed. Vol. 65.543-557.: National Council of Teachers of English, n.d. Print. College English. Devitt, Amy J. "Generalizing about Genre: New Conceptions of an Old Concept". College Composition and Communication. Vol 44. 1993. pg 573-584 Print. Theodore I. Benzer, M.D., Ph.D., Shamim H. Nejad, M.D., and James G. Flood, Ph.D.."Case 402013 A 36-Year-Old Man with Agitation and Paranoia." The New England Journal of Medicine. N.p., 12 Dec. 2013. Web. Tracey A. Cho, M.D., Jeremy D. Schmahmann, M.D., and Mary E. Cunnane, M.D."Case 302013 A 19-Year-Old Man with Otalgia, Slurred Speech, and Ataxia." The New England Journal of Medicine. N.p., 26 Sept. 2013. Web.

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