Two rads ruminate on the changing of the ‘medical gaze’ through history

Radiologists Benjamin Gray, MD, and Richard Gunderman, MD, PhD, have laid out an intriguing synthesis of their contemplations on their profession with the thoughts of the French historian, philosopher and critic of modernity Michel Foucault (1926–1984).

In commentary published online April 25 in  Academic Radiology, the physicians, both affiliated with Indiana University, draw from Foucault’s 1963 book  The Birth of the Clinic: An Archaeology of Medical Perception to compare and contrast the ways doctors have had of “seeing” patients through the years.

Prior to the late 18th century, they write, physicians had long asked “What is the matter?”

In the years since that period of rapid scientific discovery and imaging inventiveness, the question became “Where does it hurt?”

“Of course, Foucault is not so naïve as to assume that pain is the only symptom of disease, but by this new question he means to suggest that the gaze of the physician had shifted from the whole patient to particular parts of the patient,” write Gray and Gunderman. “That is, physicians began thinking of disease in terms of a process that must be localized to be understood. Disease, in other words, acquired an address within the patient's body.”

Among the ramifications of this shift for radiology is that the aspect of the patient that matters most, they write, “is no longer the aspect that talks, thinks, and feels, the one that can be interviewed and examined, but the aspect that can be abstracted from the patient, such as a pathologic specimen or a radiologic image.”

In a tone conveying more detached observation than diagnostic criticism or directly curative concern, the authors note that radiologists approach their medical work at a “particularly high degree of abstraction.”

For radiology, more than most other medical specialties, “there is a sharp distinction between the seer and the seen, the radiologist and the patient. So great is this divide that in many cases, radiologists could not identify the photograph of a patient whose radiologic images they just interpreted.”

Summarizing their application of Foucault’s thought to the field of radiology as it stands today, the authors conclude:

“When we talk about the invisibility of radiologists to patients and referring health professionals, we are not talking about a strictly 21st-century phenomenon. The seeds for such separation were sown long before the advent of picture archiving and communication systems (PACS). They extend all the way back to the 18th century, when physicians began to see patients and their diseases in a radically new way, one that only opened up vast new vistas in the medical perception and understanding of disease, but which also bequeathed to medicine—and in particular, to radiology—a host of challenges.”