LITTLE FLOWER'S LAUGHTER

ON THE LIMITS OF THE CLINICAL EXAMINATION IN MEDICAL EDUCATION

Abstract

Introduction: This essay takes Clarice Lispector's short story “The smallest woman in the world” as a parable of the clinical encounter, in order to examine the limits of the clinical examination in medical education. Objective: To argue that the limit of the clinical examination lies not in poor measurement but in measurement done well, and to propose a formative consequence of this recognition. Development: The explorer Marcel Pretre measures, names, and classifies Little Flower with rigor; her laughter, however, escapes the file. The violence of the story lies not in negligence but in the success of the procedure: in the conversion of an interior life into a variable. Drawing on Buber, Jaspers, Charon, and Canguilhem, it is argued that the mature clinician is distinguished from the merely competent not by the quality of classification, but by the recognition that something always escapes description, and by a withdrawal from the pretension of fully apprehending the other. Conclusion: Medical education teaches how to fill the file; it teaches far less how to inhabit the boundary of one's own grid. The recognition of the irreducible is not a finer technique of apprehension, but a renunciation of capture.