1. Medical Semiotics and Medical Education: can medical semiotics be part of the humanizing turn in Clinical Education?
John Tredinnick-Rowe

2. What is Medical Semiotics Medical Semiotic Literature Data Discussion
Contents
What is Medical Semiotics
Medical Semiotic Literature
Data
Discussion
Structuralist constraints with the work programme
Conclusions
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3. What is Medical Semiotics?
The application of predominantly Piercian’s semiotics to medicine
Primarily symptomatology and the history of medicine
Little use of Saussure except in contemporary texts
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Sinéad Furlong-Clancy (ed.), The DS Project: Image, Text, Space/Place, , 2015. 

4. Hellenic Literature on Medical Semiotics
Hippocrates i. 460 – c. 370 bc
HIPPOCRATES 400 B.C.E [1983]. Airs, waters, places. In: CHADWICK, J., MANN, W. N., LONIE, I. M. & WITHINGTON, E. T. (eds.) Hippocratic Writings New Edition ed. London: Penguin Classics.
HIPPOCRATES i. 460 – c. 370 bc. Cinquième Tome de Livre, 101. In: BAILLIÈRE, J. B. (ed.) Œuvres Complètes D’Hippocrate, Traduction Nouvelle Paris: L’institut Académie des Inscriptions et Belles-Lettres et de la Société d’Histoire Naturelle de Halle
Also still influencing Clinical Reform through Sir William Osler in 1900’s (Silverman, 2012, Silverman et al., 2003)
Galen i.130 – c. 210 bc – The subject of work by SEBEOK, T Galen in Medical Semiotics. Global Semiotics. Indianapolis: Indiana University Press.
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5. Historical Literature on Medical Semiotics
German and Russian doctors in the 1800’s wrote about medical Semiotics, such as Feodorovich and Hippius (1892)’s work Semiotics and Diagnosis of Childhood Diseases (Semiotik und Diagnostik der Kinderkrankheiten).
Or Hufeland (1823) in the Journal of Obstetric Practice who wrote On the value and importance of semiotics (Ueber den Werth und die Bedeutung der Semiotik), similarly Becker (1832) addressed the role of semiotics in relation to cardiology in his On the physiology and semiotics of cardiac activity (Zur Physiologie und Semiotik der Herzthätigkeit).
This literature naturally, culminates in the works of Thure von Uexküll, as the one of the originators of a modern movement in medical semiotics and psychosomatic medicine (von Uexküll, 1986, Von Uexküll, 1982, von Uexküll, 1979).
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6. Contemporary Literature on Medical Semiotics
General issue in Medical Semiotics - (Baer, 1988, Staiano, 1979, Von Uexküll, 1982, Von Uexküll 1986, Van Den Broek, 1987, Brands et al., 2000, Skopek, 1979, Staiano-Ross, 2011, Sebeok, 2001, Sebeok, 1985, Kahn, 1981, Rogers and Swadener, 2001, Hess, 1998, Nessa, 1996, Crookshank, 1923),
General issues in Neuro-linguistics (Lavorel, 1984, Andrews, 2011, Chernigovskaya Tatiana, 1999, Laughlin et al., 1981), and specific conditions in it such as aphasia (Novaes Pinto, 2013, Landzelius, 2009, Price-Williams and Sabsay, 1979, Volpe, 1991), Dementia (Fleche, 2009), Alzheimer’s (Gubrium Jaber, 1988, Donnelly and Lilly, 1998). Similarly Neuro-semiotics is covered by (Favareau, 2002, Roepstorff, 2001), Psychiatry/Psychotherapy by (Keinänen, 2003, Kuperman and Zislin, 2005, Peyrot, 1987, Shands, 1970a, Lee and Beattie, 2000, Davtian and Chernigovskaya, 2003, Ablamowicz, 1994, Mildenberger, 2004, du Plessis, 2012, Rausch, 1995, Craig, 1997, Stampfl, 2013, Donnelly, 1984, Aragno, 2011, Shands, 1970b)
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7. Contemporary Literature on Medical Semiotics
Suicide (Utriainen and Honkasalo, 1996),
Diagnostics (Kahn, 1978),
Clinical Medicine (Chinen, 1988)
Gerontology (Stafford, 1988)
Psychosomatic medicine (Langewitz, 2009),
Homeopathy (Walach, 1991, Schemm et al., 2002), Menstruation (Mazaj, 1995),
Anti-depressants/ Depression (Catt, 2012, Donnelly and Irvin, 1990),
HIV (Namaste, 1993, Scalvini, 2010, Tulloch, 1992, Ferguson, 2013, Rose, 1993),
Therapy (Kozin, 2003),
Drug Therapy (Schonauer, 1993)
Anorexia (Prewitt, 1992),
Obesity (Anderson, 1993, Herndon, 2005, Jutel, 2005, Murray, 2007), Schizophrenia (Osatuke et al., 2010, Frow, 2001),
Prescription of medicine (Nuessel, 2002),
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8. Contemporary Literature on Medical Semiotics
eHealth (Caiata Zufferey and Schulz, 2010, Neuhauser and Kreps, 2010, Orizio and Gelatti, 2010, Schulz and Rubinelli, 2010, Camerini et al., 2010, Green, 2010),
Autism (Smith and Bell, 2001, Oakley and Vidanović, 2014),
Osteopathy (Gaines and Chila, 1998),
Nursing (Donnelly, 1987)
The use of medical tools (McRoberts and Sears, 1998),
Health promotion (Brookes and Harvey, 2014),
Chronic disabilities (Connolly and Craig, 1996, Stockall and Stickels, 2000),
William’s Syndrome (James, 2009),
Fibromyalgia (Quintner et al., 2003),
Immunology (Sercarz and Celada, 1988),
Chronic pain (Priel et al., 1991, Honkasalo, 2001, Honkasalo, 2000), and
Symptomology (Baer, 1982, Dominick, 1980, Donnelly and Langley Moneyham, 1987, Staiano-Ross, 2012, Sebeok, 1986, MacBryde and Blacklow, 1971)
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9. The Humanising Turn in Medicine
In Western Medicine, the dominant model that is taught in medical schools is the biomedical model based on clinical trials
Rationalist approaches in medicine have been contested Empiricists since the early 1900s by medical reformers such as Sir William Osler, “The practice of medicine is an art based on science” (Silverman et al., 2003).
This movement reappeared in 1960/70 American and also its infancy in the University of Glasgow in the 1980s
In 1993 General Medical Council (GMC) started to recommend the incorporation of medical humanities modules in its guidance for trainee doctors Tomorrows Doctors (GMC, 1993).
SSUs, Special Study Unit, or SSCs Student Selected Components are the form of education
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10. The Humanising Turn in Medicine
Which function as an additional course for medical students, that come with additional credits but are by no means a core part of the medical curriculum.
As of 2013 humanities modules are available to medical students in 30 of the UK’s 32 medical schools (REF, 2014).
The first appraisal of the system, looking at the outcomes of this new educational programmes was conducted in 2000 by MacNaughton (2000).
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11. Thure von Uexküll
Thure Baron von Üxküll (1908– 2004) was a German scholar of psychosomatic medicine and biosemiotics. He developed the approach of his father, Jakob von Uexküll, in the study of living systems and applied it in medicine.
Going through the literature I noticed an understudied anomaly in his works
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14. German Title English Title
English Title
Uexküll, Th. von: Der Begriff der "Regulation" und seine Bedeutung für eine anthropologische Medizin. Psyche 6 (1952/53),
Uexküll, Th. Von. The term "regulation" and its importance for an anthropological medicine. Psyche 6 ( ),
Uexküll, Th. von: Ein Beitrag zur Pathologie und Klinik der Bereitstellungsregulationen. Verh. Dt. Ges. inn. Med. 59 (1953),
Uexküll, Th. Von. A contribution to the regulation of Pathology and Clinical deployment. Ratio. Dt. Ges. Inn. Med. 59 (1953),
Uexküll, Th. von: Über die heutige Stellung der inneren Medizin in den vereinigten Staaten. Verh. dt. Ges. inn. Med. 60 (1954),
Uexküll, Th Von. About the current position of internal medicine in the United States. Verh. dt.. Ges. Inn. Med. 60 (1954),
Boening, H., H.D. Cremer, W. Rotter, Th. von Uexküll: Bemerkungen zur Denkschrift der Fachgruppe Medizin und zur Reform des Medizinstudiums im allgemeinen. Fortschr. Med. 77 (1959),
Boening, H., H. D. Cremer, W. Rotter, T. von Uexküll. Remarks on the memorandum of the Section for Medicine and the reform of medical education in general. Fortschr. Med. 77 (1959),
Uexküll, Th. von: Studienreform und Fakultätsreform. Ärztl. Mitteil. 46 (1961),
Uexküll, Th. von: Academic reform and Faculty reform. Ärztl. Mitteil. 46 (1961),
Uexküll, Th. von: Heinrich Boening. Ansprache anläßlich der Gedenkfeier der Medizinischen Fakultät am 7.Juni Nachrichten der Gießener Hochschulgesellschaft 30 (1961), 7-8.
Uexküll, Th. von: Heinrich Boening. Speech on the occasion of the commemoration of the Faculty of Medicine on June 7, Nachrichten der Gießener Hochschulgesellschaft 30 (1961), 7-8.
Uexküll, Th. von: Die personelle Struktur der klinischen Fächer in den neuen Hochschulen, S Schwartz, Göttingen 1962.
Uexküll, Th. Von. The personnel structure of clinical subjects in the new colleges, S Schwartz, Göttingen 1962
Uexküll, Th. von: Eine moderne medizinische Fakultät im Rahmen einer technischen Hochschule. Festvortrag, Aachen 1965.
Uexküll, Th. von: A modern medical faculty as part of a technical college. Festvortrag, Aachen 1965.
Uexküll, Th. von: Die Zukunft der medizinischen Poliklinik. Med. Klein. 61 (1966),
Uexküll, Th. von: The future of the Medical Poly Clinic. Med. Klein. 61 (1966),
Uexküll, Th. von: Reform des Medizinunterrichts in der Bundesrepublik Deutschland. Hoffnung oder Utopie? Med. Klin. 62 (1967),
Uexküll, Th. Von. Reform of medical education in the Federal Republic of Germany. Hope or Utopia? Med. Klin. 62 (1967),
Gabelmann, W., Th. von Uexküll: Was ist ein "teaching hospital"? Das Krankenhaus 59 (1967),
Gabelmann, W., Th. von Uexküll: What is a "teaching hospital"? Das Krankenhaus 59 (1967),
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15. von Uexküll, Thure, ed. Probleme des Medizinunterrichts: Bericht über die Arbeitsgruppe Hochschuldidaktik, Untergruppe Medizin am 20. Oktober 1967 in Ulm. Urban & Schwarzenburg, 196
von Uexküll, Thure, ed. Problems of medical education. Bericht über die Arbeitsgruppe Hochschuldidaktik, Untergruppe Medizin am 20. Oktober 1967 in Ulm. Urban & Schwarzenburg, 196
Gabelmann, W., Th. von Uexküll: Akademische Lehrkrankenhäuser im Dienste der medizinischen Ausbildung. Öff. Gesundh.-Wes. 30 (1968), (textidentisch mit: Was ist ein "teaching hospital"?, 1967).
Gabelmann, W., Th. von Uexküll: Academic teaching hospitals in the service of medical education. Öff. Gesundh.-Wes. 30 (1968), (textidentisch mit: Was ist ein "teaching hospital"?, 1967).
Uexküll, Th. von: Beitrag zur Diskussion über den Entwurf einer Approbationsordnung im Rahmen der 5. Delegiertenversammlung der Bezirksärztekammer Nordwürttemberg am 22. November Ärztebl. Baden-Württemberg 25 (1970),
Uexküll, Th. Von. Contribution to the discussion on the draft licensing regulations at the 5th Assembly of Delegates of the District Medical association building on 22 November Ärztebl. Baden-Württemberg 25 (1970),
Uexküll, Th. von: Reform des Medizinstudiums. Therapiewoche 20 (1970),
Uexküll, Th. von: Medical Studies Reform. Therapiewoche 20 (1970),
Uexküll, Th. von: Das Problem der Ausbildung zum Arzt in der modernen Welt. Ärztl. Mitteil. 68 (1971),
Uexküll, Th. von: The problem of medical training in the modern world. Ärztl. Mitteil. 68 (1971),
Uexküll, Th. von: Das Allgemeine in der Medizin. Der Praktische Arzt 8 (1971),
Uexküll, Th. von: General Practice in Medicine. Der Praktische Arzt 8 (1971),
Auernhammer, W., U. Egle, J. M. Hermann, K. Köhle, R. Metzger, G. Paar, M. Rassek, N. Schäfer, O. Schairer, B. Schlecker, Th. Schmidt, O. Schonecke, W. Schüffel, K. H. Schultheis, C. Simons, Th. von Uexküll: Praktische Psychosomatik als integrierende Unterrichtsveranstaltung im Rahmen der Approbationsordnung. DÄ-Ärztl. Mitt. 74 (1977),
Auernhammer, W., U. Egle, JM Hermann, K. Kohle, R. Metzger, G. pair, M. Rassek, N. Shepherd, O. Schairer, as Schlecker, Th. Schmidt, O. Schonecke, W. Schüffel, KH Schultheis, C. Simons, T. von Uexküll. Practical Psychosomatics as an integral education event in the context of Licensing Regulations. DÄ-Physicians. Mitt. 74 (1977),
Uexküll, Th. von: Das Problem der Entsprechung von Rollen und Gegenrollen bei Arzt und Patient. In: Jappe, G., C. Nedelmann (Hrsg.): Zur Psychoanalyse der Objektbeziehungen, S Problemata, Frommann-Holzboog, Stuttgart-Bad Cannstatt 1980.
Uexküll, Th. von: The Problem of Correlation of Roles and Counter Roles between Doctor and Patient. In: Jappe, G., C. Nedelmann (Hrsg.): Zur Psychoanalyse der Objektbeziehungen, S Problemata, Frommann-Holzboog, Stuttgart-Bad Cannstatt 1980.
Uexküll, Th. von: Was weiß die Medizin vom Menschen? In: H. Rösner: Der ganze Mensch, S dtv, München 1986.
Uexküll, Th. von: What does the medicine man know? In: H. Rösner: Der ganze Mensch, S dtv, München 1986.
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16. Discussion
Thure von Uexküll’s work on Clinical Education yet to be explored in any semiotic context.
With the recent launch of Edusemiotics it seemed time to explore this undercurrent of Uexküllian literature.
In the table there are titles concerning medical regulation - an introduction to Semioethics (See (Petrilli, 2014, Petrilli, 2010, Petrilli and Ponzio, 2009) in a medical curriculum? Self et al. (1989) who found statistically significant changes in reasoning in medical students who studies ethics
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17. Structural problems – introducing humanities subjects into clinical education
Structure of the medical field can’t be modified just by attempting to change it structures
Some changes in demographics are noticeable however as a result of ‘widening participation activities’ since the 1970’s there has been great increases in the numbers of female, ethnic and minority students as well older student (BMA, 2009). However if one looks at the economic profile of medical students, there has been no significant change in the economic background of the students admitted since 1970.
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18. Structural problems – introducing humanities subjects into clinical education
Some such as Bloom (1988) have suggested that curricula reform in clinical education is merely a distraction:
“medical education’s manifest humanistic mission is little more than a screen for the research mission which is the major concern of the institutions social structure.”
The research mission here referring to the economic benefits generated from research grants, which Bloom argues is the real driving force behind curricula development.
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19. Structural problems – introducing humanities subjects into clinical education
There may be one chance of due to the nature of labour migration in medical schools that could successfully contribute to the introduction of Semiotics into medical education:
“In the UK…the medical schools with the highest research profiles have tended to retain largely traditional medical curricula, while the newest medical schools, which generally have lower research income and prestige, typically claim to have ‘innovative’ curricula which integrate science with clinical practice. This may represent attempts on the part of the new schools to symbolically differentiate themselves from the dominant players in the field, rather than to attempt to compete on the same terms” (Brosnan, 2009, p63)
Hence Cardiff – Traditional to modern
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20. Conclusions
Within Thure von Uexküll’s numerous works there is an stand of literature devoted to clinical education. All of which is in German, and so remains to be translated and introduced to the English speaking world. Translating the titles of these works, suggests that Semioethics might offer a route to introduce semiotics into medical school curriculum. The translations of the works themselves is in its infancy and has not revealed any insights so far. It remains to be seen when body of work is finally translated, if such insight exist into how to introduce medical semiotics back into medical education. And so help to add to the humanising turn in clinical education.
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21. Thank you for listening John Tredinnick-Rowe Research Assistant Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA) Plymouth University Peninsula Schools of Medicine and Dentistry, Room C506, Portland Square, Plymouth University, Drake Circus, Plymouth, PL4 8AA
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22. Additional References
BLOOM, S. W Structure and Ideology in Medical Education: An Analysis of Resistance to Change. Journal of Health and Social Behavior, 29,
BMA Equality and diversity in UK medical schools. London: British Medical Association
BROSNAN, C Pierre Bourdieu and the theory of medical education. In: BROSNAN, C. & TURNER, B. S. (eds.) Handbook of the Sociology of Medical Education. Abingdon, OXON: Routledge
GMC Tomorrow's doctors: Recommendations on undergraduate medical education, London, General Medical Council. Education Committee.
MACNAUGHTON, J The humanities in medical education: context, outcomes and structures. Medical Humanities, 26,
PETRILLI, S Sign Crossroads in Global Perspective: Semioethics and Responsibility, New Brunswick, NJ, Transaction Publishers
PETRILLI, S Sign Studies and Semioethics Communication, Translation and Values, Berlin, Mouton De Gruyter
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23. Additional References
PETRILLI, S. & PONZIO, A Semiotics Unbounded: Interpretive Routes through the Open Network of Signs, Toronto University of Toronto Press.
PETRILLI, S. & PONZIO, A Semioethics In: COBLEY, P. (ed.) The Routledge Companion to Semiotics. Abingdon, OXON: Routledge.
REF Establishing the Medical Humanities movement in the UK and influencing the education of healthcare professionals. Research Excellence Framework.
SELF, D. J., WOLINSKY, F. D. & BALDWIN, D. C. J The effect of teaching medical ethics on medical students' moral reasoning. Academic Medicine, 64,
SILVERMAN, B. D Physician behavior and bedside manners: the influence of William Osler and The Johns Hopkins School of Medicine. Proceedings (Baylor University. Medical Center), 25,
SILVERMAN, M., MURRARY, T. J. & BRYAN, C. S The Quotable Osler, Philadelphia, American College of Physicians.
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