Voices to be heard -- The many positions of a physician in Anton Chekhov's short story, "A Case History.

Anton Chekhov (1860-1904) dealt in many of his short stories and plays with various phenomena as encountered in everyday medical practice in late 19th century Russia. In A Case History (1898) Chekhov illustrates the physician’s many positions in relation to his patient. According to Mikhail Bakhtin’s philosophy of language, a speaker occupies a certain position from which he or she addresses the listener. A phenomenon may gain diVerent meanings depending on the position from which it is addressed. In his story Chekhov describes how the patient was at first addressed solely from a medical point of view, without any relief to her suVering. Only when the physician was able to shift his position in a manner which oVered the patient an opportunity to be heard as a person was she able to express the true nature of her illness and to find new ways for palliation and cure. (J Med Ethics: Medical Humanities 2000;26:37–42)