Distributed Cognition in the Past Progressive: Narratives as Representational Tools for Clinical Reasoning

Cognition may require access to past events, for example to understand undesirable outcomes or diagnose failures. When cognition is distributed between multiple participants, a particular representational challenge occurs because not all of the participants may have directly experienced the focal event. Language can transcend temporal and physical limitations on event accessibility. We suggest that people create complex linguistic constructs as tools to facilitate retrospective cognition. We illustrate this process by analyzing the use of a particular linguistic construct (narrative) in the domain of clinical reasoning. Results demonstrated that narratives support clinical cognition during practitioner-patient interactions. Narratives extended access to clinically relevant events providing information about circumstances, subjective experiences, patient functioning, and prior decisions. Whereas, the hermeneutic nature of narrative allowed collaborative hypothesis testing and creation of meaning. The use of narrative in clinical cognition challenges Bruner's (1991) distinction between narrative and paradigmatic reasoning and enriches the understanding of medical narratives.