We thank Dr. Horton for expanding the medical applicability of literary methods to include the interpretation of clinical research. In the act of writing, the author assumes a narrative contract with the reader that, if all goes well, leads to some change in the reader—edification, comfort, or a change in understanding. Rhetorical analyses can help us to achieve the critical skill required to evaluate research, thus clarifying the researchers' intentions, interpretations, and biases. In addition to defining generalizability, other projects within clinical research rest, in part, on interpretive functions; for example, deciding on statistical methods, clarifying the meaning of the data, or deciding which findings (or absence of findings) to report.

Dr. Horton's suggestion of a discipline called "clinical hermeneutics" brings us to Dr. Poses' concern with our reliance on nonmedical vocabulary. We realize that many of the terms we use are foreign to medicine, although we imagine that most physicians understand such words as "longitudinal" and "genre." Perhaps the discomfort with new words represents, in part, discomfort with new notions. Yes, our methods do lead us to believe that the medical chart masks inner chaos such as covert conflict, competing expectations of patients and physicians, routinized condescension, or sarcasm toward patients. Literary analysis does not turn on whether a text is fiction or fact. Moreover, literary methods—through which narratives are interpreted to reveal deeper meanings in the text and meanings imposed by the reader are disclosed—can help physicians to better listen to their patients and thus to obtain more accurate histories, the cornerstone of effective treatment. We refer Dr. Poses to our references for expanded discussions of these concepts. Finally, we do not want to needlessly replace one technical jargon with another, and we appreciate the reminder to speak in a common language.

The letter by Middleton and colleagues gives evidence of the penetration of literary methods and texts into medical training and practice. We appreciate especially their highlighting the fact that cultural lessons must be included in medical training and that literary texts can help to teach such lessons. We applaud their program for its texts and its methods, and we thank them for efforts to demonstrate not only literature's contributions to practice but also the means by which they are attained.