The openness of the internet conceals the constraints that medical rhetoric pushes against in areas such as regulatory writing, scientific paradigm shifts, and medical training. Regulatory agencies often guide medical writers using complicated, incomplete, and convoluted instructions, which the writer is forced to navigate while attempting to consider all the audiences to which he or she must appeal. These regulatory instructions and multiple audiences constrain the types of rhetoric in which the medical writer can engage. Rhetorical constraints can also affect scientific paradigm shifts. Kuhn suggests that major scientific paradigm shifts occur as a result of rhetorical appeals by scientists themselves. In Kuhn’s view, scientists must be highly skilled rhetoricians in order for scientific revolutions to occur. Prior to scientific revolutions, previous rhetorical constraints must be broken by new and more effective rhetoric. Medical students are also rhetorically constrained and are taught specialized medical language, incomprehensible to most outsiders. They are taught to focus strictly on the medical facts, not to consider a patient’s living or working environment, interpersonal relationships and/or their community; external cues that might be helpful for them to make more accurate diagnoses by sharpening their intuitive skills. In other words, medical students are rhetorically constrained by their medical training.

            Whether it is the historical medical rhetoric shared by patients and physicians that shaped their relationships of the 18th Century, or the contemporary medical rhetoric that challenges and shapes today’s patient/physician relationships; clearly, medical rhetoric influences and is influenced by the times in which it is practiced. Given the potential alleviation or aggravation of human suffering involved as a result of the proper or improper use of medical rhetoric, a brief survey of the literature reveals its evolution, modern challenges, existential uses, and its constraints.