Medical Talk and Medical Work

178 Pages·1995·60.072 MB·English

by  Paul Atkinson

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MEDICAL TALK
AND MEDICAL WORK
This book is dedicated to John Stoeckle,
physician and social scientist
MEDICAL TALK
AND MEDICAL WORK
The Liturgy of the Clinic
Paul Atkinson
Rt OOMINGTON
SAGE Publications
London • Thousand Oaks • New Delhi
tv-'l-1.. ....
©
Paul Atkinson 1995
First published 1995
All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, transmitted or
utilized in any form or by any means, electronic, mechanical,
photocopying, recording or otherwise, without permission in
writing from the Publishers.
SAGE Publications Ltd
6 Bonhill Street
London EC2A 4PU
SAGE Publications Inc
2455 Teller Road
Thousand Oaks, California 91320
SAGE Publications India Pvt Ltd
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British Library Cataloguing In Publkation data
A catalogue record for this book is available from the British
Library
ISBN O 8039 7730 1
ISBN O8 039 7731 X (pbk)
Library of Congress catalog card number 95-068384
Typeset by Type Study, Scarborough
Printed in Great Britain at the University Press, Cambridge
Contents
Acknowledgements
•
VI
..
Introduction
Vil
1 Work among the Haematologists
1
2 The Sociological Construction of Medicine 21
3 The Production of Medical Knowledge
37
4 Reading the Body
60
5 Constructing Cases
90
6 Voicing Opinion
110
7 Voices of Medicine
128
8 Conclusion
148
Appendix
152
References
153
Index
161
Acknowledgements
A great many people have contributed directly or indirectly to the work
contained within this monograph. Unfortunately, the people who helped in
the most direct manner- by allowing me to observe and record their work as
haematologists - are precisely those who must remain anonymous. I am
none the less in their debt. John Stoeckle encouraged me to develop some of
the ideas I have presented here, and to undertake the fieldwork as I did. Sara
Delamont has unfailingly supported me for over twenty years and continues
to be the ideal companion, collaborator and critic. My past and present
colleagues at Cardiff have helped me immeasurably over the years: I am
especially grateful to Anne Murcott, Mick Bloor and Amanda Coffey. None
of those friends and colleagues can be held responsible for the contents of
this work: its shortcomings are mine alone.
The preparation of various drafts of this book has been helped by Liz
Renton, Pauline Donovan and Jackie Swift. The fieldwork was undertaken
during a period of sabbatical leave from University College Cardiff (as it was
then called), and I worked on early analyses while I was a visiting scholar at
Boston University, at the University of California, San Francisco, and at the
University of California, Davis. I am grateful to those institutions for their
generous support.
Introduction
I originally intended to call this book Blood and Judgement ( deliberately
misrepresenting Hamlet). Blood, because the book's empirical basis is a
study of haematologists; and judgement because it evokes how doctors
reason and discuss the evidence they assemble about their patients. It is not,
however, just about a group of haematologists- a highly specialized segment
of the medical profession who deal with disorders of the blood system, such
as leukaemias, anaemias, haemophilia or thalassaemia. Frankly, I suspect
that very few people would want to read a book that was exclusively about
such specialists - unless perhaps it dealt with one of the more dramatic
medical and social problems of our day such as AIDS. My intention, as I try
to make clear throughout the book, is to raise more general issues in the
sociology and anthropology of medicine through my detailed empirical work
in that one specialty. Haematology was chosen specifically in order to
provide the opportunity to explore those broader analytic interests.
The data were collected during a period of study leave from Cardiff. Their
nature and my subsequent use of them reflect the fact that my time for data
collection 'in the field' was fairly restricted. In sharp contrast to my
experience of ethnographic work in a teaching hospital for my doctoral
research, I could not conceive this project as long-term fieldwork. This book
is not the fruit of a general ethnography . .I did not immerse myself in my
chosen research site for a protracted period of fieldwork. My main data
collection was undertaken in the United States over a period of about ten
weeks, and was supplemented by a similar period of work in a British
setting.
As I explain in Chapter 1, my foreshadowed problems were well focused,
therefore, before I embarked on the field research itself. None the less, even
within such self-imposed limits, I gathered a fair amount of data, and
developed a number of ideas and insights that I had not foreseen prior to the
research itself. In this book I do not cover all the analytic themes thrown up
by my time among the haematologists, nor do I present a great deal of the
data themselves. Indeed, because I have sought to explore general themes
through a highly selective use of those data, rather little of them actually
appears in the book. For that reason, amongst, others, this is not a richly
illustrated peek into the backrooms of medicine, even though I believe it
raises and illuminates important issues about such settings. In that sense, my
research interests were, from the outset, more formal than those associated
with general ethnography and grounded theorizing.
••• Medical talk and medical work
VIII
It is necessary for me to say a little more about my use of the data at this
early stage. It will be seen that I use data extracts - especially segments of
transcript - to illustrate and develop my arguments. It will also become
apparent that I do not normally rely on short snippets and quotes lifted out
of the data. I prefer to use a smaller number of extensive sequences of data. I
have explained that strategy in another publication (Atkinson, 1992a) and I
do not recapitulate all of my argument here. Suffice it to say that my selective
citation of lengthy data extracts is a deliberate strategy. I have been struck
by the need to preserve the form of the talk and interaction I report. That
form may unfold over protracted sequences of interaction: narratives and
arguments are not captured adequately by the accumulation of short
gobbets of talk. It is important, for instance, to trace how a particular
patient's case is assembled, either by a single physician or collaboratively in
a round or conference. That places something of a premium on the reader's
patience in working her or his way through the selected data extracts. As I
explain and justify in the first chapter, I have done my best to ease the
reader's task.
My strategy in using and presenting such extracts means that I have not
done full justice to some of the linguistic or discourse features that can be
identified in the corpus of data. I have not even commented on all the
possible features of the data reproduced in this book. My intention is to
make available some rather more technical analyses in detailed papers in
due course. For the purposes of this book, therefore, I have tried to keep the
arguments accessible and their scope broad, despite the detail of the
fieldwork itself.
I have now published a number of things about the writing of qualitative
research (Atkinson, 1990, 1992b) and it might be thought as a consequence
that this book would display some of the textual variety about which I have
commented. It does not. Despite the interest displayed in this book about
the ethnopoetics of medicine, its own textual forms are ordinary. I have
made absolutely no attempt to experiment with my own narrative forms. I
have never advocated gratuitous textual experimentation, and I found no
analytic, sociological advantage in departing from academic convention in
constructing this work. That decision, of course, does not preclude the
construction of other texts in different forms, for different audiences
elsewhere (cf. Richardson, 1990). In the meantime, this is a stubbornly
conventional text, which attempts no experimental approaches to textual
representation.
In many ways, however, representation in a more general sense is the
guiding theme of the book as a whole. In paying detailed attention to the
everyday work and talk of haematologists I seek to explore how they
produce representations of haematological disorders. That is, how they
produce and reproduce knowledge about particular medical conditions. I
seek to convey how they see and describe the medical phenomena that are
their stock in trade; how they describe and narrate their cases to their
medical colleagues; how they seek to persuade one another about diagnoses