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The production of an ethnography : some methodological and substantive issues for analyzing social setttings Katz, Bruce Allen 1975

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THE PRODUCTION OF AN ETHNOGRAPHY: SOME METHODOLOGICAL AND SUBSTANTIVE ISSUES FOR ANALYZING SOCIAL SETTINGS by BRUCE ALLEN KATZ .A. California State University, Northridge, 1968 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in the Department of Anthropology and Sociology We accept this thesis as conforming to the ' required standard THE UNIVERSITY OF BRITISH COLUMBIA February, 1975 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the Head of my Department or by his representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of /2i€sJ\»fx\»y ^ £&c\**>LtfJ**j The University of British Columbia Vancouver 8, Canada ABSTRACT This study seeks to provide an analysis of some of the features which underly any ethnographic description. F i r s t , i t focuses on the dail y routine of a community medical c l i n i c i n a large c i t y i n Western Canada, then i t "looks back" on the methodological and theo-r e t i c a l issues inherent i n the production of any ethnography. A da i l y routine known as "chart rounds" (a review of patients' medical h i s -tories) i s examined i n d e t a i l . That description i t s e l f then becomes a topic of inquiry i n i t s own r i g h t . The analysis rests on f i e l d observations conducted over a year and a half w i t h i n the research se t t i n g . During t h i s period the re-searcher was privy to medical examinations, to chart rounds, and to much of the ongoing routine of the C l i n i c . I was also able to tape-record various aspects of i t s organization. Most of the material which I have analyzed consists of transcriptions taken from tape recordings of doctor-patient interviews and of chart rounds. Some of the issues which w i l l be given special attention are (1) the beginning of the ethnographic report and the relationship of this section to the subsequent sections of an ethnography; (2) how i t i s that ethnographic descriptions are necessarily based i n a set of common sense relevancies; (3) the use of 'talk' i n in t e r a c t i o n and as a source of data for "discovering" the self-organizing features of the settings and occasions from which t h i s t a l k i s c o l l e c t e d ; and (4) the relationship between ethnographic description and the i researcher i n the research s e t t i n g . The research reported here i s to be seen as exploratory and tentative. I t i s not intended as a -manual for ethnographic researchers, but as an attempt to explicate some of the organizational features i n the construction of an ethnographic description. No doubt i t raises 3iany more questions than i t answers, but i t s purpose w i l l be s a t i s f i e d i f i t i s able to generate some debate about the organization of ethnographies. i i TABLE OF CONTENTS Page Introduction . . 1 Chapter One: Beginning an Ethnographic Report 30 The I n i t i a l Description 30 Ana l y t i c a l Features of the I n i t i a l Description 56 Chapter Two: Issues i n Producing an An a l y t i c a l Description . . 79 Introduction 79 The Research Setting: A Medical Sociology Approach . . . 81 The Ethnographic Approach 84 Chart Rounds: A H e u r i s t i c a l l y Inadequate Description . . 92 Talk and the Organization of Chart Rounds 100 Chapter Three: Chart Rounds: An Interactional Analysis . . . . 107 Introduction 107 A Characterization of the Data 109 The Progression Problem 112 The Referential Adequacy of the Use of F i r s t Name plus Last Name 120 The Reason for a V i s i t : I . 124 A Sociological Treatment of Referring . . . 127 An Organizational Treatment of an Organizational Problem . 141 The Reason for a V i s i t : I I 149 Conclusion 157 Chapter Four: The Researcher and the Research Setting 160 Introduction 160 The Sociologist as Cultural Stranger 166 i i i Page On Participant-Non-Participant Observation . . 169 Researcher I d e n t i f i c a t i o n : Accepting Staff Accounts . . . 183 Et h i c a l Considerations . . . 188 Conclusion 194 Chapter Five: Conclusion . . . . . . . . . 198 Summary and Further Research 198 Concluding Remarks 213 Bibliography 219 i v ACKNOWLEDGEMENT I would like to take this opportunity to thank Roy Turner and Matthew Speier for introducing me to this method of investigation. I am thanking Roy Turner for providing me with helpful criticism during the research and writing of this report. I wish to thank my readers for their patience and for their valuable suggestions: E l v i Whittaker, Adrian Marriage, Jay Powell, Robert Boese. I would also like to thank Peter Eglin for being a colleague throughout my graduate studies. I wish to express my thanks to the physicians and patients who provided the data for this dissertation. In order to maintain their anonymity, a l l names have been changed. v INTRODUCTION The data and observations which constitute the ethnographic section of this dissertation represent more than one and a half years of f i e l d work in a community medical c l i n i c (hereafter called the Clinic) located in greater metropolitan Vancouver. During this period, Iobbserved the ongoing activities of the C l i n i c , made notes, conducted and tape recorded interviews, etc. That i s , I did those things which might be expected of "any" researcher who intended to produce an ethno-graphy. However, this was not my primary intention and the findings which constitute the crux of this paper diverge widely from those of standard ethnographic practice for this paper is directed towards an examination of the problems inherent in the production of an ethno-graphy rather than merely an elaboration of the features of the setting Further, my findings are exploratory and tentative. This introduction is provided as an explication of some of the intellectual currents that run throughout this paper. To begin with, I would like to make i t clear that, when I began my research at the Cl i n i c , I had no f i n a l product in mind. That i s , a l though I i n i t i a l l y intended to do an ethnography I did not intend to focus upon the problems involved therein. Further, I had no formal research proposal guiding my act i v i t i e s at the Clinic, and no specific hypothesis about the parameters that this dissertation would encompass. Instead, after spending considerable time at the Clinic, I found myself in possession of a large collection of f i e l d notes and audio tapes of various medical interactions, and was faced with the problem of how I 2 could best make use of them. These are but some of the ways in which my work differs from conventional ethnographic reports. Before starting the present dissertation, I had constructed a detailed analysis of a daily c l i n i c a l routine known as chart rounds. At this time, I assumed that this analysis would occupy a section of the f i n a l research report. (Although I did not have any conception of what the f i n a l ethnographic description would look like.) When i t came time to address myself to the pragmatic task of writing a dis-sertation, I saw, for instance, that i t was necessary to provide an i n i t i a l description of the Community Clinic so that I would be able to place my description of the chart rounds in i t s proper ethnographic context. It was a concern with matters such as this, i.e., a concern with the features which make for an adequate ethnography that eventually shaped this present dissertation. The point to note, however, is that I had no interest i n these matters prior to starting f i e l d work in the Community Clinic. It was only after I began the ethnography that I became interested in certain features of ethnographic description as features which were in themselves worthy of investigation. To this end, I decided to make an ethnography into a topic in i t s own right, and to u t i l i z e my own description of the Clinic as data in order to i l l u s t r a t e some of the pervasive features of ethnographic description. Thereby, while the description of the Clinic presented in this report i s intended as a bona fide ethnographic description, that description w i l l later be treated as a resource for discovering (or better, "rediscovering") organizational features of an ethnography. 3 I t i s an attempt,necessarily an exploratory and tentative one, to move 2 towards what Berreman has cal l e d a "sociology of ethnographic know-ledge; an ethnography of ethnography." To embark upon an analysis of my own description of the C l i n i c and to then turn that description into a topic for investigation i s not equivalent to saying that such an analysis constitutes a special or priviled.edd case because of my self-conscious awareness of the research experiences under discussion. Such an awareness plays no special part i n my subsequent analysis of the organizational proper-t i e s of ethnographic description. I t i s , however, a topic which oc-cupies a prominent po s i t i o n i n recent work dealing with ethnographies. Let us consider some of the recommendations that attention to th i s issue has generated. In the i r a r t i c l e "The Emergence of Self-Consciousness i n Ethnography" Dennison Nash and Ronald Wintrob conclude that: (The) r i s e i n interest i n the subjective or personal factor i n anthropological research appears to have been accompanied by a de-objectivation of the anthropological world view. By th i s we mean that f i e l d observations are less l i k e l y to be thought of as having the quality of objective r e a l i t y and more l i k e l y to be conceived as r e l a t i v e to the observers  personality, his experiences and hi s actions  i n the f i e l d .3 (emphasis mine)3 4 They point out that the ethnographer i s inherently biased. Many s o c i a l s c i e n t i s t s maintain that such inherent biases should be brought into conscious awareness so that some remedy can be found for the errors that they cause. There i s some dismay about the paucity of knowledge 4 concerning the ethnographer's actual f i e l d experiences. Consequently, i t has been suggested that incorporating one's personal f i e l d experi-ences into the ethnographic report might make for a higher degree of cl a r i t y and objectivity.^ The relationship between the ethnographer and the subjects of his inquiry'has also been cast into question. Particular attention has been paid to the type of knowledge the ethno-grapher can obtain vis-a-vis that relationship. For example, Robert Jay contends that: The main point I am trying to make in this paper i s that the relationships we form with the subjects of our work — for whatever reasons we settle upon those relationships —- control the kind of know-ledge that the material we gain w i l l yield and also control how we exercise whatever responsibility we may feel to our subjects and to ourselves as persons. I have further been trying to show that there is a certain knowledge relevant for under-standing one another in our own personal lives, i n which we look upon one another as autonomous, mutually responsible selves, and that there i s another kind of knowledge relevant to understanding our subjects as shaped and moved by extrapersonal forces allowing at most very limited autonomy or responsibility. The knowledge involved i n each kind of understanding is not directly pr even readily translatable into that of the other. That disconformity between our direct, personal sight of the universe and the sight that an objective science gives us has been at the root of much i n -tellectual discontent i n Western c i v i l i z a t i o n for some time. 7 The ethnographer, then, is no mere reporter of socially observable phenomena, but an integral part of the description he produces. Jay seems to be suggesting that the ethnographer can make his report a more valid document of the setting by considering the types of personal relationships thattlre develops with his informants, and incorporating 5 his feelings about these relationships into his report. Jay goes on to outline some of the possible advantages of this approach. It is precisely here that I see the difference between my position i n anthropology and that of many, perhaps most, of my colleagues. I want to choose, with f u l l awareness, to relate to my sub-jects f u l l y as persons, as I would to any other — friend, colleague, student, chance acquaintance. That choice determines the realm of knowledge I shall be able to explore, and i t i s a realm for which the concept of culture, and for that matter of social structure, ecology, and the lik e (extra-personal bases for explaining behavior) are of only peripheral value.® Another procedure which takes the ethnographer's bias into account and attempts to bring that bias to the level of consciousness i s the analysis of anthropologists via the use of psychological experiments and Rorschach tests. Dennison Nash, for one, feels that Ann Roe's psychological studies of anthropologists are a useful method for as-sessing the individual anthropologists overall adaptability to what he calls the role of "ethnologist-stranger": In her project involving a number of kinds of research scientists, Roe interviewed and tested 8 eminent anthropologists and gave group Rorschach to 25 anthropologists on five faculties. Her claim that "the research scientists studied individually...show precisely the differences (on the Rorschach) between fields that the subjects studies i n groups do" appears valid. In their Rorschach responses, anthropologists are most like psychologists and least l i k e biologists and physical scientists. However, i t was not possible to specify differences between d i f -ferent fields of anthropology, e.g., between archaeology, physical anthropology, and social or cultural anthropology....(Therefore) i f the  general characteristics of Roe's sample suggest  some adaptive potential for the role of ethnologist- stranger, we may be encouraged to undertake further 6 studies with, more refined samples to reach more firm conclusions. 1 0 (emphasis mine) From the perspective of this research report the criticisms I have regarding this movement of self-awareness, and the incorporation of that awareness into the body of the research report, i s that i t t e l l s us l i t t l e about the formal properties of ethnographies and i t is in no way clear that such concerns t e l l s us much about the social background and psychological characteristics of ethnographers, matters which are i n themselves of enormous complexity. To regard the ethno-grapher as inherently biased i s to give up the enterprise of ethnography. If the ethnographer is unintentionally but nevertheless biased, i t follows that accounts of his f i e l d experiences and the relationships he develops with his subjects in the f i e l d w i l l also be biased. Does the mere re-counting of one's personal feelings towards one's informants make the ethno-graphic description more objective? Further, are we to exempt psycholo-gists from this claim to bias? Can i t be said that biases of any kind are peculiar to those anthropologists whose province is ethnography? And are the psychologists who contrive these elaborate testing procedures necessarily exempt from this ailment such that they occupy a privileged position from which they may cast judgment upon ethnographers? I think not. Indeed, there are ways in which focussing attention on ethnographic bias and on the ethnographer's self-conscious awareness i s one way of not looking at the formal properties of ethnography. Since this dissertation i s directed towards an examination of the orginizational features of an ethnographic description, I have provided the reader with l i t t l e information about my relationships with members 7 of the C l i n i c , about my musings or re f l e c t i o n s or about "how i t i s that I f e l t " at this or that time during the course of my research. This does not mean, however, that I do not intend to address the issue of the relationship which obtains between the ethnographer, the research setting, and the members who are under study. Indeed, chapter four: "The Researcher and the Research Setting," i s con-cerned s p e c i f i c a l l y with these issues. However, the material which i s examined i n that chapter consists of f i e l d notes and audio tapes of interactions between myself and members of the research setting. Issues dealt within that chapter are: (1) participant and non-participant observation; (2) the relationship of the ethnographer's situated ethics i n the doing of f i e l d work; and (3) how the r o l e of the researcher can be taken as a resource f o r the discovery of the features of a setting. In contrast, the issues dealt within chapter four are sim i l a r to those mentioned by Nash and Wintrob, although the analysis of the data presented does not involve any attempt on my part to speculate about my feelings at the time of the production of the data, or about the personal relationships between myself and members of the research s e t t i n g . Although recollections and personal feelings are often incorporated i n my description of the C l i n i c (since such feelings and personal recollections are a constituent feature of many ethnographic descriptions) they are not a part of the analysis of that description. I wish to point out that I am engaged i n the study of the organizational features of the construction of an ethno-graphic description and not with what any i n d i v i d u a l ethnographer w i l l 8 say about his ethnography or his f i e l d work experiences. This dissertation i s concerned with the production of ethno-graphies, yet, up to this point, there has been no attempt to specify what an ethnography consists of. Then, too, while I have said that this report is something other than a conventional ethnographic description, to properly make this claim is to entitle the reader to an explanation of the difference between the two, and this under-taking necessarily involves a definition of what i s meant by the term ethnography. However, to provide a complete answer to this basic question i s i t s e l f a task of much more than a dissertation magaitude, for ro complete definition i s possible. In a few brief pages, then, I would like to try to explain some of the differences between this research report and more conventional ethnographic descriptions. It is hoped that the following explication w i l l satisfy some of the questions about the basic characteristics of an ethnography, although I realize that i t w i l l not provide the reader with a definitive or f i n a l answer. Tobbegin with, The Dictionary of Anthropology affords us with 11 the following definition of 'ethnography': Ethnography. The study of individual cultures. It i s primarily a descriptive and non-inter-pretive study.Il Compare this with Charles Frake's more elaborate formulation: Ethnography...is a discipline which seeks to account for the behavior of a people by describ-ing the socially acquired and shared knowledge, or culture, that enables members of the society to behave in ways deemed appropriate by their fellows. The discipline i s akin to linguistics; indeed, descriptive linguistics i s but a special case of ethnography since i t s domain of study, 9 speech messages, i s an integral part of a larger domain of socially interpretable acts and a r t i -facts. It i s this total domain of "messages" (including speech) that is the concern of the ethnographer. The ethnographer, l i k e the linguist, seeks to describe an i n f i n i t e sets of variable messages as manifestations of a f i n i t e shared code, the code being a set of rules for the socially appropriate construction and interpre-tation of messages.^ Does Frake's formulation resolve our questions about the basic char-acter of ethnographies? Is i t in any way clearer or better than the definition given by the dictionary? When would you use one and not the other? It i s apparent that for some persons and in some situations the f i r s t definition might well be more appropriate; i f , for example, someone who had l i t t l e interest i n the subject were to require a definition of the word. On the other hand, the second definition would be seen as more appropriate i n a discussion between fellow efibhugpologists or sociologists. While both equate ethnography with cultural description, the difference between them i s that Frake's formulation t e l l s us something about how such a description is to be accomplished. It is this feature of ethnographic description — the manner i n which that description i s to be produced — that occupies 13 a focal point of debate within anthropology. The precursors for modern ethnographies were the letters, diaries travel documents, etc. by laymen who had some contact with exotic societies. Today bona fide ethnographic descriptions are confined almost exclusively to the professional community. Thus, our standards for deciding what i t i s that constitute an ethnography changes over time. 10 Whereas the aim of ethnography i s the production of a recognizable c u l t u r a l description, the manner i n which t h i s aim i s achieved, and the s p e c i f i c character of the description produced, have been controversial issues for s o c i a l s c i e n t i s t s , and to say that an ethnography i s con-cerned with describing a culture and to leave i t at that, t e l l s us next to nothing since i t s goals and the methods or fundamental "how" of i t s production are themselves problematic features of that descrip-t i o n . While acknowledging that the scope and d e f i n i t i o n of ethnography has changed i n the past, i s undergoing further r e - d e f i n i t i o n i n the present (and w i l l undoubtedly change i n the future), Harold Conklin has proposed the following formulation of ethnographic concerns: An ethnographer i s an anthropologist who attempts — at least i n part of h i s professional work — to record and describe the c u l t u r a l l y s i g n i f i c a n t beha-vi o r s of a p a r t i c u l a r society. Ideally t h i s descrip-t i o n , an ethnogaahhy, requires a long period of intimate study and residence i n a small well-defined community, knowledge of the spoken language, and the employment of a wide range of observational techniques including prolonged face-to-face contacts with members of the l o c a l group, direct p a r t i c i p a t i o n i n some of that group's a c t i v i t i e s , and a greater emphasis on intens-ive work with informants than on the use of documen-tary or survey data.^ 4 This characterization seems to provide us with a standard from which we can point out certain s i m i l a r i t i e s and differences between the present research report and conventional, i . e . , current or standard ethnographic descriptions. Therefore, l e t us take Conklin's statement as a working d e f i n i t i o n . Since ethnography i s concerned with producing c u l t u r a l descrip-tions, i t should be incumbent on any ethnographer to give his readers 11 some idea about the relationship between the data he collects and the character of the description that he produces with and from that data. This i s not usually the case. However, my second chapter, "Issues in Producing an Analytical Description," takes this relationship between research data and the production of an analytical ethnographic description as i t s central concern. That i s , i t branches off from chapter one which contains a standard piece of ethnographic material describing a community c l i n i c . This description would, in standard ethnographies, stand as a preface to some subsequent, more detailed or particular analysis of some aspect or aspects of the cli n i c ' s organization. Chapter two considers some of the issues involved i n the production of such a description. It looks at some of the ways i n which a social researcher might approach the opportunities which access to the Clinic would afford him, and also examines the primary source of data for his analysis and the relationship that adheres between the data and the setting from which i t is collected. Thus, i t begins with an analysis of how a traditional medical sociologist might approach the setting i f given the opportunity to do so. It is suggested that a medical sociological perspective would not be concerned with producing a description of c l i n i c organization alone, but would also address i t s e l f to some preconceived research hypo-theses concerning topics and issues within the area of medical sociology. The Clin i c would constitute the locus from which to gather data about such things as status relationships between physicians and nurses, be-r tween niirsesiand orderlies, or staff and patients, etc. While this 12 approach i s not to be c r i t i c i z e d as worthless, I f e e l that i t can be faulted for f a i l i n g to respect what I have cal l e d "the i n t e g r i t y of the research setting." That i s , medical and other branches of sociology tend to approach settings with a b u t t e r f l y net of a p r i o r i categories f a c t s , figures and hypotheses i n which they w i l l catch the setting i t -s e l f . On the other hand, ethnographers who have been concerned with describing the strange, and often exotic features, seem to be more con-cerned with preserving the culture's " i n t e g r i t y . " Thus, as Tyler t e l l s us, "In a very r e a l sense, the anthropologist's problem i s to discover how other prople create order out of what appears to him to be utter c h a o s , a n d the solution to t h i s problem can be either "impose a pre-existing order on i t , or discover the order underlying i t " . " ^ Many ethnographers believe that ethnographic descriptions are fundamen-t a l l y concerned with the l a t t e r task and must therefore treat the c u l t u r a l scenes observed as having, i n and of themselves, a s o c i a l l y organized character available to empirical investigation and description. The c u l t u r a l world of the ethnographer i s s o c i a l l y constructed and maintained by and for i t s members. Ethnographic description recognizes and respects t h i s feature and attempts to explicate the order underlying the doings of the culture under study. This i s what I mean when I speak of ethnographies as something which respect the " i n t e g r i t y of the research s e t t i n g . " That i s , unlike the medical s o c i o l o g i s t , the ethnographer i s concerned with the members' explanations of the ways i n which c u l t u r a l scenes are constructed and maintained. The d i s c i p l i n e of ethnography has been subjected to much c r i t i c i s m 13 from concerned s o c i a l s c i e n t i s t s and chapter two addresses some of the p i t f a l l s of what may be regarded as the e a r l i e r or more t r a d i t i o n a l methods of analysis. The thrust of t h i s c r i t i c i s m i s that, while pur-porting to describe aspects of the organization of other cultures, t r a d i t i o n a l ethnographic analysis has approached these c u l t u r a l scenes with pre-established sets of theoretical interests that, as Tyler has shown us, impose a pre-existing order on them. Among anthropologists, a aew s t y l e of ethnography ( i . e . , cognitive anthropology) has attained currency. B r i e f l y stated, whereas the old ethnography was concerned with discovering anthropological universals and a general theory of culture, cognitive anthropology addresses i t s e l f to the ways i n which: ...the people of some other culture expect me to behave i f I were a member of t h e i r culture; and what are the rules of appropriate behavior i n t h e i r culture? Answers to these questions are provided by an adequate description of the rules used by the people i n that culture. Consequently, th i s description i t s e l f constitutes the "theory" for that culture, for i t represents the conceptual model of organization used by i t s members. Such a theory i s validated by our a b i l i t y to predict how these people would expect us to behave i f we were members of their c u l t u r e . I 7 Basic to t h i s ethnographic model i s a change i n the anthropologists' t r a d i t i o n a l concept of 'culture'. The e a r l i e r anthropological position has been stated sucfdfactly by Tyler: Previous theoretical orientations i n anthropology can i n a very general way be classed into two types — those concerned primarily with change and development and those concerned with s t a t i c de-s c r i p t i o n s . Thus, the evolutionists and the d i f -fu s i o n i s t s concentrated on patterns of change, 14 while the fu n c t i o n a l i s t s eschewed this work as mere "speculative h i s t o r y , " and focussed on the in t e r n a l organization and comparison of systems, hoping there-by to discover general laws of society.... These formulations were attempts to construct uni-v e r s a l organizational types which were linked either by similar processes of change or by s i m i l a r i t i e s of in t e r n a l structure. In order to achieve t h i s goal, only certain kinds of information were accepted as relevant, and concrete ethnographic data had to be elevated to more abstract forms such as index variables and typological constructs The new ethnography, on the other hand, operates on the assumption that to describe another culture i s to describe what i t i s that one would need to know i n order to be regarded as a competent c u l t u r a l 19 member of that culture. The parameters of this task have been formulated by Charles Frake as follows: F i r s t , i t i s not, I think, the ethnographers' task to predict behavior per se, but rather to state rules of c u l t u r a l l y appropriate behavior. In this respect the ethnographer i s again akin to the l i n g u i s t who does not attempt to predict what people w i l l say but to state rules for constructing utterances which native speakers w i l l judge as grammatically appropriate. The model of an ethnographic statement i s not: " i f a person i s confronted with stimulus X, he w i l l do Y," but: " i f a person i s i n s i t u a t i o n X, perform= ance Y w i l l be judged appropriate by native actors." The second difference i s that the ethno-grapher seeks to discover, not prescribe, the s i g -n i f i c a n t s t i m u l i i n the subjects' world. He at-tempts to describe each act i n terms of the c u l t u r a l situations which appropriately evoke i t and each s i t u a t i o n i n terms of the acts i t appro-p r i a t e l y evokes. 2 u Thus, th i s perspective conceives of a culture as a set of rules fpr ap-propriate behaviour which bona f i d e members of that culture u t i l i z e i n order to conduct (and to be seen as conducting) themselves i n recognizably 15 appropriate ways. These rules have a demonstrably consequential character, for i t i s by attending to them that members are able to 21 produce the organized character of thei r world. In th i s sense, the new notion of culture i s related to Garfinkel's concept of competence. He states that: I use the term "competence" to mean the claim that a c o l l e c t i v i t y member i s e n t i t l e d to ex-ercise that he i s capable of managing his everyday a f f a i r s without i n t e r f e r e n c e . 2 2 The new ethnography i s an eminently p r a c t i c a l enterprise. I t attempts to provide a description of a culture that could be used by a c u l t u r a l stranger i n such a way that the stranger could, i f he so wished, conduct himself i n a manner which members of the culture described would deem appropriate for that culture. That i s , the reader would be able to act appropriately and, through his actual, on-going performance, display and maintain what Garfinkel has call e d his c u l t u r a l competence. The material discussed i n chapter two of this report provides certain c r i t i c i s m s of th i s new approach to ethnographic description, p a r t i c u l a r l y to the programme that i t seeks to accomplish. At the same time, i n attempting to provide an a n a l y t i c a l description of some aspect of the s o c i a l organization of the C l i n i c , t h i s d i s s e r t a t i o n adopts the position that such a description should be responsive to those s e l f -organizing features of the research setting which i t i s studying. Therefore, an ethnographer should not attempt to impose some pre-ex-i s t i n g framework on that which he describes. These issues are discussed i n chapter two, then, a more detailed 16 description of a c l i n i c a l routine known as chart rounds ( i . e . , a d a i l y review of patients medical records) i s presented. This constitutes an appropriate topic f u l f i l l i n g the requirements that the preliminary description of the C l i n i c i n chapter one provides f o r . I decided to describe chart rounds since i t i s a normal, routine feature of the organization of the C l i n i c ; a feature which members of the setting take for granted as a constituent feature of th e i r d a i l y roles as physicians, nurses, medical students, patients and the rest. Pragmatically, the occasion of chart rounds was selected because my research at the C l i n i c made i t possible for me to acquire an extensive corpus of notes and tapes of the interaction occurring i n these medical sessions. Thus, I was able to make transcribed records of actual chart rounds. Aside from the a v a i l a b i l i t y of audio recordings, i t was selected because i t i s an occasion which has as i t s underlying rationale, the generation of ta l k about p a r t i c u l a r patients and related medical matters. Then, i n my t h i r d chapter "Charts Rounds: An Interactional Analysis," I s h a l l attempt to describe t h i s occasion by attending to the t a l k which occurs between participants as data from which to d i s -cover the self-organizing features of chart rounds. Here, I s h a l l adopt 23 an ethnomethodological orientation. While i t i s not my intention to examine the major tenets of ethnomethodology, I would l i k e to offer some comments concerning the general characteristics of the analysis that w i l l be presented i n th i s chapter. As I have already noted, I had no s p e c i f i c topic of inquiry, 17 research proposal or hypothesis when I f i r s t began this dissertation. Instead, the material contained in this report, that i s , the direction that i t takes and the topics that i t addresses were "discovered" or flow from the production of the paper i t s e l f . Hence, i t s "non-standard" format. While the accepted ways for doing an ethnography may have many advantages, they may also have inherent disadvantages. Consider the fact that ethnographic researchers often provide research proposals regarding the scope, character, and objective of their research. If the main purpose of ethnographic descriptions i s to discover how some "other" culture i s organized, i t seems odd to speak of objectives other than describing the underlying organizational rules of that culture. I would l i k e to suggest that to have any other ob-jective, e.g., to have predetermined ideas about what you w i l l find and how you w i l l find i t i s to loose sight of what may actually be there awaiting discovery.^ While Conklin describes an ethnographer as "an anthropologist working in a foreign culture", as a sociologist attempting to describe his own culture, I do not encounter some of the obstacles that are characteristically faced by anthropologlstss ((puch as learning a foreign language). My problems are of a different nature. For instance, I am confronted with the fact that my research subjects often know that I am a sociologist and "know" what i t is that sociologists do. Thus, I must deal with the relationship between my own aims and those imputed to me by members of the research setting. (This feature was operative throughout my stay with the Cl i n i c . It i s given special attention in 18 chapter four.) Thus, being a member of the society which I am interested in describing is both an asset and a l i a b i l i t y . Turner has stated the relationship between sociological topics and one's own cultural knowledge of those topics in the following manner: It i s increasingly recognized as an issue for sociology that the equipment that enables the "ordinary" member of society to make his daily way through the world i s the equipment available f n r for those who would wish to do a "science" of that world. This might be formulated as the socio-logists "dilemma," but only so long as a notion of science is employed that f a i l s to recognize the socially organized character of any enterprise, including the enterprise of doing science.25 This dissertation, then, i s an attempt to u t i l i z e my own cultural equipment to provide an ethnographic description of a routine occasion within the Clinic. Throughout this report I intend to demonstrate the relationship between the production of an ethnographic description and that description's dependence on common-sense cultural knowledge for i t to obtain an accredited status as an "adequate" ethnographic description. I find i t d i f f i c u l t to state this point more succinctly and, therefore, wish to inform the reader that i t constitutes a major point of research interest in this document. Like anthropological ethnographers, I am concerned with l i n -guistic events that are a part of those cultural scenes that I am at-tempting to describe. Unlike such ethnographers, however, I am neither conducting formal interviews with my subjects, nor engaged in 26 formal e l i c i t i n g techniques aimed at taxonomic construction. Instead, my chief source of data is those naturally occurring instances of interaction themselves. Much of the integrity of the interaction i s 19 preserved i n audio tapes. The forthcoming analysis of chart rounds i n chapter three i s an attempt to describe them through an examination of transcribed tape recordings. By attending to t a l k as a naturally occurring phenomenon, I am suggesting that i t i s possible to attend to the self-organizing features of c u l t u r a l organization. To quote Turner again: A science of society that f a i l s to treat speech as both topic and resource i s doomed to f a i l u r e . And yet, although speech informs the d a i l y world and i s the sociologist's basic resource, i t s properties continue to go almost unexamined....If we take sociology to be, i n e f f e c t , "a natural history of the s o c i a l world," then sociologists are committed to a study of the a c t i v i t i e s such a world provides f o r f o r and of the methodical achievement of those a c t i v i t i e s by so c i a l i z e d members.27 While the findings offered i n th i s paper do not purport to describe the occasion of chart rounds i n ways that w i l l allow the reader to act as a competent member of the C l i n i c (and thereby d i f f e r from the descriptive goal of the cognitive anthropologist), the description offered does try to (1) respect the i n t e g r i t y of the setting by attending to actual l i n g u i s t i c events, and (2) be re-sponsive to the self-organization of the l i n g u i s t i c data under consideration. Admittedly, the findings presented i n this paper raise complicated issues for the study of s o c i a l settings. These w i l l be addressed i n forthcoming sections of th i s report. At t h i s time, I wish only to give the reader some indication of what I meant when I referred to my findings as exploratory and tentative. The analysis of chart rounds presented i n chapter three i s an 20 analysis conducted under the auspices of an ethnomethodological orien-tation. It is not my concern to address the question "What is ethnometho-dology?" I would, however, like to offer some comments about what i t i s that I mean when I refer to an "ethnomethodological orientation." Then, I would like to discuss certain methodological considerations about the primary source of data for this analysis of chart rounds, i.e., conversa-tional transcripts taken from tape recordings done during chart rounds. An ethnomethodological orientation does not mean that the researcher operates with some prefabricated theory of society. Rather, a l l social organization i s seen as members' accomplishments. And a l l "investiga-tions" are directed towards discovering how i t is that social order is possible i n the f i r s t place. More precisely, findings about members' methods of social organization can be achieved only by confronting data i t s e l f , and can not be generated from any substantive body of theory, hypotheses, or research design which simply assumes this order-as-given and summarily dismisses i t . Such procedures do not lend themselves to the learning of a set of technical s k i l l s such as survey or interview techniques, or experimental designs; that i s , specific s k i l l s wherein the researcher acquires the "how to do i t " of the enterprise. Members' methods are available for investigation, but such investigation i s not dependent on the acquisition of a body of methodological techniques. Thus 28 i t i s apparent that ethnomethodology i s not a method. To present an analysis of chart rounds under the auspices of an ethnomethodological orientation as i t i s , i s to adhere to Harold Gar-finkel 's recommendation that: In exactly the ways that a setting i s organized, i t 21 consists of members' methods for making evident that setting's ways as clear, coherent, p l a n f u l , consistent, chosen, knowable, uniform, repro-duceable connections, i . e . , r a t i o n a l connections. In exactly the way that persons are members to organized a f f a i r s , they are engaged i n serious and p r a c t i c a l work of detecting, demonstrating, and persuading through displays i n the ordinary occasions of the i r interactions the appearance of consistent, coherent, clear, chosen, plan f u l ar-rangement. In exactly the ways i n which a setting i s organized, i t consists of methods whereby i t s members are provided with accounts of the setting as countable, storyable, proverbial, comparable, picturable, r e p r e s e n t a b l e — i . e . , accountable events?9 Any data u t i l i z e d for such a study must be a constituent feature of some organization. The data must be produced and used by the setting's members of that setting during the course of t h e i r everyday a f f a i r s . Furthermore, i f we are to study members' everyday a f f a i r s and a c t i v i t i e s , then we must also examine data that are produced as part of and r e f l e c t back upon these a f f a i r s and a c t i v i t i e s . I f we are to properly study and describe s o c i a l l i f e , we must be able to attend to the d e t a i l s of events that have actually happened. We should be able to do this i n an abstract way, but, nevertheless, such a description should be r e -sponsive to the actual d e t a i l s of the events that they purport to describe. Thus, some s o c i a l s c i e n t i s t s have elected to focus t h e i r attention upon members' t a l k as a decidedly natural occurrence i n se-quences of int e r a c t i o n , developing i n and over the course of various settings and occasions. Chapter three i s one such instance of such an analysis. S p e c i f i c a l l y , then, I w i l l be treating productions of t a l k as one of the fundamental ways i n which members achieve and 22 display in, and through the occasion of their interactions, the con-sistent, coherent, clear, chosen, and planned arrangements, i.e., that fundamental foundation for any type of social order. That members' talk can be subjected to rigorous sociological 30 analysis is demonstrated in the recent works of Harvey Sacks and 31 other "conversational analysts". A c l a r i f i c a t i o n and j u s t i f i c a t i o n of the methodological foundations for conversational analysis goes well beyond the scope and intent of this research report. My reason for not addressing these issues i s not simply that to do so would require more space and time than current concerns warrant. Rather, i t i s based on a feature of the present literature concerned with conversational analysis. This literature does not provide the reader with methodological statements about i t s foundations, and, since such statements have not been made, I am unable to present a summary of them. However, since I intend to present an analysis of conversational material in chapter three, I feel that i t is uncumbent on me to present an analysis of the methodological issues raised i n that chapter. Thereby, I could attempt to relate the work of conversational analysts to various developments i n linquistics and li n g u i s t i c philosophy. It i s sometimes proposed, for example, that work on theories of meaning must be absolutely fundamental to work in con-versational analysis. This would seem to suggest that an appro-priate procedure would be to attempt to explicate the connections 32 between the philosophical literature and theories of meaning and 23 conversational analysis. The point, however, i s that these con-nections would be a r t i f i c i a l , and might have no necessary con-nection to the type of analysis presented i n chapter three. Let me give an example. In philosophy there i s debate about "meaning" and the manner in which the concept operates i n language use. The philosopher H.P. Grice has proposed a formulation of "meaning" in terms of the subjective intentions of individual speakers,33 while John Searle has offered us an opposing view in which meaning i s seen as dependent on speakers attending to the proper conventions of a language rather than to subjective intentions of individual speakers. It would be possible to engage in a lengthy and elabo-rate discussion of these philosophical "theories of meaning" since, commonsensically, i t would appear that such a discussion i s relevant to the present analysis of conversational materials. However, this is not the case. While I could compare and contrast these arguments, I know of no way of tying them to the analysis of the conversa-tional materials presented i n my own account of chart rounds. Furthermore, my analysis of chart rounds was generated inde-pendently of these "theories of meaning". It does not seem to be the case that, in daily l i f e , we need to refer to theories of meaning in order to understand each other's utterances nor does i t appear useful for me at this point to provide the reader with an explication such as Grice's theory of meaning for I see no way of tying that theory to the analyses i n chapter three. What, then, 24 is the alternative? The analysis of conversation presented in chapter three i s my attempt to treat an instance of chart rounds as a source of data from which to explicate some of the organizational features of this occasion. Thereby, I attend to the talk that occurs during the oc-casion of chart rounds. In connection with this, the reader is directed to the detailed utterance-by-utterance analysis i n chapter three and is invited to offer alternative analyses i f those which are offered there seem incorrect. While this may seem totally asci-e n t i f i c , i t i s the nature of the data that makes the analysis take this character. Roy Turner has made this point when discussing how the analysis of conversational materials i s responsive only to the materials upon which that analysis i s conducted: I stress not only that i t is to the participants that my analysis must be tied, but also the fact that we are dealing with a possible interpretive schema. The significance of this i s two-fold. In the f i r s t place, the analysis I am offering is not intended to provide a definitive, once-and-for-always reading of the utterance sequence under examination. Nevertheless, I don't mean to suggest, by offering this observation, that the analysis i s tentative i n the sense that with the application of more time and energy i t might become definitive. What is intended, i s that for the participants themselves determinate readings depend upon the application of inter-pretive schemas. Such schemas warrant the i n -t e l l i g i b i l i t y and propriety of the hearing of an utterance: there i s , of course, no further warrant. Thus, the conversational analyst may argue well or badly, may be right or wrong i n finding one piece of analysis to be entailed by another; but he cannot provide a " s c i e n t i f i c " warrant for his claim which i s stronger than the warrant -members employ as conversationalists. And this is not an admission of the primitive state of the art, but a characterization of the enter-prise and of the c r i t e r i a of adequacy which control i t , given the materials to which i t i s ultimately responsive.3^ And now I shall turn to my i n i t i a l characterization of the setting. 26 Foo tno tes: Introduction 1. This does not mean that I was unable to produce a formal research proposal. Indeed, during the course of my f i e l d work at the Com-munity Clinic the director of the c l i n i c required that I produce such a document. The point i s , however, that that research document was i t s e l f produced for practical purposes and should not be regarded as being indicative of "guiding" the character of this work. Rather i t was produced to satisfy the director's request for a research proposal and thereby satisfy one of the organiza-tional constraints placed upon me by the director. A copy of this research proposal i s presented later. 2. Gerald D. Berreman, "Anemic and Emetic Analyses i n Social Anthropology", American Anthropologist, (Vol. 68, 1966), p. 348. 3. Dennison Nash and Ronald Wintrob, "The Emergence of Self-Conscious-ness in Ethnography", Current Anthropology, (Vol. 13, No. 5, December 1972), p. 529. 4. See, for example, Dennison Nash, "The Ethnologist as Stranger", Southwestern Journal of Anthropology, (Vol. 19, 1963), p. 158 as well as Bob Scholte's discussion of the ideology of value-free social science in his a r t i c l e "Toward a Reflexive and C r i t i c a l Anthropology" in Dell Hymes, Ed., Re-inventing Anthropology, (New York: Pantheon Books, 1972), pp. 432-438. 5. Nash and Wintrob, op. c i t . 6. Ibid. 7. Robert Jay, "Personal and Extrapersonal Vision in Anthropology", in Dell Hymes, Ed., Re-inventing Anthropology, (New York: Pantheon Books, 1972), pp. 367-381. 8. Ibid., p. 375. 9. Ann Roe, "A Psychological Study of Eminent Psychologists and An-thropologists, and a Comparison with Biological and Physical Sci-entists", Psychological Monographs, (Vol. 67, 1952), pp. 1-55, and "Analysis of Group Rorschachs of Psychologists and Anthropologists", Journal of Projective Techniques (Vol. 15, 1952), pp. 211-224. 10. Nash, op. c i t . , p. 160. 11. Charles Winick, The Dictionary of Anthropology, (New York: Philosophical Library, 1956), p. 193. 27 12. Charles Frake, "Notes on Queries i n Ethnography" i n Stephen Tyler, Ed., Cognitive Anthropology, (New York: Holt Rinehart and Winston, 1969), p. 123. 13. An excellent reader i n th i s regard i s Stephen Tyler, Ed., Cognitive Anthropology, (New York: Holt Rinehart and Winston, 1969). I t addresses, i n a c r i t i c a l fashion much of the con-temporary debate between new developments i n ethnographic analysis and the more " t r a d i t i o n a l " ethnography of an e a r l i e r anthropology. 14. For a general discussion of ethnography and a comprehensive bibliography see Harold Conklin, "Ethnography" i n David S i l s , Ed., International Encyclopedia of the Social Sciences Vol. 5, (New York: Holt Rinehart and Winston, 1968), pp. 172-178. 15. Stephen Tyler, "Introduction", Cognitive Anthropology,(New York: Holt Rinehart and Winston, 1969), p. 6. 16. I b i d . , p. 11. 17. Tyler, "Introduction", Cognitive Anthropology, p. 5. 18. I b i d . , p. 2. 19. The methods used i n order to obtain this goal include the construction of taxonomies, lexicographical systems,formal i n t e r -view and e l i c i t i n g techniques, discourse analysis, and ethno-semantics to name but a few. See Tyler, Cognitive Anthropology for a detailed representation of these methodological positions. 20. Charles Frake, "Notes on Queries i n Ethnography" i n Stephen Tyler, Ed., Cognitive Anthropology, p. 124. 21. Harold Garfinkel's "A Conception of and Experiments with "Trust" as a Condition of Stable Concerted Actions", i n O.J. Harvey, Ed., Motivation and Social Interaction, (New York: Ronald Press, 1963), pp. 187-238, i l l u s t r a t e s how members attend to and demonstrate their attention to a mass of background expectancies which order their actions. 22. Harold Garfinkel, Studies i n Ethnomethodology, (Englewood C l i f f s , N.J.: Prentice-Hall, 1967), p. 57. 23. Harold Garfinkel's Studies i n Ethnomethodology, (Englewood C l i f f s , N.J.: Prentice-Hall, Inc., 1967) can be regarded as the primary source for those who are doing or who wish to know about ethno-methodology. Other suggested references are Thomas P. Wilson's "Normative and Interpretive Paradigms i n Sociology" i n Jack. D. 28 Douglas, Ed., Utidefstanding Everyday L i f e (Chicago: Aldine Publishing Co., 1970), pp. 80-103. These i l l u s t r a t e some of the differences between what I have cal l e d an "ethnomethodological orientation" and standard ways of approaching s o c i a l phenomena. Roy Turner's, Ed., Ethnomethodology, (London: Penguin Books, 1974) furnishes us with an example of the wide v a r i e t y of research that i s now being conducted under the name of ethnomethodology. I would l i k e to point out, here, that ethnomethodological studies are, at present, viewed with some disdain by many of the "standard brand" methodologists. And, whereas stigmatized d i s -c i p l i n e s are often c a l l e d upon to defend t h e i r p o s i t i o n , i t may we l l be the case that t h e i r status r e f l e c t s fashions and trends i n u n i v e r s i t i e s , i n publishing companies, i n public taste, etc., rather than any actual q u a l i t i e s they may have. 24. Even Berreman, for example, adopts such a research perspective when he states i n his a r t i c l e " Social Categories and Social Inter-action i n Urban India", American Anthropologist, (Vol. 74, 1972), p. 567 that: The research was undertaken from a "symbolic i n t e r -a c t i o n i s t " perspective, using detailed observation and inquiry regarding what people do i n face-to-face in t e r a c t i o n , to discover how they choose among alternative behaviours i n terms of the meanings of sp e c i f i c a t t r i b u t es, actions, and s o c i a l situations have for them and for those with whom they inte r a c t . 25. Roy Turner, "Words, Utterances and A c t i v i t i e s " i n Jack Douglas, Ed., Understanding Everyday L i f e , (Chicago: Aldine Publishing Co., 1970), p. 169. 26. See footnote 19. 27. Turner, op. c i t . 28. Richard J . H i l l and Kathleen Stones Crittenden, Eds., Proceedings  of the Purdue Symposium on Ethnomethodology, (Department of Sociology, Purdue'University: I n s t i t u t e f o r the Study of Social Change, 1968). This monograph contains a series of edited trans-c r i p t s between Harold Garfinkel and other s o c i o l o g i s t s i n which the issue of whether ethnomethodology i s a "method" or a major topic of discussion. 29. Harold Garfinkel, Studies i n Ethnomethodology, p. 34. 30. Throughout t h i s report I have been influenced by the writings of Harvey Sacks and I would l i k e to take this opportunity to ac-knowledge the insight I have obtained through encountering his work. 29 31. Until recently much of the research in the area of conversational analysis was only available through the private circulation of unpublished papers. This situation i s now changing. Two excel-lent readers that contain a representation of the works of many conversational analysts are David Sudnow, Ed., Studies i n Social  Interaction, (New York: The Tree Press, 1972), and Roy Turner, Ed., Ethnomethodology, (London: Penguin Books, 1974). 32. The philosophical literature dealing with this issue is vast. I can do no more here than to offer specific references that deal directly with this issue of "meaning" and which also supply the reader with a multitude of references. J.L. Austin, Philosophical  Papers, (London: Oxford University Press, 1970), L. Jonathan Cohen, The Diversity of Meaning, (London: Menthuen and Co.,1966), Harold Morrick, Ed., Wittgenstein and the Problem of Other Minds, (New York: McGraw-Hill, 1967), George Pitcher, Ed., Wittgenstein: The Philosophical Investigations, (London: MacMillan, 1968), John Searle, Speech Acts: An Essay in the Philosophy of Language, (London: Cambridge University Press, 1970), Ludwig Wittgenstein, Philosophical Investigations, (Oxford: Basil Blackwell, 1963), and Paul Z i f f , Semantic Analysis, (New York: Cornell University Press, 1964). 33. H.P. Grice, "Meaning", Philosophical Review, 1957. 34. John Searle, "What i s a Speech Act", i n Max Black, Ed., Philosophy  in America, (New York: MacMillan, 1969), pp. 221-239. 35. Roy Turner, private correspondence, 1973. 30 CHAPTER I BEGINNING AN ETHNOGRAPHIC REPORT The I n i t i a l Description  The Setting The i n i t i a l overtures for this paper came from my thesis super-visor. A colleague had informed him of an attempt to establish a series of community medical c l i n i c s i n Vancouver. He suggested that i t might be possible for me to obtain a position in one of these c l i n i c s since many of the doctors attached to the project seemed amiable to the goals and values of sociology and might allow me to study the project. While I had had no previous training i n medical sociology, the opportunity to do an ethnography i n such a setting seemed too good to miss.^ Before discussing the procedures I used to gain access to the setting, I would like to provide a description of the Clinic and i t s surroundings. It i s located i n a predominantly lower class area i n the eastern end of the city. The neighbourhood i s predominantly Italian but has a large Chinese population and a number of other, smaller, ethnic groups. The Clinic i s located on a busy street lined with clothing shops, record shops, pool halls and an array of ethnic restaurants and groceterias. The Clinic i t s e l f i s housed i n what was once a business office, but has been renovated to meet the needs of medical practititioners. What were i n i t i a l l y secretarial offices were converted into examination 31 rooms. A small laboratory, a reception area and three small offices were constructed in the rear of the building. During the course of this research, however, the Clinic expanded i t s f a c i l i t i e s by ac-quiring an adjacent building which has been renovated to accommodate a dental c l i n i c . Yet, from the outside, i t i s an inconspicuous building; one without many of the characteristics typically associated with medical buildings. Although the name of the Clinic appears on the door and on the window of the waiting room as well, and a closer inspection w i l l show a l i s t of those physicians who operate the Clinic, i t i s quite possible to walk or drive past the building without realizing that i t is a medical c l i n i c . Although i t is a community-medical f a c i l i t y , the Clinic does not provide in-patients care, i.e., i t has neither a resident patient population nor a specialist f a c i l i t y such as an eye, ear, nose and throat c l i n i c . Therefore, i t does not have restrictive medical practices but provides the type of medical care one would normally associate with a private medical practice. However, this similarity to ordinary medical practice requires some essential c l a r i f i c a t i o n . While the patients at the Clinic are, as a matter of routine, assigned to one, and only one physician, they are also thought of as patients of the Clinics as a whole and may thus, as a matter of course, be treated by a physician other than their "own" (regular) physician. While continuity of patient care is viewed (here, as else-where,) as desirable, contingencies peculiar to the Centre may mean 32 that a patient's regular physician can not attend to him. When this happens the patient i s seen by another C l i n i c physician. Note however, that patients are informed of this practice. The o r i g i n a l s t a f f consisted of four f u l l - t i m e physicians, one public health nurse, a laboratory technician, a volunteer community worker, and three secretaries. Later, related medical professionals such as a n u t r i t i o n i s t and dental hygienists were added to the s t a f f . In addition, since the C l i n i c has some support from the Faculty of Medicine at the University of B r i t i s h Columbia, fourth-year medical clerks (students) may elect to spend two weeks train i n g at the C l i n i c i n order to gain experience i n the " r e a l world" of the medical o f f i c e . In addition to a f u l l - t i m e s t a f f and medical students who work on a part-time basis, the C l i n i c has a group of family physicians who donate their services on a part-time basis. O r i g i n a l l y , physicians who maintained their own practice and worked only part-time had a roster of patients at the C l i n i c who they saw on a scheduled basis. However, this procedure was changed to allow them more time for d i s -cussion with the medical students. While the s t a f f does not view the organization as aelilwglfare" or charity c l i n i c , there i s a substantial proportion of i t s patient population who i s , for economic or s o c i a l reasons, unable to receive conventional private medical care. One physician characterized the patient population as "...the type of persons that a regular doctor would not want to drop into his o f f i c e . Theysiscare other patients, cause trouble, and require bureaucratic red tape." Thus, the 33 clientele of the Clinic is labelled as somehow different from that of "conventional'' office practice. The Clini c sees i t s e l f as an alter-native to the traditional mode of treatment offered in the out-patient centres of the local hospitals. Those patients who could be seen by the staff as financially and socially acceptable to conventional physicians, yet preferred to use the f a c i l i t i e s of the Clinic, were seen as expressing a "preference" for the type of care offered at the Clinic. In addition to i t s regular operations, the Clinic also runs a Night Drop in Clinic for youths. This Night Clinic i s typical of the pattern followed by many of the youth-oriented Clinics that have recently sprung up in many metropolitan areas. The Youth Night Clinic 2 advertises i n one of the local underground newspapers and, as is expectable, much of the patient population on such nights consists of youths from the community regularly serviced by the Clinic and of transients who have come to Vancouver and are in need of medical attention or advice. A l l share some common and recurrent problems. Many youths want general information on contraception or request birth control p i l l s or abortions. Other common problems include amenorrhea (overdue menstrual periods), vaginal discharge, venereal disease, skin problems, and nutritional problems arising from a vegetarian diet or improper nutritional habits. Absent from this l i s t are drug-related complaints for the Vancouver area has many neighbourhood clinics that specialize i n such problems, and the majority of patients suffering from such problems u t i l i z e those 34 f a c i l i t i e s rather than the services of the C l i n i c . Indeed, the s t a f f of the C l i n i c does not want the place to be characterized as a "drug" c l i n i c , and those who telephone the C l i n i c about drug-related problems are r e f e r r e d to another treatment f a c i l i t y . This does not mean that a patient who comes to the Youth Night C l i n i c with a drug problem w i l l be refused, treatment, but thatethe c l i n i c w i l l not go out of i t s way to acquire a drug-using patient population. Here i s a quote from t h e i r "Student Handbook, Community Youth Night Program, September 1971". I t furnishes us with an i n t e r e s t i n g s e l f - d e s c r i p t i o n : I PHILOSOPHY AND HISTORY An often unrecognized medically under-privileged, neglected and alienated group i s the "youth" of our society. Medical groups have been organized i n the past to provide temporary emergency medical care during rock f e s t i v a l s and student demonstra-tions, but many of these groups were as transient as t h e i r patients. In September of 1970 the Community C l i n i c and the Interprofessional Educa-t i o n of developed an "adolescent c l i n i c " to reach and provide medical care to the youth community of Vancouver. The Community C l i n i c , under the d i r e c t i o n of Dr. iBobkAllenl Jones, donated the p h y s i c a l , pharmaceutical and laboratory f a c i l i t i e s and encouraged the volunteer help of physicians and d e n t i s t s , while the PPE group, under Dr. L. P i t k i n ' s auspices, arranged the volunteer m u l t i d i s c i p l i n a r y help of medical,. nursing and s o c i a l work students. The objectives of the "adolescent c l i n i c " were to d e l i v e r high q u a l i t y care to a young popula-t i o n between the ages of 13 to 25 years, to educate the adolescent i n preventive (contra-ceptive) medicine, and to provide a learning s i t u a t i o n i n which students could experience i n t e r -p r o f e s s i o n a l cooperation. 35 II INTERPROFESSIONAL EDUCATION 1. I t i s our b e l i e f that only an i n t e r p r o f e s s i o n a l team can provide comprehensive care. 2. The Thursday night program o f f e r s the student an opportunity to observe the ro l e s of d i f -ferent professionals and u t i l i z e t h e i r s p e c i a l i z e d s k i l l s when appropriate. Nursing, n u t r i t i o n , r e h a b i l i t a t i o n , dental and medical students w i l l s t a f f the c l i n i c each week. The Youth Night C l i n i c i s much d i f f e r e n t from day-time o f f i c e p r a c t i c e . A t y p i c a l evening c l i n i c begins around 7:30, and at or around t t e t time one may often f i n d a group.of both patients and medical students congregating i n front of the main entrance — a l l awaiting one of the physicians who has a key. Indeed, I often found i t d i f f i c u l t to d i s t i n g u i s h medical and nursing students from the actual patient popu-l a t i o n since both groups were of the same age. Thus I had to r e l y heavily on cues such as manner of dress and grooming to provide an i n -d i c a t i o n of t h e i r " r e a l " s o c i a l i d e n t i t i e s . I t i s i n t e r e s t i n g that some of the medical students were also confronted with t h i s problem and i t s p o s s i b l e consequences and brought t h e i r stethoscopes so that i t was sometimes possible to locate "students" by searching f o r the stethoscope hanging out of t h e i r pocket. Eventually, 1 was able to i d e n t i f y many of the students on sight,. However, since the students on duty d i f f e r e d from week to week.„identification was always a p o t e n t i a l / problem. My f i r s t encounter with the Research s e t t i n g was with the Youth Night C l i n i c . The following f i e l d note r e c a l l s my f i r s t im-pressions of the C l i n i c and i l l u s t r a t e s the problem of s t a f f 3 i d e n t i f i c a t i o n ; 36 October 13, 1971 — accompanied by and Dr. Turner. R e l a t i v e l y free and easy at-mosphere with a noticeable absence of what I ' l l c a l l "recognizable apparel', that i s , doctor's uniforms. Staff wear name tags. Staff composed not only of doctors, but also nurses, n u t r i t i o n i s t s , rehab, medicine, etc. Name tags consist of name + medical category. One person was wearing a tag that said "Isabel Nurse" where I take i t that her l a s t name was not 'Nurse'. To say that s t a f f recognition i s problematic point to joke that occurred. Since s t a f f i s voluntary and often changes from week to week there is/can always be a new set of personnel. Consequently determining who these new people are can be i n -ter e s t i n g f o r the s t a f f already present. Dr. Turner and were asked the question " I f anybody here was a doctor". They were seen as p o t e n t i a l candidates f o r that s l o t given t h e i r age and the fac t that we were on the in s i d e ( i n the lunch room/lounge area) rather than i n the waiting room. I was treated as a student. 3 As I was to f i n d out l a t e r , the organization of the s t a f f and provisions f o r the care of patients i s d i f f e r e n t on youth night than during day-time p r a c t i c e . For instance, the regular s e c r e t a r i a l s t a f f i s replaced by volunteer help from the community. The two following t r a n s c r i p t i o n s may give the sense of what i s meant by "a r e l a t i v e l y free and easy atmosphere." The f i r s t involves a medical student and the C l i n i c ' s r e c e p t i o n i s t , and the second a patient and the r e c e p t i o n i s t : #1. CLINIC RECEPTIONIST AND MEDICAL STUDENT: 1. Receptionist: Hi 2. Medical student: Hi,- I am a second-year medical student thought I'd come by tonight spend some time here i f I can 3. Receptionist: Yes 37 Researcher: 5. Medical student: 8. 9. 10. 11. Receptionist: Medical student: Receptionist: Researcher: Receptionist: Medical student: 12. Receptionist: Sure (Note: I was helping at the reception desk on t h i s occasion and my tape recorder was placed i n view near the top of the r e c e p t i o n i s t ' s desk.) Look around f o r awhile, some of my classmates have been by and said i t was worth coming down Good, we've been very busy but we're j u s t sort of ( s i t t i n g ) getting our second wind. Get your second wind eh - so so should I j u s t f l o a t around or Yes Might put you to work Yes might put you to work Can't stay too long have to go home and do some work (laughs) Good ( ) and you know I'm sure y o u ' l l f i n d youirwayay around i t i s n ' t too complicated that y o u ' l l get l o s t . #2. CLINIC RECEPTIONIST AND PATIENT 1. Receptionist: 2. Patient: 3. Receptionist: Have you beerithere before? (Note: There i s much noise around the reception desk due to patients queueing to see the r e c e p t i o n i s t ) I was suppose to have an ap-pointment on Monday but I'm going away so I c a l l e d i n today and they/.said to come i n tonight. That's f i n e , ah but the doctor won't see you t i l l I've made t h i s out (a patient's intake form). You've never been before 38 4. Patient: 5. Receptionist: 6. Patient: 7. Receptionist: 8. Patient: 9. Receptionist: 10. Patient: 11. Receptionist: 12. Patient: 13. Receptionist: 14. Patient: 15. Receptionist':': 16. Patient: 17. Receptionist: 18. Patient: Yes I've been here before, my doctor was Doctor M i l l e r but he's on holiday so they said I ' l l be seeing Doctor Jones I see, so what's your name? Joan Smith Smithnt (the receptionist looks at the f i l e s to f i n d the patient's name and cor-responding chart number) two seven two nine (pause) You ah ah are you a vegetarian? Umm? Ah I jus t wondered because ah we have someone here who i s interested i n ah taking s t a t i s t i c s umm Just about though Umm? Just about though Umm, just about though ah are you s t i l l at two three four si x Howard Avenue? Yes and you s t i l l have the same B.C.M.P. ( B r i t i s h Columbia Medical Plan) number? Yes and ah what did you come i n to see the doctor tonight about? ah he's going to ah I.U.D. he's going to give me one of those 39 19. Receptionist: Well ( ) 20. Patient: O.K. 21. Receptionist: Fine — have a seat This relaxed, less formal attitude i s intended as something which encourages p a r t i c i p a t i o n i n the youth night program. Once the receptionist has obtained the necessary information and collected the minimum (<£.00) fee, the patient i s asked to take a seat i n the waiting room. I t i s not uncommon on youth night to see an odd assortment of patients. On one part i c u l a r night the waiting room was f i l l e d with members of the Hare Krishna order accompanying a fellow devotee who had broken his ankle while chanting on the street. There were also some very nervous young women, [And, according to the s t a f f , such nervousness usually indicates that they have problems related to b i r t h control or abortion.] transient youth, young transient parents with their children, and some adults who, for various personal and si t u a t i o n a l reasons, prefer to attend the Youth Night C l i n i c . The students who c a l l the patients from the waiting room ad-dress them by f i r s t name or, sometimes, f i r s t name plus l a s t name, but terms such as Mr. or Miss are seldom used. The patient i s con-ducted into offices which, during the day serve as regular physicians' o f f i c e s , but are, for the present purposes, made available as i n t e r -viewing rooms. Here, the students interview the patient and note his medical history. This procedure provides them with an opportunity to make a tentative diagnosis. After the interview the patient i s taken to an examination room or i s asked to return to the waiting room 40 u n t i l an examination room becomes available. And since there are only three examination rooms and a short supply of doctors, i t i s the norm that patients are often returned to the waiting room. I t i s not at a l l uncommon to hear students asking, "Is there a doctor available?" or "Is there an examination room open?" When an examination room becomes available and a physician i s located, the patient i s recalled from the waiting room. Frequently, one of the students . w i l l try to secure the examination room ( i . e . , to occupy i t p h y s i c a l l y ) , while the other student t e l l s the physician that they are going to get the patient. (Furthermore, i t i s not un-common for additional students to be summoned to an examination room i f , upon^examination i t i s revealed that a patient has some ailment that the physician considers to be of p r a c t i c a l interest to students.) After the examination and any necessary laboratory work, the patient's dealings with the C l i n i c may be terminated, or he may be instructed to return to the C l i n i c the next week for a follow-up. That the Youth Night C l i n i c deals with a transient patient popu-l a t i o n i s , for some members of the medical profession, a problematic phenomenon. Thus, one physician was concerned with the fact that the Youth Night C l i n i c i s dealing only i n "episodic" medical care and not able to do the necessary follow-up care and which i s standard • medical practice. The C l i n i c ' s s t a f f sees this f a i l u r e as one of the major differences between the day-time practice and the Youth Night C l i n i c . Yet, i t i s notable that the Youth Night C l i n i c also d i f f e r s 41 from the day-time C l i n i c i n other essential ways. Its patients are observed as coming i n "off the street", and, while a p a r t i c u l a r patient may be referred to as a "regular" Youth Night C l i n i c patient, he, l i k e a l l other patients here, i s not regarded as a regular i n the sense of having made an appointment. I t i s also a fact that patients encounter student personnel before seeing a regular physician. And, as alluded to above, the s t a f f views the. youth night program as some-thing which i s essent i a l l y different from the day-time o f f i c e practice. As the previous description of the Youth NightCGblnic's "Philosophy and History" states, i t s purpose i s "to provide a learning s i t u a t i o n i n which students could experience interprofessional cooperation". Yet, unlike the day-time practice which the s t a f f sees as correspond-ing to everyday conceptions of standard medical practice, the very openness of the programme created essential problems. The director of the C l i n i c had apprehensions about youth night turning into what he called a " f i s h bowl", that i s , that the C l i n i c might become so open that anyone could come down and view what was happening. And this would of course run contrary to the C l i n i c ' s conception of i t s e l f as a community medical practice rather than a neighbourhood medical drop-in centre. Yet, the centre seems to have avoided this problem f o r , as a nurse told me, "At f i r s t patients would j u s t drop i n but they have learned that i t i s necessary to make an appointment." Since the C l i n i c operates on a group rather than s t r i c t l y i n d i v i d u a l basis and i t i s possible for patients to be treated by physicians other than the one they normally v i s i t , the C l i n i c has 42 developed a special routine procedure to monitor patient care. This procedure i s called "chart rounds" and deserves special comment;.: I t involves a review of patients' medical h i s t o r i e s (their charts) 4 by the medical st a f f of the c l i n i c . O r i g i n a l l y , this was done every morning, before any patients were attended to. The sta f f would review the charts of those patients scheduled to be seen that day. This allows the s t a f f to keep a finger on the day-to-day s i t u a t i o n of the C l i n i c . Later, this procedure was changed to allow £'8MD-&§ to be taken at the -end rather than the beginning of the working day. This proved to be more e f f i c i e n t for two reasons. (a) Patients discussed at morning chart rounds might miss their appointments, and (b) unexpected (and unreviewed) patients might "drop i n " to the c l i n i c . Gaining Entry The above constitutes a general description of the C l i n i c . In this section of the paper I intend to provide an explication of the procedures which I followed i n order to gain access to the c l i n i c i t -s e l f . While both my supervisor and his colleague thought there would be few problems involved i n doing a research project at the C l i n i c , this did not turn out to be the case. Instead, my entrance into the C l i n i c as a sociological researcher proved to be immanently and diversely problematic. My f i r s t encounter with the C l i n i c took place on October 13, 1971. A Youth Night C l i n i c was i n progress as my thesis supervisor, his aforementioned colleague and£ I entered the C l i n i c . None of us 43 had v i s i t e d the place before but my supervisor's colleague knew the director of the C l i n i c and had arranged this v i s i t for us. Our f i r s t impressions of the C l i n i c are summed up i n the following f i e l d note which I made shortly after this " f i r s t contact":"' Everyone commented that the C l i n i c did not appear to be si m i l a r to any other c l i n i c we had seen. Thus, the problematic question: what i s i t about "~ the place Tthat allows us to recognize i t as being a medical c l i n i c ? That i s , without amy of the external appointments of medical settings what allows this c l i n i c to have i t s status as a c l i n i c ? Doctors do not look l i k e doctors, s t a f f do not look l i k e t y p i c a l medical s t a f f , the place does not appear to be'a c l i n i c . - * We were a l l , no doubt, somewhat surprised by the absence of the t r a d i t i o n a l "white" which i s usually associated with hospital and c l i n i c a l settings. This being youth night, the place had that un-expectedly informal character described above. r.And to add further to the picture, there was a video camera team wandering throughout the premise's, filming doctor-patient encounters and the o v e r a l l C l i n i c . We were introduced to the director, Dr. Cough. Dr. Cough said that he was busy at the time but would be able to t a l k with us l a t e r i n the evening and he suggested that we should "look around" u n t i l then. Dr. Turner and I saw the director l a t e r that evening. (Our companion had l e f t us to attend to some other business.) We pointed out that we were both interested i n studying doctor-patient communica-tion and that i t was often d i f f i c u l t for sociologists to gain access to medical settings. We discussed the purpose of our research and 44 told how we hoped that the C l i n i c would prove an i d e a l research setting for t h i s . Naturally, we also expressed our appreciation for being a l -lowed access to the C l i n i c . I t soon became evident that the director viewed the C l i n i c as something quite outside the t r a d i t i o n a l mode of treatment afforded by most hospitals. He appeared to be favorably i n -clined towards so c i o l o g i c a l research although he seemed to hold the view that most sociological research i s or at least ought toiVbe something which i s s o c i a l l y relevant arid/or problem-oriented. That i s , he saw i t as something akin to a remedy for a disease. Thus he hoped that our research might p o t e n t i a l l y contribute to the betterment of the C l i n i c . Several times, he expressed the hope that I would be able to give the C l i n i c some "feedback" on how w e l l they were communicating with patients. We agreed that we too were interested i n the communication obtaining between doctors and patients and suggested that the i d e a l procedure would be to tape-record physician-patients conversations. The director understood our concern for d e t a i l , but suggested that tape-recording con-versations would be problematic because of the e t h i c a l issues involved. The f i r s t encounter ended s a t i s f a c t o r i l y and i t was decided that I would return at a l a t e r date i n order that we could discuss my research plans i n greater d e t a i l . I can r e c a l l a sense of excitement about this f i r s t encounter with the C l i n i c . At that time, an acquaintance of mine who was also a graduate student was engaged i n a study of the maternity ward at one of the l o c a l hospitals. Unfortunately, he was encountering considerable resistance from hospital s t a f f . I was enthusiastic 45 about the C l i n i c and i t s apparent openness, I entertained visions of being allowed r e l a t i v e l y unhampered access to the setting and was ex-cited by the prospect of viewing and tape-recording actual medical encounters. My next v i s i t to the C l i n i c was on November 4, 1971. ( i . e . , 22 days after the i n i t i a l meeting) The purpose of the v i s i t was to discuss with Dr. 'Cough what goals I would pursue i n observing the C l i n i c and how I would conduct that observation. P r i o r to t h i s , I had had discussions with my supervisor about what the " l i n e " I should take when I saw the director. We decided that I should d i s -cuss my interest i n communication, leaving the topic broad enough so that I would be permitted access to the workings of the C l i n i c while at the same time giving Dr. 'Cough some idea of what I would actually be doing. (At this time, i t was my intention to tape some pieces of interaction occurring between doctors and patients.) After the second meeting at the C l i n i c I went home and made the following notes which, although lengthy, I s h a l l now present i n thei r entirety as they show c l e a r l y how I f e l t about the research setting at this time. Clinic,November 4, 1971 — 1-3 p.m. 1. After t e l l i n g Dr. Cough that I would l i k e to observe the various aspects of the C l i n i c he posed the question: "With what purpose i n mind?" My answer contained general comments concerning communication and how I would l i k e to study doctor-patient interactions. I admit this i s a gloss of the encounter but i t w i l l provide a "sense of this encounter. 2. Dr. Sough was concerned with the methodology of my research. He proposed an alternative to observation interviews and surveys. Since I do not regard t h i s a l t e r n a t i v e as adequate, I believe I was c r i t i c a l of the interview method. I explained that I was interested i n observing the workings of the C l i n i c i n some l i t e r a l sense, rather than dealing with data removed from the d a i l y routines of c l i n i c l i f e by various coding procedures. In discussing my r o l e as observer c e r t a i n factors became apparent. Dr. Cough wanted to know the intended length of my research study. I t o l d him the study would take at le a s t a year and that I intended to become involved with the C l i n i c . I offered my services as a volunteer worker and i t appeared that t h i s o f f e r was we l l received. I thought that by volunteering I would not i n -t e r f e r e with the workings of the C l i n i c and yet be able to gain a quick understanding of c l i n i c procedure. Dr. 'Cough seemed very much concerned with the u t i l i t y of my research f o r the C l i n i c . He was not r e a l l y interested i n my own s o c i o l o g i c a l p o s i t i o n . No reason why he should be. He was very much C l i n i c - o r i e n t e d . I did some i n t e r -a c t i o n a l work s t a t i n g that I am not engaged i n pure t h e o r e t i c a l research, hoping to demonstrate that I am not an "Ivory Tower" s o c i o l o g i s t . I also s a i d that I thought i t was only f a i r that the C l i n i c should receive "feedback" from me concerning my research. I f e e l as i f I could have presented any research idea to the d i r e c t o r and he would have trans-formed i t into a research concern f o r the C l i n i c . Communication became the equivalent of problems i n communicating. I f e l t that i t was better to allow the d i r e c t o r to adopt t h i s view of my research rather than engage i n some speech con-cerning "how d i f f i c u l t the concept of communica-t i o n was" and so f o r t h . I stated that I did think there would be some "spin o f f " of my research that would be relevant f o r the C l i n i c . Dr. Sough said that he wanted feedback from me. I s a i d that was a good idea. Put b l u n t l y , Dr. Tough has a d e f i n i t e idea ofwwhat he wants from me as a person about to come to the C l i n i c and I foresee that I may have to give i t to him. 47 5. The end of our ta l k resulted i n his willingness to allow my presence at the C l i n i c . He thought that the rest of the sta f f would agree but he wanted me to come back and explain to the staff my research goals. He thought that t h i s would be a mere formality.^ Note that while the C l i n i c had i n i t i a l l y held f o r t h the promise of easy and unproblematic access, these expectations were not borne out by the actual course of events. The director of the '3'Clinic demanded convincing answers to rigorous questions before entrance was allowed. His concerns with methodology, hypotheses, and the s o c i a l u t i l i t y of the research werenmuch more r i g i d and demanding than those concerns which I encountered on the part of my own dis s e r t a t i o n committee. Another appointment was made for me. I was to go to the C l i n i c i n order to discuss my research with the s t a f f . I remember feeling dismayed about the prospect of having to re i t e r a t e my "story" for their benefit. Concomitantly, I was becoming more and more pessi-mistic about the p o s s i b i l i t y of being permitted to undertake research i n the C l i n i c . My ta l k with the C l i n i c s t a f f was similar to the interview with the director. I did not make any f i e l d notes at th i s time since I did not know whether or not I would ultimately be admitted as a researcher. Indeed, I feared that I would not be. Our meeting took place early one morning. The director introduced me to the staff and 'ligaveor. a b r i e f presentation of my research interests and mentioned that I would eventually l i k e to tape-record medical interactions. The sta f f seemed upset by t h i s . They made comments about my being able to evaluate the i r performance. I t r i e d to impress upon them that I was 48 not interested or involved i n such an evaluation. In a d d i t i o n to t h i s , members of s t a f f were very concerned about the use of the tape recorder and suggested that i t s , and/or my own presence i n the examination room would r a i s e a host of e t h i c a l and l e g a l issues. The d i r e c t o r of the C l i n i c was concerned about the p o s s i b i l i t y that I might publish any-thing about the C l i n i c i n a sociology j o u r n a l without f i r s t providing him with a copy. This meeting with the s t a f f was terminated and I was t o l d that I would be informed i n a week or so about t h e i r d e c i s i o n . Three days l a t e r I received a phone c a l l g i v i ng me permission to do research at the C l i n i c (during the regular day time and the s p e c i a l Youth Night C l i n i c ) , but that the use of a tape recorder was s t i l l a problematic issue. Going to the C l i n i c for the f i r s t time as a research s o c i o l o g i s t was a somewhat d i s o r i e n t i n g experience.. I found myself attending to matters of dress and p h y s i c a l appearance .that I had not considered p r i o r to t h i s event. During my past contacts with the C l i n i c i t had become evident that dress was casual with blue jeans being permissible on youth night. By casual I mean that male physicians would often wear a sport coat and t i e and female physicians and s t a f f were often a t t i r e d i n dresses or pant s u i t s . In contrast, I frequently wore a s h i r t and t i e (never blue jeans) while doing research during day-time p r a c t i c e . I was t o l d that chart rounds began at 8:30 a.m. Other than that, li had no idea of what to expect i n t h i s s i t u a t i o n or what would be expected of me. However, I hoped that doing these Eoundsdwo.ulda 49 allow me to learn the physical layout of the C l i n i c . I soon found out where i t was not permissible or appropriate for me to go. Aside from the director's o f f i c e , a l l the other rooms became open areas and as I soon learned through experience, I was permitted to use the phone or to make notes at the desk i f i t was not occupied. Since there was no organizational " s l o t " for me i n the workings of the C l i n i c , a great deal of my time i n the research setting was spent i n purposeful wandering. Sometimes I would just s i t i n the lunch room, i n the waiting room, or i n an empty examination room. At this time, I want to emphasize that the s t a f f made.no organizational, i . e . , functional use of my presence i n the C l i n i c . Thus a very substantial portion of my research time at the C l i n i c was spent "standing around" and observing. While i t had formally .been' established that I would be able to observe doctor-patient encounters, i t turned out to be ©.ver a month before I was permitted to enter an examination room. I would often stand i n the area outside the examination rooms hoping that a physi-cian would ask i f I would l i k e to observe a medical encounter. Some-times I would ask to observe a medical interview and receive a reply such as "I think I'd better see him (or her) alone". I t soon became clear that, while the C l i n i c presented a casual appearance, the ethic of privacy of the examination room was an i d e a l which was to be maintained. During this period of research, I regularly attended da i l y sessions.of morning chart rounds and would often spend entire days at the C l i n i c . I arrived at the C l i n i c at 8:30 a.m. and usually l e f t sometime after 5 p.m. when I would return home and apply myself to 50 the task of writing up notes from that day. I soon learned that many of the staff bought their lunch at the local cafe. Often they would phone in their order and walk across the street to pick i t up when i t was ready. I started to order lunch from this cafe as well and to offer* to pick up the lunch of other Clinic personnel as well as my own. I ate with the staff and participated in noontime lunch discussions. My research at the Clinic was directed towards obtaining a corpus of audio tapes of various types of interactions that take place between staff and patients. Since this was not happening I often f e l t that the time which I spent there was being wasted. In retrospect, however, I canlsee many advantages accruing from this period. I became acquainted with the C l i n i c ^ i t s e l f and learned some-thing about the personalities of the physicians and nurses. Meanwhile, I became more and more a normal and unquestioned features of the setting. The staff became accustomed to seeing me around, e.g., when I did not go to the Clinic, staff members would sometimes comment upon my next v i s i t "where were you" or "we missed you." In many respects I began to feel obligated to go to the Clinic as much as possible, even though I was not securing the corpus of audio tapes that I had i n i t i a l l y desired to obtain. While the opportunity to observe chart rounds was providing me with certain details, i t upset me that I was not permitted to tape-record even this aspect of Clinic l i f e . I told the director that I was finding i t d i f f i c u l t to remember a l l that was said during the 51 conference and that I f e l t that taking notes during chart rounds would be very d i s r u p t i v e . I asked him i f i t might be p o s s i b l e to tape record these sessions. He s a i d that he would ask the s t a f f and would l e t me know t h e i r d e c i s i o n . I was eventually allowed to tape-record morning chart rounds. I f e l t that t h i s was a s i g n i f i c a n t changing point i n the conduct and progress of my research. And a f t e r spending two and one-half months i n the f i e l d , 1 was f i n a l l y permitted to bring a tape recorder into the C l i n i c . O r i g i n a l l y I used a Sony TC100 portable tape recorder but was eventually able to purchase a Sony TC40, a much smaller and more v e r s a t i l e machine. C l i n i c members soon became accustomed to the presence of the tape recorder. While up to t h i s point I had only been permitted to observe a very small number of medical i n t e r a c t i o n s between doctors and patients, once I began to tape-record chart rounds some of the physicians allowed me to observe, but not to record some of t h e i r i n t e r a c t i o n s with patients. As time progressed, I r e a l i z e d that my chances of being permitted to observe doctor-patient i n t e r -a ction were better on c e r t a i n days than on others, depending l a r g e l y upon which members were working that day. For example, the d i r e c t o r never asked me i f I would l i k e to observe him with a patient and, for obvious reasons, I f e l t that i t was best not to make any attempt i n t h i s d i r e c t i o n . While many other physicians were quite f r i e n d l y other-wise, they were reluctant to allow me i n t o the examination room. One of the younger physicians s a i d that he was concerned with e t h i c a l con-siderations and, although he did allow me to observe some of h i s 52 encounters with patients, i t was always on my own i n i t i a t i v e ; he never asked i f I would " l i k e to s i t i n on this one." He would allow me to observe one type of patient only, — this usually was an older male rather than one of the many female patients who frequented the C l i n i c and who often required physical .examinations. My two best informants were a female physician and an older physician who had recently moved to Vancouver and secured a position with the C l i n i c . Both informants, while not becoming close personal friends, expressed an interest i n my research and allowed me access to their encounters with patients. Some of the apprehension about my presence at the C l i n i c may be attributed to the fact that the C l i n i c was p a r t i a l l y funded by the university and was conscious of i t s status as an experimental medical f a c i l i t y . The C l i n i c was being monitored by members of the medical profession to determine i t s effectiveness and worthwhileness. There was some c o n f l i c t between those members of the medical profession who f e l t that the t r a d i t i o n a l "out patient" departments of hospitals were s u f f i c i e n t , and those physicians who advocated the establishment of community medical c l i n i c s . Because of t h i s , the C l i n i c was more than or d i n a r i l y anxious about being able to present a favourable image. Therefore, having a sociologist i n th e i r midst must have made for some uncertainties on the part of many staff members. I assume, too, that many of the staff did not believe me when I told them that I was not interested i n the inte r n a l p o l i t i c s of the C l i n i c or the personal p o l i t i c s of indi v i d u a l staff members. When I f i r s t started the research I would often participate i n the Wednesday business-lunch meeting, but I soon refrained from this practice because some of the issues discussed at these meetings were " p o l i t i c a l l y hot" and I wanted to make i t clear that I was not concerned with the p o l i t i c s of the C l i n i c . Nevertheless, I believe that many of the sta f f s t i l l viewed my presence with considerable caution. U n t i l May 1972 my research a c t i v i t i e s at the C l i n i c consisted i n observing and tape-recording sessions of chart rounds, and of observ ing the general workings of the C l i n i c and some, but not many, medical encounters. In addition I t r i e d to attend the Youth Night C l i n i c on a regular basis. Some additional s t a f f was hired during this period since additional funds had been acquired through various community and governmental agencies. Further, the C l i n i c had been able to expand to include not only general medical services but also dental and n u t r i t i o n a l c l i n i c s . As was previously the case, there was s t i l l no defined organizational place for.me i n the structure of the C l i n i c , so that much of my time was spent standing and waiting for opportuni-t i e s to view medical interactions. In May 1972 I managed to secure a research stipend from the Department of Paediatrics at the University. The purpose of the s t i -pend was to allow me to continue my research at the C l i n i c throughout the coming summer months. This was important because, aside from f i n a n c i a l support alone, i t meant that for the f i r s t time during my research at the C l i n i c , I was legitimately e n t i t l e d to say that I was working for a medical department. I t also brought me into closer contact with those physicians i n the Faculty of Medicine who expected 54 to see some results at the end of the summer period. Hereafter my research position in the Clinic was one of a semi-credentialed re-search sociologist who was employed by a medical department to do research into doctor-patient communication. In this way c l i n i c members knew that my research was being monitored by physicians out-side the staff of the Clinic. I remember going to a cocktail party in which one medical Department Head asked me while the director of the Clinic was within hearing distance, i f I thought that the Clinic was really worthwhile. I replied that I thought i t was most inno-vative. Thus the director could not only credit me with a favourable response towards the Clinic but was also made aware of the fact that I was in contact with other medical professionals who were monitoring the Clinic. I confess that gaining this position of a credentialed appointment to do research at the Clinic made me feel more confident for I was now a bona-fide medical researcher receiving money from a medical department to secure tape recordings of doctor-patient interaction. At this state I spoke to the director and informed him that I was hoping that I could begin to record medical interactions as soon as possible. He thought there would be no problem in doing so but asked that I construct a formal proposal of the type and quantity of medical interactions I wished to record. The rationale given for this was that the staff should have an idea of exactly what i t was that I was interested in recording. I remember going home and considering the f e a s i b i l i t y of complaining to one of my medical contacts that Dr. Tough 55 was not c o o p e r a t i n g , but i n s t e a d I decided to produce the requested p r o p o s a l . I t was subsequently d i s t r i b u t e d to the s t a f f . The use of the tape r e c o r d e r posed c e r t a i n p r a c t i c a l and e t h i c a l problems. The C l i n i c s t a f f decided that the p h y s i c i a n should ask h i s p a t i e n t i f i t was p e r m i s s i b l e to r e c o r d the medical encounter. The e t h i c a l problems were f u r t h e r r e s o l v e d when my r e s e a r c h p r o p o s a l was approved by the F a c u l t y of' Mea'ielhe E t h i c s Committee. At l a s t I was going to be allowed to t a p e - r e c o r d medical i n t e r a c t i o n s . The majority of the data i n t h i s r e p o r t comes from t r a n s c r i p t s of these tape r e c o r d i n g s . Thus f a r , t h i s chapter has been o r i e n t e d towards the p r o d u c t i o n of an opening d e s c r i p t i o n f o r an ethnographic r e p o r t . I t s main c o n -cern has been to p r o v i d e the reader w i t h a summary and d e s c r i p t i o n of the C l i n i c , i t s s e t t i n g and'modus o p e r a n d i . In c o n t r a s t , I would now l i k e to focus upon the ways i n which the preceding d e s c r i p t i o n i s , i n i t s e l f , made a v a i l a b l e to us as a t o p i c f o r i n v e s t i g a t i o n . In the remainder of t h i s chapter I wish to examine the ways i n which an i n i t i a l d e s c r i p t i o n such as t h i s i s a c o n s t i t u e n t component of the "standard ethnographic f o r m a t . " I a l s o i n t e n d to show how t h i s i n i t i a l d e s c r i p t i o n i s r e l a t e d to other and subsequent s e c t i o n s of an ethnographic r e p o r t . And i n a d d i t i o n , I want to o u t l i n e the r e l a t i o n -ship which obtains between the p r o d u c t i o n o f an ethnographic d e s c r i p -t i o n and the r e c i p i e n t s of that d e s c r i p t i o n . 56 A n a l y t i c a l Features -ofl the I n i t i a l Description Like any ethnographer, producing a d e s c r i p t i o n of a research s e t t i n g , I have provided my reading audience with a general d e s c r i p -t i o n of the character of the research s e t t i n g . The reader can presume that the materials presented thus f a r constitute what might be c a l l e d a "background d e s c r i p t i o n " of the C l i n i c and that a more a n a l y t i c a l d e s c r i p t i o n of the C l i n i c i s to follow. He might expect further that i n subsequent sections of t h i s report I w i l l address issues concerning various s o c i a l organizational features of the C l i n i c . I t would be reasonable to a n t i c i p a t e such subsequent topics as: the c h a r a c t e r i s t i c s of community as compared to p r i v a t e medical p r a c t i c e , r o l e - c o n f l i c t between various c l i n i c s t a f f , drug problems amongst the young, middle c l a s s doctors and the treatment of lower class p a t i e n t s , the organizational structure of medical interviews, the search f o r an abortion, disease terms used by non-medical personnel,'pregnancy and i l l e g i t i m a c y , medical diagnosis as a s o c i a l achievement, and so f o r t h . In short, a f t e r reading these i n i t i a l materials, i t would not be unreasonable f o r the reader to expect to f i n d that the subsequent report was concerned with and organized around topics such as .those suggested above. And to see such expectations as "normal" expectations would not be seen as inappropriate. Indeed, the i n i t i a l d e s c r i p t i o n of the C l i n i c thus f a r presented must be viewed as the background to some subsequent and more a n a l y t i c section of the ethnography, f o r , were I to f u r n i s h only the previous 57 description of the C l i n i c and claim that such a description was an adequate ethnography, this claim would be rejected by anyone who has had some experience i n ethnographic research. Although we are unable to specify exactly what i t i s that constitutes adequate ethnographic description we are able to see that these i n i t i a l descriptive materials do not comprise an ethnography of the C l i n i c . At best, t h i s : - i n i t i a l description can be viewed as mere background material prefacing a subsequent analysis of some aspects of c l i n i c a l organization. In standard ethnographies, the fact that a description such as the one given at the star t of this chapter i s to be seen as "a preface or lead i n " to some subsequent body of material, islno.tsanf eafcuf eat^.e to be examined i n those ethnographies themselves. In contrast to standard ethnographies which take such features for granted as an obvious and unquestionable part of "the scheme of things," i t i s my intention to make a r a d i c a l departure here. To wit, I want to ask how i t i s that such material can be seen as a resource to the reader f o r the understanding of subsequent sections of the ethnography, that i s , useful i n such a way that i f this prefatory material was absent the ethnography could be viewed somehow deficient or defective. Therefore, instead of proceeding with a description of the C l i n i c ' s analytic features, this chapter w i l l now focus on how i t i s that such prefatory or background materials contribute to the s o c i a l organization of the ethnography as a whole. I would l i k e to add that i t i s not my primary intention to come up with a l i s t of d e f i n i t i v e answers for the 58 successful production of an ethnography. Yet, i f no such l i s t s are forthcoming then, hopefully, some thought-provoking questions w i l l have been r e a l i z e d . The d e s c r i p t i o n of the C l i n i c given at the s t a r t of the present chapter could have been, had I decided to follow i t up as such,;.a c e r t i f i e d and acceptable way of beginning an ethnographic monograph on the subject of the C l i n i c . I t would have been* seen; and accepted as such by anthropologists and s o c i o l o g i s t s doing Ethnographic research. It would not have been seen as some i d i o s y n c r a t i c format adopted f o r esoteric reasons. It i s a common p r a c t i c e f o r anthropological ethnographers to provide t h e i r readers with a preliminary d e s c r i p t i o n of "some other c u l t u r e " as a preface f o r a more highly d e t a i l e d and a n a l y t i c a l descrip-t i o n of that culture. Thus Raymond F i r t h i n h i s work We, The Tikopia gives some preliminary information concerning the Tikopia: Rarely v i s i t e d by Europeans and with no white residents, Tikopia l i e s i n the extreme east of of the B r i t i s h Solomon Island Protectorate, and i s inhabited by twelve hundred healthy and vigorous natives. Homogeneous i n speech and culture, they are a unit of what may be termed the "Polynesian f r i n g e " i n Melanesia, t h e i r c l o s e s t a f f i n i t i e s being not with the people of the Solomons region but with those of Samoa, Tonga and even more d i s t a n t groups to the east. Almost untouched by the outside world the people of Tikopia manage t h e i r own a f f a i r s , are governed by the c h i e f s , and are proud of themselves and t h e i r c u l t u r e . They are p r i m i t i v e i n the sense that the l e v e l of t h e i r material t e c h n i c a l achie-vement i s not high and they have been affected i n only a few externals by Western c i v i l i z a t i o n ; at the same time they have an elaborate code of e t i -quette, a clear-cut systematic s o c i a l organization and they have developed very strongly the ceremonial side of t h e i r l i f e . They s t i l l wear only t h e i r sim 59 simple bark-cloth, they l i v e i n p l a i n sago-leaf thatch huts, they carry out the t r a d i t i o n a l forms of mourning, marriage, and i n i t i a t i o n . M i r a b i l e  d i c t u , a large section of them s t i l l worship t h e i r ancient gods with f u l l panoply of r i t u a l , a con-d i t i o n almost unique i n the Polynesia of to-day. A b r i e f reference to the r e l i g i o u s condition of thercpeople i s necessary i n order to give some idea of the s e t t i n g i n which my work was c a r r i e d out. . . J In a s i m i l a r fashion Evans-Pritchard makes some preliminary remarks about the Azande i n h i s c l a s s i c ethnography Witchraft Among the Azande: The Azande (singular, Zande) are a negroid people who l i v e on the Nile-Congo d i v i d e . They are mesa-t i c e p h a l i c , of medium stature, and of a skin colour varying from chocolate to l i g h t reddish brown. No further account of t h e i r p h y s i c a l characters i s given here because the photographs of a number of Azande are s u f f i c i e n t to show the reader what they look l i k e . Likewise no e f f o r t i s made to assess s c i e n t i f i c a l l y t h e i r psychological characters,but i t may he s a i d that i n the experience of the author, as well as i n the experience of other Englishmen who have l i v e d among them, the Azande are so used to Authority that they are d o c i l e ; that i t i s usually easy for Europeans to e s t a b l i s h contact with them; that they are hospitable, good natured, and almost always cheerful and sociable; that they adapt them-selves without undue d i f f i c u l t y to new conditions of l i f e and are always ready to copy the behaviour of those they regard as t h e i r s u p e r i o r s . i n culture and to borrow new modes of dress, new weapons, and u t e n s i l s , new words, and even new ideas and habits; and that they are usually i n t e l l i g e n t , sophisticated, and progressive, o f f e r i n g l i t t l e opposition to f o r e i g n administration, and d i s p l a y i n g l i t t l e scorn f o r foreigners. The reader w i l l be able to form hi s own judgement of t h e i r characters from the idea and actions recorded i n t h i s book. The royal class are more proud and conservative; they are contemptuous of t h e i r subjects and detest t h e i r European conquerors. They are often handsome, frequently talented, and can be charming hosts and companions, but generally they mask behind a cold 60 politeness their d i s l i k e of the new order of things and of those who impose i t , and I found that, with rare exceptions, they were useless as informants, since they firmly refused to discuss their customs and b e l i e f s , always deflecting conversation into some other channel,, and that they contrasted i n this respect with their subjects, who seldom objected and were often keen, to furnish information....^ I t would appear that the accredited ethnographic constructions of an ethnographic report follow a recognizable structure which may be char/aeferifzed as a "standard ethnographic format". When reading an eth-nography, the f i r s t thing which a reader encounters i s a body of materials designed tct60 "set the scene", "to serve as an introduction to", or "to provide background material f o r " subsequent a n a l y t i c a l sections of the ethnographic report. Firth's characterizations of Polynesian society and Evans-Pritchard's description of Azandeland occur i n the i n t r o -ductory sections of their reports, that i s , before their detailed main accounts of the society which they are studying i n much the same way as my i n i t i a l description of the C l i n i c stands as prefatory to what could w e l l have been a more detailed and thoroughgoing report on the organi-zation of the C l i n i c . To speak of a "standard ethnographic format" i s to do much more than to notice that ethnographic reports are recurrently constructed 9 i n this manner. In attending to t h i s , one raises as an issue the relationship between these i n i t i a l , introductory sections and those subsequent a n a l y t i c a l sections of the ethnography that are presumed to be forthcoming. In this way, the format i t s e l f becomes available as a topic i n i t s own r i g h t ; one suitable for empirical investigation. It. may w e l l be the case that an investigation of the relationship 61 between the beginning sections of an ethnography and the more a n a l y t i c a l sections of the ethnographic report w i l l contribute to our understanding of the s o c i a l organization of ethnographic description. Let us begin our present inquiry by examining my own i n i t i a l description of the C l i n i c and asking the following question: How does such prefatory descriptive material .contribute to the reader's under-standing of the forthcoming analytic sections of the ethnography? One possible answer to this question i s that such prefatory material provides the reader with a "sense of the setting". Unfor-tunately, this answer does not address the question, for the issue i s how does this - prefatory material relate to the subsequent analytic section of the ethnography rather than whether or not we are able to characterize i t s contents. In what sense i s the material contained i n the i n i t i a l description of the C l i n i c relevant for an understanding of some subsequent organizational feature of the C l i n i c ? I t remains that while such material may be used by the reader to understand the subsequent a n a l y t i c a l sections of an ethnographic report, exactly how the reader i s to u t i l i z e this material remains something which i s not customarily specified by the writer of an ethnography. An example may help to c l a r i f y this point. Evans-Pritchard provides the reader with the following charac-t e r i z a t i o n of the Azande:"^ The Azande of the Anglo-Egyptian Sudan l i v e i n Savannah forest. During the rainy season the grasses grow so high and so densely that they present a serious obstacle to any one who wishes to leave the paths. During the dry season, which commences i n November and continues t i l l 62 A p r i l , the whole hush i s f i r e d and the country i s revealed as an undulating p l a i n , intersected by innumerable small streams, and not so l e v e l as one might suppose when traversing i t while the grasses are high. I t i s sparsely wooded and the trees grow to a great height at the sides of streams where they form fringing forests. Azande prefer to l i v e along, these streams rather than i n the open plain,but are now forbidden to do so i n the Anglo-Egyptian Sudan because species of tsetse (Glossina) which contain trypanosomes harmful to man breed near water. Here and there are outcrops of ironstone or granite, either bare or covered with low grasses.^ u Admittedly we recognize Evans-Pritchars's commentary about the Azande as being a.recognizably standard way of beginning an ethnography and can rest assured that i n the forthcoming sections of his work he w i l l provide us with detailed accounts of ZSnde witchcraft. This commentary, however, gives absolutely no ind i c a t i o n of the ways i n which Evans-Pritchard 1s readers are to u t i l i z e t his information v i s - a - v i s the subsequent materials on witchcraft. How i s i t that information about such things as the rainy season, the savannah forest, or^the height of the trees at the side of the stream w i l l be usable by the reader when reading subsequent parts of the ethnography? The point I am making i s that ethnographic descriptions do not, as a routine part of their procedure, recognize a need for outlining the r e l -ationship between prefatory sections of the ethnography and those sections that are t y p i c a l l y to follow. By instructions I mean a common sense d e f i -n i t i o n or set of principles t e l l i n g the reader to use the materials i n some s p e c i f i c way. Te l l i n g him, for instance, "to use the information about the rainy season when reading (and only when reading) chapter four of this report" or "to make special note of the fact that Azande 63 t e r r i t o r y i s intersected by innumerable small streams," (or, perhaps, small streams). My description of the C l i n i c included information about the "et h n i c i t y " of the neighbourhood, the characteristics of the patient population, the dress and character of the s t a f f , and so fort h . These materials may give a "sense of the research setting 1,'" — at no point i n this description do I t e l l the reader why I. have included this information or state how i t i s that t h i s material i s part of and relevant to subsequent sections of the ethnographic report. Thus i t appears that, although we can speak of a "standard ethnographic format" i n which the ethnographer provides some i n i t i a l and prefatory material i n order to provide the reader with a sense of the setting, the reader i s l e f t on his own to make the necessary con-nections between these prefatory materials and the more a n a l y t i c a l sections that follow. Let us continue our examination of the r e l a t i o n -ship between them. There are some d i s c i p l i n e s , for example, formal lo g i c or chemistry, where the reader's a b i l i t y to make sense out of what he i s reading may be d i r e c t l y dependent upon the s e r i a l placement of the materials presented to him. That i s , some of these presentations are unavoidably "cumulative" i n nature so that the reader must understand theorem A before he can grasp theorem B, or he must appreciate chapter one before he w i l l be able to read chapter two with the necessary comprehension, etc. This means that there w i l l be recognizably correct ways of doing a report. Be that as i t may, there seem to be no such constraints i n the 6 4 ordering of the parts of an ethnographic report. While ethnographies t y p i c a l l y have beginning sections, and these sections constitute background material to the more a n a l y t i c a l sections of the report, the reader i s not required to read the beginning section f i r s t so that he w i l l then have the requisite knowledge for understanding the subsequent sections of the ethnography. Indeed, the report could w e l l be arranged i n such a way that present lead-in material would then appear elsewhere i n the monograph and this rearrangement would not i n -terfere with the reader's a b i l i t y to understand the material presented to him i n the a n a l y t i c a l sections of.the report. For example, i t would be possible for Evans-Pritchard to have informed his readers about Azande witchcraft, poison oracles, accusations of witchcraft, etc., without requiring.that the reader f i r s t become f a m i l i a r with his material containing information, about the geography of the Egyptian-Sudan. Our examination of the relationship between the i n i t i a l and sub-sequent a n a l y t i c a l sections of the ethnographic report suggests that i t s construction follows from the dictates of what i s seen as an ac-cepted format for ethnographies rather than from any necessary or l o g i c a l ordering of material. I t i s also notable that introductory descriptions of the research setting, l i k e my own description of the C l i n i c , are at the beginning of ethnographies merely to s a t i s f y s t y l i s t i c and presentational concerns, and not because i t i s i n some s t r i c t sense necessary that the reader understands them before at-tempting to make good or comprehensive sense out of subsequent material. While one.could perhaps claim that these i n i t i a l materials are intended 65 to provide the reader with some sense of the setting or to get him i n the proper mood, such claims have l i t t l e theoretical import i f these beginning sections make l i t t l e contribution towards or are problematically related to the a n a l y t i c a l materials that follow. Another feature of ethnographic description which becomes ap-parent when we consider t h e . i n i t i a l sections of these ethnographies i s that the descriptions which they give us could easily have been supplied by an educated layman. I t i s obvious, too, that i n order to produce such a description, one does not have to acquire any special or previous training in' the s o c i a l sciences. Indeed, my description of the C l i n i c might well have been written had I no knowledge whatso-ever about i t s possible or potential relationship to the subsequent sections of this report. A l l of these considerations point to the fact that this description i s a product of "common-1 sense" rather than rigorous " s c i e n t i f i c v procedures." Therefore, the dominant facts about the materials under consideration are a) that their production rests largely upon mere commonssense and i s largely independent of any anthropological or s o c i o l o g i c a l considerations; and b) that these materials are related to the subsequent'sections of the ethnographic report i n unspecified and problematic ways. This second feature of ethnographic description w i l l be discussed i n greater d e t a i l l a t e r i n this chapter. The preceding observations and comments are not meant as c r i t i c i s m s of the ethnographic enterprise, nor are they c r i t i c i s m s of the work of F i r t h or Evans-Pritchard. The observation that the i n i t i a l prefatory 66 materials of ethnographic reports are not l o g i c a l l y or the o r e t i c a l l y connected to the subsequent a n a l y t i c a l sections of an ethnography i s not a proposal that such materials should be so connected. I t i s observable too that the main part or body of an ethnography contains materials that are more a n a l y t i c a l than those which occur i n the introductory sections and that these more a n a l y t i c a l materials generate various theoretical problems for the s o c i a l s c i e n t i s t . Such sections t y p i c a l l y concern such things as kinship and/or family organi-zation, various views of r e l i g i o n or magic, or p o l i t i c a l organization and i t s relationship to economic organization. whereas members of the professional community frequently f i n d that they are able to engage i n conversations about, to agree with or argue about the main sections of ethnographic reports, these main features are, as has already been pointed out, generally prefaced by some descriptive body of material which has been designed to give the reader a sense for the setting of the major portion of the ethnography. And such prefaces, while omnipresent parts of standard ethnographic presentations are, i n themselves, not seen as something which has any abiding theoretical interest. Thus, e.g., while there has been much controversy about Evans-Pritchard's r i g i d dichotomy of Azande b e l i e f s concerning that which just happens and that which i s caused by magic, no investigator could be expected to argue with his statement that, "Azande prefer to l i v e along these streams rather than i n the open , . „11 p l a i n . . . Are we to regard these i n i t i a l sections to ethnographic reports 67 as being merely "scene s e t t i n g " materials? And, since their r e l a t i o n -ship to the more a n a l y t i c a l sections of an ethnographic report i s not grounded i n any l o g i c a l connection but i n adherence to a presentational format alone, do they have no theoretical interest? • I would l i k e to suggest that instead of treating these i n i t i a l materials as mere scene setting devices, they should be examined i n t h e i r own r i g h t , i . e . , i n terms of the i r organizational relevance for the construction of ethno-graphic reports. Thus, having noted some of the features which obtain between the i n i t i a l and subsequent sections of the ethnography, l e t us focus our attention, upon the examination of these i n i t i a l materials them-selves, and attempt to explicate th e i r organizational import for what may.ybe seen as the standard ethnographic format. The ethnographer enjoys a privileged position or perspective which the reader does not. For one thing, he has a greater knowledge of the culture under study than does the reader. Ethnographers often become s p e c i a l i s t s on some culture or society and can be said to "own" a certain expertise on that culture which, by and large, the reader 12 does not and w i l l never "own." The ethnographer has the job of mediating between the phenomena which comprise the research setting and the reader of his report. In many instances, a l l that the reader w i l l come to know about the research setting i s dependent on what i t i s that the ethnographer t e l l s him. Ethnographic descriptions have been characterized by A.R. Lough as somewhat sim i l a r to " t r a v e l l e r ' s t a l e s " : 1 3 68 Recall f i r s t that the anthropologist was at the beginning a t r a v e l l e r . By v i r t u e of h i s acquaintance with parts of the world out of reach of most of us, he could t e l l stay-at-homes i n t e r e s t i n g s t o r i e s about the d i e t and economy, the r e l i g i o u s and sexual pr a c t i c e s of a l i e n and often exotic peoples. His t a l k looks to be of a piece with that of one's neighbour who has j u s t come back (with s l i d e s ) from Bermuda or a tour of the Western Parks-l 3 So-called "arm-chair s o c i a l s c i e n t i s t s (that i s , insofar as they are unable to p a r t i c i p a t e i n the actual experiences of the ethnographer they are necessarily f i n d i n g out what he meant from a distance) must tr u s t that the ethnographer has done his best to provide an accurate and comprehensive d e s c r i p t i o n of the culture being studied. The reader must assume that the ethnographer i s not fattening up h i s descriptions or simply l y i n g to him. For example, consider my d e s c r i p t i o n of the C l i n i c . I t i s evident that readers are not able to i n v e s t i g a t e my propositions about the C l i n i c , and to a s c e r t a i n that i t i s i n f a c t located i n an I t a l i a n area of Vancouver, that i t s s t a f f were casually dressed, that the C l i n i c had a free and easy atmosphere, etc. (In other cases, of course, where, say,the researcher i s t a l k i n g about some distant or extinct society, v e r i f i c a t i o n i s an almost insurmountable problem.) Further, t h i s p r i v i l e g e d p o s i t i o n ' i s a general feature of a:: ethnographies and does not apply to each and every type of d e s c r i p t i o n . For example, people commonly read p o l i t i c a l documents or newspapers with the intent of f i n d i n g not true accounts but propaganda i n these. For they have assumed from the outset that the author has a bMased view-point. In' contrast, the reader of an ethnographic report i s not supposed 69 to hold this type of attitude towards the ethnographer. While the reader may i n i t i a l l y grant the ethnographer qua ethnographer, a high degree of unquestionability, this i s to say that there i s no guarantee that the reader w i l l maintain this attitude throughout the reading of the ethnography. What i s there about the character of ethnographic descriptions that allows the ethnographer to continue to have this privileged position? I suggest that those i n i t i a l and prefatory sections of ethnographic reports, while not being l o g i c a l l y connected to the more a n a l y t i c a l sections that follow, help provide the ethnographer with this credentialed status. Because he has a reading audience composed almost en t i r e l y of stay-at-homes, the ethnographer can r e l y on this fact to assume that his reading audience w i l l have some c u r i o s i t y about, but no actual experience i n the research setting. For example, how members i n the foreign culture dress, what women do i n the society, various r e l i g i o u s aspects of the culture, what type of personalities they have,and so forth are a l l matters that can be assumed to be of interest to the reader, and the ethnographer can presume that the readers of his ethno-graphic description can make use of the fact that his audience w i l l have a set of common sense' c u l t u r a l relevancies concerning the culture being studied. The ethnographer can r e l y upon these c u l t u r a l r e l -evancies f o r the construction of his i n i t i a l prefatory materials for he knows i n advance that they w i l l constitute items which can be ap-propriately included i n the opening section of his ethnography. While such materials may not be the central concern of the 7 0 ethnographic report, their placement i n this i n i t i a l or prefatory section s a t i s f i e s much of the reader's c u r i o s i t y about the research setting. These prefatory materials also serve to indicate that the ethnographer knows much more about the culture than he intends to put down i n his report. And they further claim that he knows the setting i n the ways that are t y p i c a l l y expected of someone who has spent a considerable period of time i n some culture. While the ethnographic report may be a specialized monograph on a subject such as kinship, the sum of materials presented i n the opening section demonstrates that the ethnographer has considerably more knowledge about the culture than he has chosen to present i n the ethnography. Thus, i f he had wanted to he could have told the reader not only about kinship but about other aspects of s o c i a l organization. Thereby, introductory materials often suggest that the author has much knowledge which i s not spelled out i n the main section of the paper. Yet, such materials do not indicate how i t i s that the ethnographer has chosenato include some .things i n the preface and quite different things i n the body. Nor, of course, does the.preface t e l l us exactly what i t i s that the ethnographer has f a i l e d to t e l l us i n the major parts of his presentation. Thus, the relationship between these two parts remains unclear. The ethnographer does not merely occupy a privileged position v i s - a - y i s his reading audience, but rather he displays that p r i v i l e g e d position. The ethnographer uses the opening sections of his report to furnish his readers with a description of some phenomena relevant to the society which i s being studied. He assumes that his audience would 71 normally be curious about these features and that they would expect him to mention them i n his report. I t was pointed out e a r l i e r that these i n i t i a l or prefatory materials do not come with an e x p l i c i t set of instructions explaining their relationship to subsequent sections of the ethnography. However, these i n i t i a l materials do provide the reader with a host of i m p l i c i t resources which he can use i n his subsequent reading of the ethnogra-phy. Thus, while the i n i t i a l materials customarily included i n such a report do not provide the reader with an e x p l i c i t l i s t stating how he should or must use them, they are s t i l l an important part of the ethnography and, as such, merit attention. Perhaps an example w i l l help c l a r i f y what I mean by t h i s . Evans-Pritchard (see above) t e l l s the reader that the Azande l i v e i n the Anglo-Egyptian Sudan (see above). Although this piece of geographical or locational information i s not accompanied by a set of instructions t e l l i n g the reader why i t i s relevant or important and how i t i s to be understood and used, i t i s , nevertheless, informa-tion that has consequentiality for the ethnography of the Azande. Had Evans-Pritchard l e f t the reader to.take a guess at the location of Azande t e r r i t o r y , the reader could easily be misled. Were he to assume, for instance, that the Azande l i v e d i n South America or Polynesia, his entire understanding of the ethnographic report would be colored by this assumption since he would try to make what he read about the Azande f i t i n with his knowledge of these cultures. Or, to use.an absurd example, were he to decide that the Azande were native to 72 Oxford rather than to Azandeland, i t would be quite possible for him (the reader) to fi n d Evans-Pritchard's materials on .witchcraft pre-posterous since he knows about Oxford and what goes on there and realizes that practices such as those described by Evans-Pritchard could not possibly take place there. Then, too, the author i s es-tablishing the fact that the things described i n the ethnographic report are things common to the Anglo-Egyptian Sudan (and, by i m p l i -cation, to Africa) and are not necessarily things bearing any resem-blance to any other society with which the reader i s himself f a m i l i a r . In this way too, Evans-Pritchard i s setting himself up as an expert, i . e . , as one who, i n contrast to the reader, i s legitimately e n t i t l e d to describe Azande culture. Thus, materials that may i n i t i a l l y appear to have the chatty 14 character of a travelogue, are usable by a reader as a resource for understanding the subsequent a n a l y t i c a l sections of the ethnography. However, these materials are a resource made available to the reader which i s to be used i n any way he so chooses. For this reason, they are not subject to enumeration as a set of e x p l i c i t instructions. For instance, my description of the C l i n i c stated that i t was located i n Vancouver. This description allows the reader to use his own stock of common sense knowledge about the organization of medical practice i n North America and toccome up with an approximation that i s ap-propriate to Vancouver. And this characterization w i l l be important to subsequent descriptions of the C l i n i c . Note, however, that the exact relationship between this geographical information and subsequent 73 a n a l y t i c a l materials remains u n s p e c i f i a b l e . While such i n i t i a l , materials c o n s t i t u t e resources which readers can u t i l i z e , the ordering of these materials i s based on common sense rather than a set of s c i e n t i f i c procedures. E a r l i e r , I showed that the materials contained i n my d e s c r i p t i o n of the C l i n i c was not the product of any.-cspecial s o c i o l o g i c a l t r a i n i n g but were selected with-out reference to any s c i e n t i f i c " procedure. A few examples may help to c l a r i f y and expand upon t h i s . Let us assume that an ethnographer i s w r i t i n g a d e s c r i p t i o n of some feature* i n his own society. I t may not be necessary f o r him to include a d e s c r i p t i o n of the climate, topography, or p h y s i o l o g i c a l c h a r a c t e r i s t i c s of the people he i s studying although such informa-t i o n i s t y p i c a l l y included i n ethnographies of f o r e i g n cultures. The decision of what to include and what to omit i s not, however, something which he decides upon a f t e r r e f e r r i n g to some empirical standard f o r the construction of ethnographic reports. Instead, such decisions are made on the basis of what i t i s that he common-s e n s i c a l l y knows about his intended audience and t h e i r r e l a t i o n s h i p to the s.etiting. Thus, i n my d e s c r i p t i o n of the C l i n i c , I f e l t no need to d i s -cuss the climate or geographical c h a r a c t e r i s t i c s of Vancouver for I know that I can r e l y upon my reader's knowledge of Canada and Van-couver to supply the d e t a i l s for these features. Thus, were I to say for instance,that the number of patients attending the Youth Night C l i n i c i s considerably higher i n summer than i n winter, I would not 74 have to go into an analysis f o r t h i s but could r e l y on the reader's knowledge of Canada and Vancouver•-,to account for t h i s increase. That i s , I would expect him to know that r a i n f a l l i s heaviest here during the winter months, and that during the summer Vancouver at-t r a c t s a considerable number of transi e n t s . And these should ac-count for the d i f f e r e n t rates of attendance. If however, I expected my audience to be ignorant of the climate and geography of the c i t y , then, and only then should such features be described f o r t h e i r b e n e f i t . Indeed, had I elected, to include such information i n my i n i t i a l d e s c r i p t i o n of the C l i n i c , the reader may w e i l r have found the material boring or questioned,my competence as an ethnographer. Further i t i s apparent that a) d i f f e r e n t ethnographers may describe the same society i n very d i f f e r e n t ways, and b) an eth-nographer w i l l attend to d i f f e r e n t features i n d i f f e r e n t ethnogra-phies. That i s , he w i l l not describe, say, the magical b e l i e f s of every society f o r which he produces an ethnographic report. These features are a r e s u l t of the f a c t that h i s descriptions are based upon the dic t a t e s of common.sense rather than some empirical system. A chief constraint here i s the v a r i a b l e of the audience. This has pragmatic implications f or the production of the report. Thus, one can imagine, say, Evans-Pritchard constructing a monograph which i s intended f o r those'familiar with the doing of ethnographies, and, on a l a t e r occasion, r e v i s i n g i t i n order to present i t to a lay audience. I t i s apparent here that a lay audience would have c e r t a i n problems appreciating a report addressed to p r o f e s s i o n a l ethnographers, 75 while a p r o f e s s i o n a l audience might well f i n d any other presentation unsa t i s f a c t o r y . Thus f a r I have shown how the ethnographer constructs the prefatory materials of the ethnographic report by using common-sense c r i t e r i a to decide what i s and what i s not proper material i n terms of h i s intended audience. I have also shown that readers are able to understand and to make good use of these materials i n a way which i s recognizably sensible. That i s , whereas the ethnographer provides the reader with resource materials, he does t h i s without knowing how i t i s that the reader w i l l be able to make use of them i n h i s reading of subsequent sections of the report. This allows f o r the p o s s i b i l i t y that the reader may u t u l i z e these i n i t i a l resources i n ways that are completely d i f f e r e n t than those intended by the ethnographer. Therefore, there does not have to be a one-to-one correspondence between the ethnographers intentions and the reader's understanding i n order f o r these materials to contribute to the under-standing of subsequent sections of the ethnography. Thus, i t i s to the ethnographer's advantage to provide the reader with as much information about the research s e t t i n g as he thinks might contribute to an understanding of the subsequent sections of the ethno-graphy. While these prefatory sections follow no empirically demons st r a b l e order, they have the advantage of being open to an extremely wide range of i n t e r p r e t a t i o n s . The ethnographer would usually prefer to f u r n i s h the reader with too much rather than too l i t t l e information about the research s e t t i n g i n order to be on the "safe side". That i s , he provides the reader with any and a l l information which might con-t r i b u t e to h i s understanding of the subsequent sections of the ethnography. 76 Here, remember that my d e s c r i p t i o n of the C l i n i c included materials designed to provide the reader with a sense of the research s e t t i n g . However, I am unable to s p e c i f y exactly how i t i s that these materials are relevant to the forthcoming sections of t h i s paper. Nor am I able to formulate the ways i n which the reader w i l l u t i l i z e these materials when v i s - a - v i s subsequent parts of t h i s presentation (such as my analysis of chart rounds presented i n chapter three). In t h i s chapter I have examined some of the organizational features inherent i n ethnographic reports. I have presented a d e s c r i p t i o n of a community medical c l i n i c (the C l i n i c ) and then ex-amined that d e s c r i p t i o n i t s e l f i n order to i l l u s t r a t e features common to the beginning sections 1P;f ethnographic reports. By t r e a t i n g t h i s i n i t i a l d e s c r i p t i o n as data, I have argued that an ethnography i s ordered i n terms of common,sense procedures and common sense relevan-cies rather than i n terms of some s p e c i f i c empirical procedures. I have, to t h i s end, focussed on the r e l a t i o n s h i p between the ethno-grapher and h i s intended readers. In the following chapter, I s h a l l consider some of the issues involved i n producing the next section that i s , the a n a l y t i c section to an ethnography. 77 Footnotes: Chapter One 1. While having no previous trai n i n g i n medical sociology, I did have an interest i n studying the general features of conversa-t i o n a l structure. At the time this research was i n i t i a t e d I f e l t that the C l i n i c would provide an excellent opportunity for me to c o l l e c t a corpus of conversational materials on which i t would be possible to conduct a "conversational analysis". This goal became transformed over the course of the research. 2. Note: Respect for the c o n f i d e n t i a l i t y of the _ C l i n i c dictates that no source be quoted here: Community C l i n i c Address Telephone Number i s open 9-5 Monday-Friday i f you.have B.C. insurance and make an appointment; or, i f you don't have insurance, go"to their Youth C l i n i c on Thursday 6-9 p.m. Cost i s $2. 3. Author's f i e l d note October 13, 1971. The reader should note that I constructed this note several hours after terminating my v i s i t to"the C l i n i c . 4. During youth night i t i s routine c l i n i c a l practice to open a medical chart on each new patient. These charts are f i l l e d and are u t i l i z e d on each subsequent v i s i t to the Youth Night C l i n i c . These charts, however, are not usually reviewed during the oc-casion of chart rounds as the Youth Night C l i n i c patient popula-ti o n i s regarded as s t r i c t l y a transient patient population. 5. Author's f i e l d note October 13, 1971. 6. AutaiorVs f i e l d note November 4, 1971. 7. Raymond F i r t h , We, The Tikopia, (Boston: Beacon Press, 1957), pp. 3-4. 8. E.E. Evans-Pritchard, Witchcraft, Oracles and Magic Among the  Azande, (London: Oxford University Press, 1937), pp. 13-14. 9. EornexamplebarWerner Oswald, "The Basic Assumptions of Ethno-science", .Semiotica, (Vol. 1, 1969), pp. 329-338. 10. Evans-Pritchard, op. c i t . , p. 17. 11. Ibid. 78 12. See W.W. Sharrock, "On Owning Knowledge", i n Roy Turner, Ed., Ethnomethodology, (London: Penguin Books, 1974), pp. 45-54. 13. A.R. Louch, Explanation and Human Action, (Berkeley: The "University of C a l i f o r n i a Press, 1969), p. 159. 14. See D.L. Wieder, The Convict Code: A Study of a Moral Order as a Persuasive A c t i v i t y , (Unpublished doctoral d i s s e r t a t i o n , University of C a l i f o r n i a at Los Angeles, 1969), Chapter Four. 79 CHAPTER TWO ISSUES IN PRODUCING-AN ANALYTICAL DESCRIPTION Introduction In the preceding chapter, I looked at some of the features of the standard ethnographic format and examined some of the properties of those materials that may be'said to occur routinely i n the i n i t i a l part of an ethnographic report. The next section of this report were i t a "standard ethnography," would provide the reader with a detailed, a n a l y t i c a l description of some noteworthy aspect of C l i n i c organization. This would necessitate that I select some feature which I considered 1 to be p a r t i c u l a r l y important or interesting and describe i t i n d e t a i l and i n a way that i s responsive to the c u l t u r a l l y s i g n i f i c a n t behaviour of C l i n i c members. Instead of presenting such a description, this chapter w i l l attend primarily to the question: How i s i t that the ethnographer i s able to do a description of a setting i n the f i r s t place? Thereby, I w i l l consider my relationship to the research setting and how i t i s that I am able to select some aspect of C l i n i c organization from which to produce a description. I wMia-lsoaexami-neWiflyie relationship to the type of data that I have collected and look at some of the ways i n which I might u t i l i z e that data were i t my intention to provide a "standard description of C l i n i c organization." As i n the previous chapter, our focus w i l l be on the production of an ethnographic description i t s e l f . S p e c i f i c a l l y , this chapter w i l l discuss some of the issues involved i n producing a description of "chart rounds." The core of this chapter w i l l 8 0 be devoted to a look at the steps leading to the s e l e c t i o n of t h i s oc-casion as a topic i n an ethnographic report and to an examination of the manner i n which a d e s c r i p t i o n of i t s organizational features i s produced. I w i l l begin t h i s chapter with a review of some of the ways i n which a s o c i a l s c i e n t i s t could u t i l i z e the corpus of data which I c o l -lected during my research at the C l i n i c . This w i l l force us to consider the r e l a t i o n s h i p obtaining between the researcher and the research s e t t i n g . I w i l l examine 'the way i n which a medical s o c i o l o g i s t m±£'":. might u t i l i z e data c o l l e c t e d at the C l i n i c and w i l l demonstrate that such an approach f a i l s to preserve the i n t e g r i t y of those a c t i v i t i e s and oc-casions from which the data o r i g i n a t e s . I w i l l thereby show how i t i s that chart rounds constitute an appropriate possible topic f or further a n a l y t i c a l d e s c r i p t i o n . However, I w i l l argue that a d e s c r i p t i o n of an occasion should be responsive to how the members of the s e t t i n g organize that occasion, and point out some of the d e f i c i e n c i e s inherent i n t r a -d i t i o n a l ethnographic analyses. Next, I w i l l consider how a new approach to ethnography ( i . e . , cognitive anthropology) attends to the r e l a t i o n -ship between the researcher and .the research s e t t i n g . The research goal of t h i s new approach to ethnography, although admirable, i s c r i t i c i z e d as an unattainable goal. A f t e r considering some of the various ways i n which a researcher could.relate to the data gathered of the C l i n i c , I w i l l present the reader with what I term an "inadequate" d e s c r i p t i o n " of chart rounds. In t h i s way, I intend to demonstrate some of .tneaadvan-tages i n using t a l k as a resource f o r describing the s e l f - o r g a n i z i n g 81 features of an occasion. At the same time, the issues discussed i n this chapter are intended as an introduction leading up to the in t e r a c t i o n a l analysis of chart rounds presented i n the following chapter. This chap-ter, then, could be regarded as a map of the path that I ventured i n producing the description of chart rounds which occurs i n the following chapter. The Research Setting: TlAs Medical Sociology Approach I found myself i n the possession of many hours of audio tapes and many pages of f i e l d notes taken at the . C l i n i c . Like any researcher, I now faced the task of organizing this data and presenting i t to the reader i n a competently organized format. Since I did not have a research hypothesis directing my research, I had to consider the various ways i n which.my data, might best be u t i l i z e d i n a way that would r e f l e c t the re-search setting from which i t was collected. Therefore, as a f i r s t step towards a solution to this problem, I thought about some of the ways i n which a t r a d i t i o n a l medical sociologist might orient himself to research within the C l i n i c and how he might want to make use of the data which I had collected. The t r a d i t i o n a l approach would regard the privileged position of the researcher being " i n " the research setting as a way of obtaining information about how physicians treat lower class patients, how sta f f c o n f l i c t s are resolved, patients' attitudes towards physicians, the "informal" organizational structure of the C l i n i c , etc. He would f e e l free to use data collected from the entire range of s o c i a l interactions that.occur within the C l i n i c , and would not be required to attend to the 82 s o c i a l context from which h i s data was c o l l e c t e d . An example may help to show what I mean by t h i s . Let us assume that the researcher i s concerned with studying how physicians treat lower class patients. When I say that the researcher could u t i l i z e data obtained from within the C l i n i c and yet f a i l to at-tend to the s o c i a l context i n and by which that data was produced, I mean *v that he could use data obtained from such diverse pieces of i n t e r a c t i o n as medical examinations, coffee breaks, lunch-time conversations and so f o r t h as i n d i c a t i o n s of physicians' actual attitudes towards lower class patients. I t would be appropriate f o r the researcher to extract from the stream of C l i n i c behaviour those instances of i n t e r a c t i o n that somehow manage to support his.research i n t e r e s t s . However, an approach such as th i s presupposes that the researcher knows beforehand — i n terms of hypotheses, methodology and research d e s i g n — the nature and scope of the questions that h i s research was directed towards answering i n the f i r s t place. More .importantly, i t presupposes that the researcher knows what data would constitute s o c i o l o g i c a l l y relevant answers to such questions. I t i s apparent, however, that an o r i e n t a t i o n such as t h i s i s not a t t e n t i v e to occasions and a c t i v i t i e s as topics i n t h e i r own r i g h t . That i s , i t i s not concerned with preserving the i n t e g r i t y of the stream of C l i n i c behaviours but focusses upon t h e . C l i n i c as a l o c a t i o n f o r gaining information about some predecided research i n t e r e s t . That i s , an approach such as t h i s sees an event i n a second-hand way. I t sees what i t sees and reaches the conclusions that i t does only a f t e r f i l t e r i n g the events at hand through the prism of a p r e s p e c i f i e d package of 83 orientations and hypotheses. However, as I w i l l show, there i s an alter.-* native to t h i s approach. I t i s also possible for a s o c i a l researcher to attend tp the occasions and a c t i v i t i e s that occur within the C l i n i c as i n t r i n s i c a l l y i n t e r e s t i n g topics for i n v e s t i g a t i o n . That i s , i t i s pos-s i b l e to treat the data which one obtains from the research s e t t i n g as something bounded p r i m a r i l y by i t s actual context (context-sensitive) rather than something which w i l l . b e defined p r i m a r i l y by the nature of our research upon i t . Thus, an occasion such as chart rounds can become a proper s o c i o l o g i c a l topic i n i t s own r i g h t . I t i s my i n t e n t i o n to attempt such an analysis here. To begin with, chart rounds occur on a r e g u l a r l y scheduled b a s i s . They form a recurrent and bounded occasion.for members of the C l i n i c . That i s , they have prescribed beginning and ending times and constitute a normal and natural part of the working day f o r C l i n i c s t a f f . As such, they c o n s t i t u t e an i n t e r e s t i n g aspect of C l i n i c organization; an aspect which an ethnographer might.analyze i n d e t a i l . This present d e s c r i p t i o n i s directed towards an analysis of chart rounds, however, i t intends above a l l else to respect the i n t e g r i t y of t h i s occasion. I t w i l l do t h i s by describing how p a r t i c i p a n t s view and o r i e n t to i t as a normal and natural feature of t h e i r everyday l i v e s . In t h i s respect, such a des-c r i p t i o n d i f f e r s from the above mentioned medical sociology approach since i t i s the occasion of chart rounds i t s e l f that i s being examined rather than factors derived from any preconceived, extraneous research i n t e r e s t . 84 The Ethnographic Approach Si m i l a r l y , ethnographies are distinguished from most other re-searches by.their abiding concern to protect the i n t e g r i t y of the setting they study. They try to produce a description of how members themselves orient to a setting rather than impose his own (the ethno-grapher's) e x t r i n s i c categories upon i t . This means that the ethnogra-phic researcher must have f i r s t hand knowledge of how the society under study i s organized. Of course, this does not mean that the ethnographer has mojtheoretical interests, but rather that those interests which he does have must be subordinate to a description of how those c u l t u r a l members he i s studying actually view and organize t h e i r culture. A l -though we recognize that descriptions, such as Evans-Pritchard's presen-tation of Azande witchcraft, have relevance for broader anthropological issues (issues such as magic and r e l i g i o n ) , we can presume that these descriptions are intended primarily as descriptions of how the Azande organize their; witchcraft practices. . That i s , they are not intended as elaborations or part of some preconceived hypothesis about how witch-craft i s organized i n general. (Of. course,.Evans-Pritchard' o r some other theorist might make use of h i s descriptions i n th i s way i n some subsequent analysis.) Since I: was concerned with the production of an a n a l y t i c a l descrip-t i o n of chart"rounds,.I was forced to examine the t r a d i t i o n a l ethnographic approach. I soon found that such an approach might be less responsive to the i n t e g r i t y of the research setting than i t f i r s t seemed to be. At this point, I would l i k e to introduce some materials that, at f i r s t glance, 85 might seem to bear l i t t l e r e l a t i o n to the topic of ethnographic des-c r i p t i o n . That i s , I s h a l l consider some findings gleaned from research into the s o c i a l psychology of experiments. The relevance of these materials should become apparent over the course of the following d i s -cussion. A vast amount of .'literature has recently been devoted to what has been termed the s o c i a l psychology of the experiment."'" Researchers have attempted to abstract and examine some of the organizational features that researchers and subjects attend to when conducting or p a r t i c i p a t i n g i n an experiment. Thereby, much attention has been focussed upon the ongoing matrix of s o c i a l l i f e i n which, experiments necessarily occur. For example, those doing experimental s o c i a l research often talk about "dependent" and "independent" variables. They try to inform their readers about those variables which were under thei r control and those which were not. The experimental researcher t e l l s how his subjects were selected, what they knew or did not know about the experiment at hand, etc. Yet, research into the social.psychology of experiments has shown how the experimental-situation i s eminently connected.to the everyday r e a l - l i f e - w o r l d of the researcher and his research subjects. For i n -stance, students may i n fact know beforehand or be able to make accurate guesses about the design and intent of the research, and so on. A l l of these may occur outside of the experiment proper. Yet as current c r i t i c s point out,, i t i s only because the experimental s i t u a t i o n i s a part of our ongoing r e a l l i f e that i t i s made available to us as a topic for emperi-ca l investigation. Because this i s so, i t i s f u t i l e to speak of 86 "independent" or "dependent" variables i f we f a i l to attend to those background expectancies which allow for the organization of the ex-periment. The experimental researcher usually ignores, and feels j u s t i f i e d i n ignoring, factors such as these. I t i s apparent however that, were i t not for features such as these, i t would be impossible for him to conduct an experiment. In this way, experimental research abstracts observations about human behaviour out of the context of everyday l i f e and ignores the fact that actions are irremediably a part of the context i n which they occur. Needless to say,, such an approach i s of limited u t i l i t y and, while i t might purport t o . t e l l us something about pain, pleasure, the behaviour of crowds, etc., i t w i l l t e l l us nothing about how these come to be recognizable phenomena i n the f i r s t place. Although ethnographers do not speak of dependent or independent variables, the construction of an ethnographic report displays similar features. That i s , the ethnographer, assumes that he can simply and as a matter of routine, make observations related to various anthropolo-g i c a l topics as i f those topics were observable independent of the 2 matrix of everyday l i f e i n which he found them. That i s , although ethnographers have a more loosely' defined research language and speak i n terms of s o c i a l organization, r e l i g i o n , magic, p o l i t i c s and power, the family, economic organization, and the l i k e , i t i s often the case that these subjects are abstracted from the s o c i a l context i n which they were encountered i n the course of f i e l d research. When the ethnographer makes a f i e l d note about, say., kinship organization, that note came from some-where. I t may have been generated from data which he picked up while 87 eating a meal, while walking with an informant, from overhearing a conversation, or from various situations which he may have encoun-tered. To see each piece of data primarily as an instance of k i n -ship organization i s to deny the i n t e g r i t y of the s o c i a l situations from which the information was collected. In some mundane sense, members of a culture do not just happen to exhibit kinship organiza-t i o n (or anything else for that matter). And to view some feature or features of a society as phenomena routinely displayed as a part of everyday l i f e i s to ignore the s o c i a l situations from which ethnogra-phers extract their data. Thus, t r a d i t i o n a l ethnographic description may inadvertently impose a pre-existing framework on a description of another culture by going to the f i e l d "armed" and "programmed" with a set of theoretical issues and topics that tend to .make their ethno,-r graphic report:less responsive to the self-organizing features of re-current bounded occasions and a c t i v i t i e s . Thereby, too, they ignore the world of : d a i l y l i f e as a primary topic for investigation. Since my concern was with the production of an a n a l y t i c a l des-c r i p t i o n of chart rounds, I considered this t r a d i t i o n a l ethnographic approach and came to the conclusion that although such an approach was concerned with.preserving the i n t e g r i t y of the research se t t i n g , i t f e l l far short of i t s aim. Recently, however, t r a d i t i o n a l ethnographic des-criptions have been reconsidered and their goals have been reformulated. The result of this reconsideration has been called the "new ethnography" or cognitive anthropology. I soon turned to this new approach to eth-nographic description i n the hope that i t would help me to produce a 88 description which would respect the i n t e g r i t y of the C l i n i c . Some of the prominent features of this new approach to ethnogra-phic description have been outlined by Tyler i n the introduction to his work, Cognitive Anthropology. He t e l l s us that, i n contrast to other, older ways of doing an ethnography, ...cognitive anthropology constitutes a new theoretical orientation. I t focusses on discovering how different peoples organize and use t h e i r cultures. This i s not so much a search for some generalized unit of behavioral analysis as i t i s an attempt to understand the organizing p r i n c i p l e s underlying behavior. I t i s assumed that each people has a unique system for perceiving and organizing ma-t e r i a l phenomena — things, events, behavior,and emotions. The object of study i s not these ma-t e r i a l phenomena themselves, but the way they are organized i n the minds of men. Cultures then are not material phenomena; they are cognitive organi-zations of material phenomena. Consequently, cultures are neither described -by mere arbitrary l i s t s of anatomical t r a i t s and i n s t i t u t i o n s such as house type, family type, kinship type, economic type, and personality type, nor are they necessar-. i l y equated with some ov e r - a l l integrative pattern of these phenomena. Such descriptions may t e l l us something about the way an anthropologist thinks about a culture, but there i s l i t t l e , i f any, reason to believe that they t e l l us anything of how the people of some culture think about thei r culture. In essence, cognitive anthropology seeks to answer two^questions: What material phenomena are s i g -gnificant for the people of some culture; and, how do they organize these phenomena.3 To u t i l i z e t his approach i n attempting a description of chart rounds necessitates a concern with the ways i n which the members who participate i n chart rounds cognitively organize the occasion. By t h i s I mean not only that my description must respect the i n t e g r i t y of t h i s occasion, but also that i t must discover and describe the way(s) i n 89 Vhi'ch the s t a f f produces the occasion as a regular and recurrent feature of l i f e at the C l i n i c . Naturally, to respond to the aims of a d i s c i p l i n e such as cognitive anthropology i s to r a i s e issues about data c o l l e c t i o n and about .what i s to be.done with the data a f t e r i t has been c o l l e c t e d . These issues w i l l be discussed l a t e r . For the moment I would l i k e tooconsider Tyler's formulation of the research goal of cognitive anthropology: The "theory" here i s not so much a THEORY OF CULTURE as i t i s theories of cultures, or a theory of descriptions. The aim of such a theory i s to provide answers to the questions: How would the people of some other culture expect me to behave i f I were a member of t h e i r culture; and what are the r u l e s of appropriate behavior i n t h e i r c u l t u r e . Answers to these questions are provided by an adequate d e s c r i p t i o n of the ru l e s used by the people i n that culture. Consequently, t h i s d e s c r i p t i o n i t s e l f constitutes the "theory" f o r that culture, for i t represents the conceptual model of organi-zation used by i t s members. Such a theory i s vali d a t e d by our a b i l i t y to predict how these people would expect ,us to behave i f we were mem-bers of t h e i r c u l t u r e . ^ I t i s not my in t e n t i o n to engage i n a c r i t i c i s m of cognitive anthropology.^ I would, however, l i k e to note two features derivable from Tyler's preceding comments; F i r s t , and a p o s i t i v e feature, i s the way that t h i s approach d i r e c t s the ethnographer to discover how s o c i a l scenes and structures are organized from the standpoint of the members who produce them. To t h i s end, the very f a c t that some scene can be recognized as an. "X" i n the f i r s t place i s made a topic f o r i n -v e s t i g a t i o n and i s not simply incorporated into the ethnographer's a n a l y s i s . Second, and a negative feature, i s that the research goal of cognitive anthropology i s not att a i n a b l e . Some of the reasons why th i s 90 i s so have been discussed i n the preceding chapter, however, th i s w i l l require further elaboration. I t seems as i f , for the cognitive anthropologist, an adequate ethnographic description consists of an analysis that would allow the reader who had the opportunity and wished to do so, to behave i n ways that would be deemed c u l t u r a l l y appropriate by members of the society which he i s describing. This i s an utterly, impossible goal for at least two reasons, the f i r s t reason i s not nearly as interesting as the second. Let us consider the recommendation from the standpoint of an ethnographer who wishes to produce an adequate ethnographic description of chart rounds. I t should be obvious that no matter how detailed or responsive a description of members' cognitive organization or doing of chart rounds i s made, i t could never allow the reader to act as a f u l l y competent participant to a l l aspects of this occasion. For instance, a necessary component of such competence i s a certain degree of medical expertise and no matter how detailed and sophisticated my description became, the reader would not be able to act as a f u l l y competent member of the C l i n i c such that he could.fully p a r t i c i p a t e i n this occasion unless he were w i l l i n g and able - to acquire the appropriate medical t r a i n i n g . The second and more interesting point i s that of common-sense relevancies. That i s , the construction of any description requires that the ethnogra-pher u t i l i z e his own predetermined set of common-sense relevancies with reference to which items are to be included or omitted from his description. This point was discussed i n d e t a i l i n the preceding chapter. Further, the ethnographer not only uses his own set of common-sense relevancies to produce his description, but also r e l i e s upon his reader to employ their own common-sense knowledge to inform or to f i l l i n the ethno-graphic description. While. Tyler's comments seem to suggest that the ethnographer would be able to describe everything one would need to know i n order to act as a competent c u l t u r a l member.1?, as I have demonstrated here, to attempt any complete description i s an impossible task to attempt. Tyler.and others'have, however, f a i l e d to take this into account After examining t r a d i t i o n a l ethnographic description and the recommendations promulgated by the exponents of cognitive anthropology, I found that T s t i l l faced.the task of producing an a n a l y t i c a l descrip-tion of chart rounds. I f e l t that any description that I produced should respect the i n t e g r i t y of the occasion but I also realized that my description would not enable the reader, to act i n the same ways that a f u l l y competent participant..to t h i s occasion would i n fact act. Fur-thermore, unlike t r a d i t i o n a l ethnographers or those engaged i n cognitive anthropology, I did not have some a p r i o r i theoretical or t o p i c a l i n -terest .in the research setting before commencing my research. In many ways this proved to be an asset for I was trying to make the best possible sense of what .I was observing'at the C l i n i c . With no research proposal, design, or hypothesis to be empirically proved or disproved, I was often free to do so. Thus, while I propose to offer a more a n a l y t i c a l descrip-tion of some aspects of C l i n i c organization, namely chart rounds, the generation of this description was prompted by my examination of the 92 issues involved i n the production of an ethnographic description, and c h i e f l y my consideration of t r a d i t i o n a l and cognitive anthropologies • The preceding discussion has dealt with the manner i n which a researcher could relate tolthis description of some aspect of a setting's organization. I t has not, however, provided the reader with any d e f i n i t i v e recommendations for the construction of such a description. However, i t i s interesting that descriptions are something which I/we have been doing'as a member of society long before gaining any pro-fessional s o c i o l o g i c a l competence. For instance, i t i s by and through our everyday common-sense knowledge that we can see that the occasion of chart rounds could constitute a possible and appropriate subject for further investigation i n a standard ethnography. This, l i k e any of our ongoing a f f a i r s i n the l i f e - w o r l d i s intimately connected to our a b i l i t y to use a vast amount of common sense. What follows i s a description of chart rounds. I t i s a description which I have labeled as "inadequate." The reasons for this w i l l be examined after the reader has had a chance to examine i t s contents. Chart Rounds: A H e u r i s t i c a l l y Inadequate Description Chart rounds i s a scheduled occasion for reviewing patients' medical h i s t o r i e s . I t i s .a review of patients' charts. During my research, there were two occasions w;rhie^eino:some of i&s.ec<b£ai^ c Sights, tfeirfes--were eahacmgnejdd. At f i r s t , chart rounds consisted of a review of the charts of those patients scheduled to be seen on that day. This review took place i n the morning, around 8:30 a.m., that i s before seeing any patients. Later, this procedure was changed to a review of the charts 93 that belong to those patients who had been seen on the previous day. When I questioned a nurse about the reason or reasons for t h i s round-about change, I received the following account:^ Researcher:. And morning yeah, what was the reason fo r changing chart rounds? Nurse: Well we decided that we were missing a l o t of people and a l o t of the people we were discussing weren't coming i n i t would be better to discuss i t a f t e r they came i n and cover everybody. This procedure was also changed. The following explanation of t h i s new 8 change i n procedure was offered to me by the d i r e c t o r of the C l i n i c : D i r e c t o r : ...We're j u s t modifying our chart round procedure a l i t t l e Bruce Researcher: Urnm mm Dire c t o r : i n that ah ah we're we're going to change the system so that one of the part-time one of the f u l l time family doctors i s going to be responsible for a student each two weeks Researcher: I see Dir e c t o r : and part of t h e i r job have you met Sh e r r i (Note: at t h i s point an introduction occurs between a member of s t a f f and a new medical student)... Ah the ah the ah idea w i l l be that the family doctor w i l l go through a l l of the charts from the preceding day and try to s e l e c t out Researcher: Dir e c t o r : Urnm mm Urnm mm ah representative group ah which w e ' l l sort of go over... Note the taken-for-grahted character of chart rounds. This i s attested to by the lack of concern which C l i n i c s t a f f display i n o r i e n t i n g 9 4 to their occurrence. Chart rounds take place every day at prescribed times. They constitute one of the many demand characteristics which C l i n i c s t a f f orient to i n the course of thei r d a i l y occupational rou-9 tines. Chart rounds are a part of the schedule of the C l i n i c . There-by, such things as medical appointments are scheduled i n a way that w i l l not c o n f l i c t with the time allb.tited for chart rounds. Indeed, I have seen physicians hurry through an examination i n order to be on time for chart rounds. When sta f f arrive l a t e for chart rounds, how-ever, i t i s not normally necessary to offer an apology; they usually j u s t enter the room and take a seat. A minimal number of participants i s required i f chart rounds are to proceed as scheduled. I have observed that at least one physician, and at least one other medical person (usually a nurse or a medical student) i s required. This necessary minimum complement of personnel i s f a c i l i t a t e d by having a scheduled time and place for reviewing charts. Thus, on any given day,members of the C l i n i c know who they may expect to see at.chart rounds for they are f a m i l i a r with each other's schedules. This does not mean that chart rounds do not take place i f a usual or ex-pected participant has not arrived, but his absence provides grounds for starting without him. Chart rounds are scheduled to l a s t approximately f o r t y - f i v e minutes. That i s , they have a scheduled beginning and a scheduled end, and are geared into some notion of time which participants orient to i n thei r jobs at the C l i n i c . While reviewing the charts requires a minimum complement of p a r t i -cipants, i t i s t y p i c a l l y the case that only one st a f f member presents 9 5 (that i s , has control of) the charts. Physicians and nurses take turns presenting the charts to the rest of the group that has assembled for chart rounds. I f , for some reason, the.person scheduled to present the charts i s absent, one of the other s t a f f members w i l l present the charts, and i f the person who was i n i t i a l l y supposed to present the charts should arrive while a review i s i n progress, the charts are not relinquished to him. Sometimes, the charts scheduled f o r review.were assembled by the secretary on the previous evening; at other times they were selected by a physician just p r i o r to chart rounds. Thus, they were made ready, for the person presenting the.charts during chart.rounds. A l l the charts i n the p i l e had to be reviewed, so..that members were able to orient to the progress of any par t i c u l a r occasion by noting the number of charts l e f t to be reviewed. Chart rounds are intended .primarily-as a procedure which w i l l f a c i l i t a t e and promote'better patient care but they serve other functions as w e l l . They provide an occasion for s t a f f to exchange and to pool thei r knowledge about diagnoses, treatment,, and so on. That i s , they serve as a general forum where .pertinent information i s exchanged. Some-times, a chart w i l l generate discussions about current a r t i c l e s i n medical journals, about research, about new techniques i n surgery, etc. Organiza-t i o n a l l y , chart rounds are an' occasion where physicians and nurses can and should take the opportunity to f a m i l i a r i z e themselves with current advances i n the medical profession. Of course, they also serve as a training session for medical students. A patient's medical chart..is always available as a document-in-use 96 for the benefit of medical personnel.. I t constitutes a patient's natural history and i s referred- to as a matter of routine i n almost every interaction between physician and patient. A patient's chart consists.of a standard 8 1/2 x 11 inch f i l e folder which i s divided into two parts; a "face.sheet" i s attached to .the l e f t hand portion of the folder. A face sheet i s a medical form containing general informa-t i o n about the patient: name, address, age,., occupation, and B r i t i s h Columbia Medical Insurance number. This form remains i n the patient's chart for a l l subsequent encounters with the C l i n i c . In addition to the face sheet, the patient Is chart contains, another form. This i s composed of detachable .sections for,laboratory work, a section for the writing of prescriptions, and a return appointment' date for the patient. The physician consults t h i s form during every encounter with a patient. I t i s constantly updated. A completed medical form .is l e f t i n the patient's chart and i s la t e r re-arranged i n the following manner. A " v i s i t record" form i s attached to the face sheet. This form contains a b r i e f summary of what occurred during a patient's v i s i t . Each.time the patient v i s i t s the C l i n i c , another " v i s i t record" form i s placed above the form which represents the preceding v i s i t . A h i s t o r i c a l .record of the patient's v i s i t s to the C l i n i c i s thereby easily available. To the righ t hand portion of a patient's chart i s attached a l l other medical documents and laboratory reports. Thus when a physician opens a patient's chart the information contained therein i s usable f o r the purposes at hand — a medical interview or chart rounds. 97 Chart rounds constitute for their participants an occasion characterizable by the necessity to "get through" them."'"^  "Getting through", however, i s not subject to the capriciousness of the i n -dividual participants. The successful accomplishment of a review of the charts i s tied to and interrelated to u t i l i z i n g the patient's chart to s a t i s f y the organizational features mentioned thus f a r . Whatever t a l k that occurs during chart rounds i s oriented to these features. I t i s ta l k by medical personnel being medical personnel. The above description of chart rounds i s decidedly more analy-t i c a l than the i n i t i a l description which I presented i n the previous chapter. Following the standard ethnographic .format, I provided the reader with some prefatory, chatty comments about the C l i n i c i n general and a subsequent detailed analysis. I t s a n a l y t i c a l status, however, i s not a feature of i t s p o s i t i o n . i n the standard ethnographic format, but derives ff.rom--<theu fact tfhati.it i s a detailed description of some sp e c i f i c aspect of c l i n i c a l organization. The description of chart rounds presented above i s supposedly informative about the ways i n which participants accomplish i t s organization. The word 'supposedly' i s used deliberately for I regard the above description as ana-inadequate one. . An alternative description w i l l be offered i n the next chapter. At this point, however, l e t us consider some of the factors which make for an inadequate description. The above description of char grounds i s not an incorrect descrip-tion. Yet, i t could be c r i t i c i z e d on the grounds that i t does not provide enough information about the occasion. This c r i t i c i s m could be attended 98 to by expanding the d e s c r i p t i v e material to include, f o r example, f i e l d notes or t r a n s c r i p t s of things said during the occasion. The problem facing the ethnographer however, i s not that of providing e i t h e r , _ moo rsioe-e ojr le s s data but deciding what the guidelines are f o r the construction of an ethnographic report. What i s i t that an analyst of some s o c i a l scene must attend to i n order to produce a d e s c r i p t i o n that i s responsive to h i s observations and preserves the i n t e g r i t y of the s e t t i n g under consideration? To provide a tentative answer to t h i s ques-t i o n , one must consider the r e l a t i o n s h i p between the researcher and the everyday world of the society he i s i n v e s t i g a t i n g . Let me elaborate. It i s an inescapable f a c t that s o c i a l s c i e n t i s t s , l i k e any other members of the world of d a i l y l i f e , see the world as a sensible and manageable phenomenon. Their everyday being i n the world i s not usually problematic f o r them. Note, for instance, how members of the C l i n i c found nothing strange, unusual, or problematic about the p r a c t i c a l accomplish-ment of chart rounds. Instead, they were taken for granted as a routine feature of l i f e around the c l i n i c . Once I became acquainted with the d a i l y routine of the C l i n i c , I was also able to r e l a t e to chart rounds i n t h i s way. That i s , they soon became a routine and an expected part of my l i f e as a researcher at the C l i n i c . And I found parts of my l i f e oriented to chart rounds as a matter of course. To treat t h i s common-place order of the C l i n i c and p a r t i c u l a r l y chart rounds as problematic i s , however, an analyst's device to f a c i l i t a t e the production of an ethnogra-phic d e s c r i p t i o n of t h i s routine C l i n i c occasion. Members do not see the same problems as researchers do. G a r f i n k e l explicates the analyst's 99 position when he states: In exactly the ways that a setting i s organized, i t consists of •members' methods for making evident that setting's ways as clear, coherent, p l a n f u l , consistent, chosen, knowable, uniform, reproduc-i b l e connections, — i . e . , r a t i o n a l connections. In exactly the ways that persons are members to organized a f f a i r s , they are engaged i n serious and p r a c t i c a l work of detecting, demonstrating, and persuading through displays i n the ordinary occasions of their interactions the appearance of consistent, coherent, clear, chosen, p l a n f u l arrangements. In exactly the ways i n which a setting i s organized, i t consists of methods whereby i t s members are provided with accounts of the setting as countable, storyable, proverbial, comparable, picturable, representable — i . e . , accountable events.H Thus the problem facing the ethnographer i s to discover how the members he i s observing.utilize procedures and methods for producing recognizably, coherent s o c i a l scenes. In attempting to provide an ethnographic des-c r i p t i o n of chart rounds, I w i l l take the very fact that they are events as problematic, and w i l l attempt to explicate the procedures employed by the members of the C l i n i c i n their production of chart rounds. In other words, an ethnographic description of chart rounds should attend to the self-organizing features that C l i n i c members u t i l i z e i n producing this occasion. In contrast, the description of chart rounds that I presented e a r l i e r does.not constitute ,a description of this type. Instead, i t merely provides the reader, with a description of what trans-pires. For this reason I have termed the previous description of chart rounds an inadequate' description s i n c e ' i t does not attend to providing a description of the self-organizing features of this occasion. That the ethnographer should attend to the self-organizing features 100 of some s o c i a l scene i s i t s e l f a recommendation. However, there i s s t i l l a problem about what the fundamental source of data for conducting such research w i l l be. That i s , what w i l l constitute evidence of the s o c i a l organization of some observable s o c i a l scene, and how w i l l t his data be u t i l i z e d ? whatever the da'fcaogs.yp'&fermust be an i n t r i n s i c feature of the a c t i v i t y under study. That i s , i t must be produced and u t i l i z e d by parties to the setting as an essential part of their everyday a f f a i r s . If we are to study members' everyday a f f a i r s and a c t i v i t i e s , we must u t i l i z e data that r e f l e c t these concerns. We should be able to attend to the actual ongoing d e t a i l s of an event when offering descriptions thereof. We can do th i s i n an abstract way, but, nevertheless, such a description should be responsive to the actual d e t a i l s of those s o c i a l scenes being described. A candidate piece of data for such a descrip-tion i s members' ta l k as i t occurs i n and over the course of sequences of interaction. Since the next chapter.presents an analysis of con-versational materials , ( i . e . , transcripts of recorded sessions of chart rounds), I would l i k e to discuss the u t i l i t y of these materials for study and description" of s o c i a l organization. Talk and the Organization of Chart Rounds In the course of my research I was able to observe and tape record various segments.of i n t e r a c t i o n ithat occurred during chart rounds. Such recordings constitute a f a i r l y detailed record of the occasions, for f i r s t , t a l k i s a pervasive feature of s o c i a l l i f e and, of course, the 101 use of a tape recorder adds substantially to one's memory and to the r e l i a b i l i t y of one's f i e l d notes. But secondly, and most importantly, these materials are an exceptionally good record of chart rounds since these rounds are designed s p e c i f i c a l l y for the purpose of discussing patients' medical h i s t o r i e s . Talk does not f a c i l i t a t e some other ob-j e c t i v e , for.example, giving a patient an i n j e c t i o n or taking a blood sample, but rather talk i s central to.this occasion, that i s , were no tal k to take place here, chart rounds would be impossible i n the f i r s t place. Chart rounds, then, i s an in t e r a c t i o n a l and conversational oc-casion such that the ta l k which, transpires over theeco.urseiof dts occurrence . i s central to the self-organizing, character of the occasion. A good deal of the i n t e g r i t y of the occasion.is preservable by audio tapes. I propose,that an ethnographic description of chart rounds should be responsive to the.kinds of organizational features that are locatable 12 'within isuch'a data record. . I am not proposing that talk constitutes a l l that occurs during the occasion of chart rounds for i t i s easily observable that things other than.talk routinely occur as an in t e g r a l part of the occasion. Thus, people routinely.stay seated,. look at each other, leave the room to answer the phone, and so for t h . . The.list i s v i r t u a l l y endless and I have not attended to such occurrences aside from those instances i n -corporated into the subsequent analysis.. Furthermore, while things other than t a l k occur, i t i s presumed and presumable that the reader w i l l make use of his common-sense knowledge i n order to incorporate these taken-for-granted -.features of the world into his analysis of these 102 occasions. As stated i n the previous chapter, i t would be impossible for the ethnographer to construct any report i n the f i r s t place i f he were not able to re l y on his audience to use their common sense, that i s , to f i l l out and inform the description which he offers them. S p e c i f i c a l l y , then, transcripts made from tape recordings of chart rounds w i l l constitute the data for my analysis of this routine C l i n i c occasion. Thereby i intend to-examine a member's ta l k as constituting displays i n and through which members accomplish and give to their actions the appearance of consistent, coherent, clear, chosen, planful arrangement.'1"^ That i s , my analysis . w i l l .treat memberss' conversations as an index for determining how talk i s a constituent feature of the organization of da i l y l i f e . As I said before, the format of chart rounds was changed twice during my research at the C l i n i c . These changes were i n s t i t u t e d s i n order to increase the effic i e n c y of patient care. While such changes occurred for organizational reasons:, I am suggesting that there are certain invariant features that C l i n i c staff must necessarily orient towards 5Ln order to (1) allow.changes i n procedure to be recognized as such, and (2) provide for these changes to be easily implemented. Thus i n my next chapter I w i l l attempt to describe some of the features which provide for the inte r a c t i o n a l structure of chart, rounds. I w i l l not be concerned with predicting what w i l l , as.a c e r t i f i a b l e matter of f a c t , be said at some subsequent chart rounds. While i t i s possible for C l i n i c s t a f f to i n s t i t u t e changes i n i t s chart round procedure, i t i s the inva-r i a n t features of the occasion that allow for changes i n procedure!to 103 occur i n the f i r s t place. These are the things that I intend to study. Our attention w i l l now be directed•towards a detailed examination of the routine features of chart rounds. 104 Footnotes: Chapter Two 1. See A.J. Crowle, Post Experimental Interviews: An Experiment and  a S o c i o l i n g u i s t i c Analysis. Unpublished doctoral d i s s e r t a t i o n , U n i v e r s i t y of C a l i f o r n i a , Santa Barbara, 1971, N e i l Friedman, The  S o c i a l Nature of Psychological Research: The Psychological Ex- periment as a S o c i a l Interaction. (New York: Basic Books, 1967), Martin T. Orne, "On the S o c i a l Psychology of the Psychological Experiment", American Psychologist, November 1962, pp. 776-783,, and Roy Turner, "The Ethnography of Experiment' 1, American- Behavioural  S c i e n t i s t . 2. By way of i l l u s t r a t i o n consider the following excerpt from a doctoral candidate's research proposal: , ; The main topic of research i s a d e t a i l e d examination on the ideology and operation of leadership i n a Melanesian society. A c e n t r a l aim of the study w i l l be to depart from the common emphasis on personal c h a r a c t e r i s t i c s as determinants of leadership i n Melanesia. The s t r a t e g i c focus of the study w i l l be the analysis of the r e l a t i o n s between leaders and followers QUESTIONS TO BE POSED IN THE FIELD:...!. Arenas of p o l i t i c a l competition: What are the arenas of p o l i t i c a l competition and how are these defined?...Are c e r t a i n kinds of c o a l i t i o n s s t r u c -t u r a l l y enjoined, i n h i b i t e d , or prohibited? What normative rules are appropriate i n which arenas? How does a l l the above a f f e c t strategies of leader-ship?... 3. P o l i t i c a l resources: How are p o l i t i c a l resources defined? Has the d e f i n i t i o n of p o l i t i c a l resources changed over time? How?...TECHNIQUES AND METHODS: 1. Formal Interviewing. Formal interviews w i l l be conducted along the l i n e s suggested by Black, Metzger, and others to e l i c i t the conceptual frame-work of p o l i t i c a l a c t i v i t y . . . . A n important goal i n t h i s phase of work w i l l be to discover the ways i n which people conceive of and t a l k about p o l i t i c s and the determination of meaningful questions that can be asked about p o l i t i c s . . . . 5. P a r t i c i p a n t observation. P a r t i c i p a n t observation w i l l carry much of the burden of data c o l l e c t i o n and w i l l be p a r t i c u l a r l y important i n the analysis of disputing and p o l i t i c a l manoeuvring which may occur during the time spent i n the f i e l d . Thus, we hThusf.nwenhav.ecanoinstancehofpanoanthropoibQgisttgoingetd the f i e l d programmed with a set of preconceived research i n t e r e s t s and goals. It would appear that, i n observing " p o l i t i c s , " much of the matrix of everyday l i f e from which such observations w i l l be abandoned for some p r i o r t h e o r e t i c a l i n t e r e s t when i t comes time to construct the f i n a l monograph. 105 3. Stephen T y l e r , Ed., Cognitive Anthropology, (New York: Holt Rine-hart, and Winston, 1969), p. 3. • 4. I b i d . , p. 5. 5. For a d e t a i l e d discussion of the cognitive anthropology approach see Peter E g l i n , A Taxonomy of Canadian Doctors: Ethnosemantics and Ethnomethodology, Unpublished doctoral d i s s e r t a t i o n , The Uni-v e r s i t y of B r i t i s h Columbia, forthcoming. 6. For a further discussion of t h i s point see Harold G a r f i n k e l , (Ibid.) pp. 24-31. 7. Transcribed from a tape recorded session of chart rounds. 8. Ibid . 9. I am using the term "demand c h a r a c t e r i s t i c s " i n the same sense as Roy Turner uses i t i n h i s paper "Occupational Routines: Some Demand Ch a r a c t e r i s t i c s of P o l i c e Work", presented to the Canadian Sociology and Anthropology Association, Toronto, June 1969. He s t a t e s ! "By demand c h a r a c t e r i s t i c s I mean to r e f e r to those s i t u a t i o n a l and con-textual features which persons engaged i n everyday routines o r i e n t to as governing and organizing t h e i r ^ a c t i v i t i e s . . . " 10. This formulation i s borrowed from a working paper by Melvin P o l l n e r , Department of Sociology U n i v e r s i t y of C a l i f o r n i a at Los Angeles e n t i t l e d "Working Notes on Ad-Hocing i n a S e l f - E x p l i c a t i n g F i e l d . " P o l lner uses the term "getting through" i n r e f e r r i n g to, for instance, how t r a f f i c court i s an occasion requiring courtroom personnel to "ge gget through i t " . 11. Harold G a r f i n k e l , op. c i t . , p. 34. 12. The use of transcribed material i s often c r i t i c i s e d on the ground that i t does not constitute an adequate i n t e r a c t i o n a l record since t r a n s c r i p t s do not attend the p a r a l i n g u i s t i c features of face-to-face i n t e r a c t i o n . Within our society, however, t r a n s c r i p t s are often used i n making serious and consequential decisions. For ex-ample, appellate courts often consult the t r a n s c r i p t s of lower court proceedings i n a r r i v i n g at t h e i r v e r d i c t . Such t r a n s c r i p t s are not regarded as inadequate because they do not contain p a r a l i n g u i s t i c features. That i s , they are not regarded as d e f i c i e n t , u n i n t e l l i g i b l e , open to a thousand and one i n t e r p r e t a t i o n s , and so f o r t h . I t would < ^ abpearrtosbeiatpre-theoreticalaf aetho.f. l i f e lihatotranser.dipts have-a usablegstatused'espite tffietf act Lthatitheyjdoi not^attend t t o :par-alin-guis.tie-;features o f t i n t e f actofomie Whiifcewaelcn6wjkedgingtthat5t.tr.ans-criptionsddoonotrattend^toucertafnifeaturesoof interaction.;! t h i s -dbesenotlmean that there w i l l be any necessary " f a t a l flaw" i n any analysis that may be performed upon transcribed material. That 106 members of society can u t i l i z e t r a n s c r i p t s and render p r a c t i c a l and consequential decisions from them i s i n d i c a t i v e that they do not have the e s s e n t i a l weaknesses that opponents to t h e i r use claim for them. An examination of t r a n s c r i p t s of C l i n i c chart rounds should allow us to discover some of the se l f - o r g a n i z i n g features of t h i s occasion. 107 CHAPTER THREE CHART ROUNDS: AN INTERACTIONAL ANALYSIS Introduction It i s the purpose of th i s chapter to do an examination of a piece of data obtained from a session of chart rounds. During the course of my research I was able to secure a number of audio tapes and, consequently, to produce numerous t r a n s c r i p t s of what transpired on each occasion that was recorded. The instance to be examined was extracted from t h i s corpus of materials. In the following, a nurse i s presenting the charts of those patients to be seen by c l i n i c s t a f f on that day. The TheaData 1. Doctor A. This i s ah you know the ah upper (bar) of the ah lower (bar) of the femeral gland 2. Doctor B. Um QUesecci pause) 3. Nurse John Doe 4. Doctor B. Who? 5. Nurse John Doe (spoken louder than i n Utterance 3) 6. Doctor A. He's a routine baby who's a b i t constipated 7. Doctor B. That's ah the 8. Nurse The commune 9. 9. Doctor B. Oh yeah John Doe ( ) 10. Nurse ( ) 11. Doctor A. They've put him a b i t early f o r t h i s afternoon. I don't know whether he's coming to see me or to see you but I s h a l l be s o f t of squeezed I , think to get back i n time you deal with i t 108 12. Doctor B. Well ah Mama's patient 13. Doctor A. Urnm? 14. Doctor B. Mothers a patient woman 15. Nurse He's probably here for 16. Doctor A. Oh yeah he's a month from his last shot so that's (mostly what he's here for 17. Doctor B. He had mumps? 18. Doctor A. Urnm? 19. Doctor B. Did you say he had mumps? 20. Docdor A. Ho ah month 21. Doctor B. Oh ah month 22. Nurse He's here for his second shot 23. Doctor A. Judy was (pause) Judy.was immunizing him I guess. Have we got him on fluoride? 24. Nurse Yeah 25. Doctor A. Yep ((Doctor has looked at chart)) I saw that the enlightened citizens of North City had voted for... Before starting our analysis, the reader should note that I did not select this instance by referring to any preconceived method or methods for data selection. While an analysis has indeed been produced, i t was not generated by a preconceived interest TthatH'had in mind" prior to an examination of the corpus from which i t was taken. Although i t is true, £hatithisrpar.Meular piece of data would not have been used were I unable to produce some analysis of i t , i t i s important that the reader realize that i t was selected in a relatively unmotivated manner. The data was not selected via a "coding procedure" where I had a set of analytical issues 109-and a set of categories that would allow me to select instances of data that would be appropriately responsive tossuch categories. The abbve data, then, i s not to be regarded either as a sample of chart rounds or as a typical occurrence thereof. Rather, I selected this particular piece of conversation because i t happened to strike my interest, and i t is from this i n i t i a l interest that the subsequent analysis took form. A Characterization of the Data As a beginning we might offer a single,simple characterization of of the data, e.g., there appears to be a progression from talking about one patient to talking about another. While this observation may i n i -t i a l l y appear to be of l i t t l e interest, i t is nevertheless an ob-servable feature and responsive to the data. Having noticed this, i t might now be attended to in a more analytical fashion and come to reveal a more complicated structure than is f i r s t apparent. If we are to at-tend to the self-organizing features of this occasion, we should attend to the fact that progress from one chart to another is something which i s oriented or attuned to by participants and thus a legitimate topic of i n -vestigation despite (and some would say because of) i t s mundane appearance. The ser i a l review of the charts i s an artfully and intricately ac-complished activity. Progression from one chart to another i s problem-atica l for the participants in many ways. For example, they face a problem with reference to the opening and closing of talk generated by the review of a specific chart or patient. The problem of how to terminate talk generated from a review of one chart and progressing to a review of the next is a constraint faced by the person presenting the charts. He 110 or she has some control over the procedings and an obligation to : "pace the charts" so as to manage the forty-five minute period allotted to the task at hand. Our concern here w i l l be with the devices employed for terminating talk about one chart and opening talk about the next. Throughout the analysis, reference w i l l be made to the internal or-ganization of conversational structure. The reason for doing so i s that chart rounds is specifically an occasion wherein talk i s produced by the participants and i s , -more importantly, a resource used by them. As such, i t is available to the analyst as data from which to examine the s e l f -organizing features of an occasion. Tn utterance 2 (U2) we have an instance of a doctor completing talk generated from a discussion of a previous chart. U3 is an ex-ample of the person presenting the charts doing a progression to the next chart via the use of a patient's name. How is i t that we are able to recognize completions and progressions in this context? What is i t that provides for the accomplishment of termination of talk about one chart and the progression'to the next? Obviously, i t does not just happen, but is somehow made to happen. It is my intention to look at some of the ways in which this is a planned and motivated occurrence. Let us begin by examining the more general phenomenon of how we recognize that a particular conversational participant has finished talking. Harvey Sacks 1(1) has noted two general features of conversation (1) at least no more than one party talks at a time in a single conversation and (2) speaker change recurs. With reference to the co-occurrence of these features he raises the following issues: I l l I want how to make a case f o r what may or may not be obvious to you on any sort of r e f l e c t i o n ; that achieving the co-occurrence of 1 and 2 takes work. And what we want i n i t i a l l y to do, i s to come up with some determination of the sorts of work i t takes. We have an i n i t i a l problem, how i s i t that while 2_pccurs 1 i s preserved, and what we want to do : i s to f i n d out what the achievement of a s o l u t i o n to that problem involves. What sorts of coordinative work are involved. F i r s t of a l l , there's that sort of work as between a current speaker and any others; which involves how i s i t that a current speaker i s able to show other p a r t i c i p a n t s to the conversation that he i s n ' t yet, that he's about to be, that he i s now completing. What does he do so as to i n d i c a t e that he's s t i l l t a l k i n g , or that now he's not t a l k i n g . I take i t that i t ' s p l a i n to you that i t i s n ' t obviously the case that you j u s t have to keep spewing f o r t h words; i . e . , people are recognizably ' s t i l l t a l k i n g ' when they are e.g., paused. Apparently i n any event, speakers have ways of showing that they are s t i l l t a l k i n g ; and more importantly i n i t s fashion, showing that they are now f i n i s h e d . If the feature i s that exactly one should be t a l k i n g , then showing that you're f i n i s h e d when you're f i n -ished, i s important so as to allow somebody to s t a r t t a l k i n g d i r e c t l y upon your completion. One sort of thing then i s , how i t i s that a speaker goes about showing others that he's not f i n i s h e d , that he's about to be f i n i s h e d , that i s he i s f i n i s h e d , or whatever i t i s that those sorts of problems look l i k e . Showing these things to a l l others. And i t has a c o r r e l a t e , how i s i t that non-current speakers go about determining, from whatever i t i s that a speaker i s doing, that he i s or i s not f i n i s h i n g , i s or i s not f i n i s h e d . Another sort of problem concerns — i n i t i a l l y anyway • the r e l a t i o n s h i p between the various non-current speakers. How i s i t that the various current non-speakers coordinate t h e i r actions at the t r a n s i t i o n point so that at the t r a n s i t i o n point someone of them talks and only one of them talksl" 1' 112 The P r o g r e s s i o n Problem The person p r e s e n t i n g the charts must o r i e n t to what we may c a l l "the p r o g r e - s i o n problem", i . e . , proceeding from one chart to the next . The person p r e s e n t i n g the c h a r t s must monitor the other p a r t i c i p a n t s ' t a l k not only for c o n v e r s a t i o n a l appropriateness but a l s o f o r i n d i c a t i o n s as to when t a l k generated by one c h a r t i s "ended" or " p o s s i b l y ended". Secondly, when such t a l k i s over they present a next chart w i t h i n some reasonable l i m i t of time. A p o s s i b l e s o l u t i o n would be for a t e r m i n a t i o n to be e x p l i c i t l y c a l l e d for — e i t h e r by the person p r e s e n t i n g the c h a r t s or by one of the other p a r t i c i p a n t s . Someone could say, for example, "That i s the end of d i s c u s s i o n oh t h i s c h a r t , l e t us proceed to the n e x t . " However, t h i s c o u l d w e l l prove more d i s r u p t i v e than b e n e f i c i a l . Suppose speaker B proposes t e r m i n a t i o n to the d i s c u s s i o n of a chart but speaker(s) A , C, D , . . . N wish to c o n t r i b u t e something to the c o n v e r s a -t i o n . A formulated ending by B would then c o n s t i t u t e a premature ending and would r e q u i r e the other c o n v e r s a t i o n a l p a r t i c i p a n t s to do something i n order to f o r e s t a l l the proposed t e r m i n a t i o n . Something a k i n to a vote might have to be taken to determine i f indeed that was to be a l l the d i s -c u s s i o n about a p a r t i c u l a r c h a r t . . Such a formulated t e r m i n a t i o n to the t a l k would a l s o imply that the person doing the f o r m u l a t i o n has a degree of c o n t r o l over speaker s e l e c t i o n and speaker a c t i v i t y that they do not i n f a c t possess. T y p i c a l l y , formulated endings do not o c c u r . How then i s the p r o g r e s s i o n from one chart to the next accomplished? While the person p r e s e n t i n g the c h a r t s must "place the c h a r t s " , t h i s 113 does not mean that he can proceed at any pace whatsoever. Rather, the progression of rounds i s achieved by the consent of the conversational participants. A discussion can be monitored by the participants for i t s relatedness to the current chart. Pacing requires that the person presenting the chart, and other participants as w e l l , orient to i n t e r -actional devices for terminating the discussion and for opening talk about another chart. Given the sequencing rules of conversation d i s -cussed by Sacks,ewe may venture a solution to the progression problem. Uss 1 and 2 deal with instances of talk generated from a previous chart. U3 i s the name of the patient tcowhom the next chart belongs. Progression from one chart to the next has taken place. Can we formulate the notion of an end to the talk about a,previous chart such that i t warrants the Nurse i n U3 progressing to the next chart. Our f i r s t concern, then, i s with the notion of an end to the previous tal k . The four-second pause i n Ul seems to indicate the end of the speaker's turn. That the pause comes at the end of what i s recognizable as a complete utterance i s a rather strong indication that this i s a completed utterance. That i s , i f someone weretbospeak at this point, i t would not be seen as an interruption. More generally, one of. the ways speakers have of indicating that they are finished and a next speaker may speak (take a turn at talk) i s to pause at the end of their utterance (assopposed to a pause i n the middle of an utterance which might indicate that something more i s to follow and that the present speaker has not yet finished). Sacks makes the following comments: How i s i t that people go about producing recog-nizably complete utterances. And a basic thing, 114 at least generally, that seems to be involved i s that there's a generically available packaging device for utterances; and that's the sentence, s And what w e ' l l , at least for our purposes, be doing with the sentence, i s to be considering i t as a packaging device for utterances i n conversation; to be examined for those aspects of i t s structure which are relevant to sequencing i n conversation.... The sentence i s a great packaging technique for a series of reasons; only a few of which I ' l l mention. I t has a structure which can at a l l points be seen as to whether i t i s possibly complete or not possibly complete, and people are able to deal with i t i n such a way as to see that e.g., i t i s now possibly com-plete; i . e . , to see on i t s occurrence that i t ' s pos-s i b l y complete. And also, from i t s beginning i t can be looked at to see what I t w i l l take to complete i t . If somebody begins with " I f " , for example, then there's s already strongly usable information as to what i t w i l l take to complete that sentence.... ] That suggests to us how people massively go about producing utterances which are recognizably complete or recognizably incomplete, and how then, i f others don't talk while they're t a l k i n g , you get one-at-a-time u n t i l the t r a n s i t i o n point. And i t t e l l s us when i t i s that t r a n s i t i o n points w i l l occur.^ Returning to our data, the pause following the Doctor's complete utterance provides a s l o t whereby any of the other participants may take a turn at talking. That i s , a possible complete utterance followed by a silence provides for a next.speaker to take a turn at ta l k i n g . Is there some way we can assign ownership to this silence, that i s , whose silence i s i t ? One p o s s i b i l i t y i s that the pause following the Doctor's utterance may belong to the Doctor. That i s a pause following an adequate complete utterance does not "condemn" a speaker to the loss of his turn at talk . I t merely creates the p o s s i b i l i t y of such a loss. Given the pause i n Ul, 115 and given the f a c t that no one else has chosen to speak a f t e r the speaker has stopped, there might w e l l e x i s t some o b l i g a t i o n f o r the speaker to continue. However, as the t r a n s c r i p t shows, t h i s does not happen. The Doctor who spoke utterance Ul paused and provided a s l o t which anyone wishing to speak may f i l l , yet no one does. Therefore, we may regard the s i l e n c e which occurs between Us 2 and 3 as a c o l l e c t i v e s i l e n c e . By c o l l e c t i v e s i l e n c e I mean'that each 0^jtfeeepaa^c%aits.ctoGilfl24tagct-he • l a s t speaker, are.saying, i n e f f e c t , " I have nothing more to say about t h i s p a r t i c u l a r chart." Thus, a mere four-second pause generated out of the t a l k about one chart has s i g n a l l e d the closure of one chart and the opening, of another. This instance of a pause at the end of an utterance i s one example of members' methods f o r producing and/or recognizing a completed utterance. The pause i s heard as a possible end to the speaker's turn and a legitimate place f or another speaker to begin. Given the f a c t that none of the other conversational p a r t i c i p a n t s took a turn at t a l k i n g , i s there a way of ac-counting for the Nurse, presenting the charts, speaking i n U3? When everyone i s s i l e n t , can we perhaps formulate whose turn i t .is to speak next given that the l a s t speaker has produced a complete utterance and does not engage i n i a continuation? I suggest that i t i s not mere chance that accounts for the Nurse taking a turn at t a l k , but that there are good organizational reasons f o r her speaking next. These reasons trade upon the sequencing rules of conversation. While the current speaker can s e l e c t a next speaker, he need not 1 1 6 do so. Instead, he may, f o r example, s e l e c t a next action. For instance, someone may ask a question, but not specify who should answer i t . I f a group of people had seen a movie, and you hadn't, you might say "Well, was i t a good p i c t u r e ? " and then somebody w i l l s e l e c t themselves to speak, i . e . , provide an answer to that question. The f a c t that charts are presented by a p a r t i c u l a r i n d i v i d u a l i s a resource which establishes a set of appropriate actions f o r the p a r t i c i -pants. I t i s possible to view, settings and occasions as constraining 4 t o p i c a l t a l k . With reference to the organization of chart rounds, the "core a c t i v i t y " i s the review: of patients' charts. The person presenting the charts must accomplish a review by managing the t a l k that occurs during the occasion. That i s , he or she has an o b l i g a t i o n to l i s t e n to the t a l k which occurs, not only out of polite n e s s , but to be able to see, e.g., when ta l k about a given chart i s coming to an end, d r i f t i n g , etc. In addition, since he must "pace the charts", he should proceed to the next chart when in d i c a t i o n s such as these constraints of time, etc. require that a progression be accomplished. During the four-second pause following U2, the person presenting the charts can hear the ensuing s i l e n c e as a consensual s i l e n c e authorized by the p a r t i c i p a n t s i This provides good organizational reasons f o r her being the next speaker. She can say something pertaining to the current chart or to proceed to the next chart. This does not mean that the pro-gression to a next chart p r o h i b i t s further t a l k about a current chart. Hence, U3 i s only a candidate f o r closure. Consider the following piece of data. 117 1. Researcher What? 2. Doctor A. The t r i a l of labor. Letting the baby go and see i f the baby comes out. If i t doesn't come, move down then -H t h e y ' l l ah do do ah Ceasarean section 3. Researcher Urnm mm (7 seconds) 4. Nurse Mrs. Smith 5. Doctor B. Incidentally i f I can go on for a moment there's a very recent paper i n one of the journals... S i m i l a r l y , talk generated from one chart can be extended even though the progression to a next chart has been proposed. Such an extension, how-ever, requires some remedial work. The 'Incidentally' i n U5 t i e s U5 back to i t s relevant target, i . e . , the discussion generated from the previous chart. What i s of interest i s that U5 does not propose that U4 consti-tutes an interruption. That i s , the segment which reads 'Incidentally i f I can go on for a moment' i s not something that would j u s t i f y our cl a s s i f y i n g Us 3 and 4 as interruptions to Doctor B's turn at talk . Since U5 does not.address i t s e l f to an interruption, the referent of the utterance becomes the previous chart, i . e . , i n the preface ' I n c i -dentally i f I can go on for a moment' the hearers can orient to the ut-terance being t i e d back to the l a s t chart I(as opposed to, say, any other chart). In "unpacking" the.interactional structure of U5, I have attempted to show that, while talk about one chart can be extended even after talk about the next chart has been proposed, such an extension requires work, i . e . , i s an int e r a c t i o n a l accomplishment. Furthermore, by examining U5, we may be able to formulate when, i n some temporal sense, what gets said, 118 i s shaped i n t e r a c t i o n a l l y by the s t r u c t u r a l features of the occasion. Let me elaborate. U5 extends the talk about a previous chart. I t occupies second position with reference to the f i r s t mention of a new chart i n U4. I f a participant wishes to say more about a p a r t i c u l a r chart, given the pro-gression by the Nurse to the next chart,. then there -might be certain i n t e r -a c t i o n a l l y important reasons why U5 occurs i n second position rather than say e^ .g., t h i r d , fourth, f i f t h , or nth position. I am suggesting that i t becomes more problematic and requires more int e r a c t i o n a l work to say some-thing about a previous chart after t a l k about a next chart has been a l -lowed to develop. With each utterance about a new chart, i t becomes harder to return to a previous chart. What gets said, with reference to any p a r t i c u l a r chart, i s not merely an outcome of the fact that someone has something to say, but results from the ways i n which participants must r e l y on the o v e r a l l structure of conversation to f i n d appropriate slot s for r?their comments. Thus f a r , i t has been established that the four-second pause f o l -lowing U2 (in our o r i g i n a l data) provides warrantable grounds for the person presenting the charts to proceed to the "next" 'chart. This i s accomplished by using the patient's name as an i n t e r a c t i o n a l device for opening a review of his chart. Having started with a characterization of our data, we have pro-ceeded to examine that characterization i n d e t a i l . Such a procedure tends to raise further issues to be examined that were not part of our i n i t i a l characterization. One such issue i s how the organization of the 119 occasion warrants the use of the patient's name to f a c i l i t a t e the pro-gression of the charts. I t should be noted that the use of the patient's name i s i t s e l f a methodical accomplishment. The person presenting the charts picks up the next chart and reads aloud from i t . For example: Doctor;. ...Carol Bern (7 sec.) whose age (3 sec.) twenty-six (4 sec.) ((Note: Doctor looking through, chart)) She seems to have a l o t of s t u f f , abdominal pain,  abdominal pain, urinary tract i n f e c t i o n , cough arid fever,:pain i n the chest and shooting pains i n the legs, and a history of perhaps phebitis thinks this  might be the same, cOugh arid fever, agitated and can't sleep, worried Ree: daughter's boyfriend won't make up his  itiind whether to marry her, agitated  depression and i s claimirig pains i n her legs again ( 3 sec.) (Note: The underlined portions of transcript i n -dicate material being read l i t e r a l l y from the patient's chart) Nurse She the one that John.(another doctor) C ) see her leg problems? Doctor Yeah, Urnm of course.... The patient's name — l a s t name (LN) + f i r s t name (FN), age and date of b i r t h are written on his chart. However, the person presenting the charts gives a patient's name and age as i t normally occurs i n ordinary conversation. Name and age are not merely read aloud, but rather constructed into pieces of natural tal k . Reading aloud i s far more than just saying what i s written. I t i s an accomplished a c t i v i t y , subject tonMie organizational constraints of settings and occasions. The use of a patient's name serves as both a proposed terminator to thePdisUussionaofa^ichart an'de aseavdeviceb.fiok op'endngsdiscussion on 120 a next chart. The person presenting the charts can and should monitor the talk to determine i f i t i s attentive to the constraints of the oc-casion, i . e . , i f i t i s contributing to the successful completion of chart rounds. When i t becomes apparent that the talk generated by a chart i s 'wandering' or 'closing down' the person con t r o l l i n g the charts can terminate.the t a l k by introducing the next chart v i a the patient's name. This change i n topic i s usually accompanied by certain v i s u a l cues. The person presenting the charts might put down one chart and pickcup the next while reading off the patient's name. This a l l o -cates the previous chart to the completed p i l e . The physical closing of a chart however, does not warrant the assumption that that chart has been f u l l y reviewed. That .is, t a l k generated by a chart may con-tinue even though the person presenting the chart may elect to close i t . His doing so, however, does indicate that he sees that chart as one which i s possibly completed. The Referential Adequacy of the Use of F i r s t Name plus Last Name This section examines how the use of a patient's name does not pro-vide adequate information about the patient. I t must be remembered that the patient i s not present at chart rounds. What we are dealing with i s the use of names as adequate r e f e r e n t i a l devices, that i s , with t h i r d party references i n conversation. F i r s t , l e t us consider the i n -teractional work accomplished by the use of the patient's f i r s t name (FN) and l a s t name (LN). The s o c i a l organization of chart rounds has as i t s fundamental concern the review of a corpus of patient's charts. One of the features 121 of chart rounds i s that the patient may or may not be known to many of the physicians present. Further, the patient's physician mah or may not be present. The use of the patient's FN plus LN provides s u f f i c i e n t information, for those physicians who know the patient, to locate the patient into some category v i s - a - v i s t h e i r encounters with that patient. I t provides for a c e r t a i n amount of memory work. The previous section dealt with the use of the patient's name for progressing to the next chart. Such progression provided for appropriate speaker actions, i . e . , t a l k about the chart. However, the patient's name can also provide for a next speaker f o r , i f the patient's physician i s present, then the introduction of a chart v i a the use of the patient's name provides grounds f o r that physician to speak next. I f the patient's physician i s not present but another physician who knows the patient i s present, i t i s l i k e l y that he w i l l make some comment at t h i s time. Although the use of the patient's name may provide those who know the patient with adequate r e f e r e n t i a l information, a name alone does not provide much for those who are not acquainted with the patient. An examination of the question "Who?" of U4 should help to c l a r i f y t h i s point. 122 Two d i f f e r e n t hearings of the question "Who?" of U 4 are provided and acted upon. In U 5 the Nurse.hears the 'Who?' as. a simple request fo r a repeat. One possible reason for a repeat i s that Doctor B. did not hear her. Un U 6 , however, Doctor A. treats Doctor B's question as more than a simple request f o r a repeat. Instead he o f f e r s a referent other than the patient's name to locate the patient f o r him. The question 'Who?' then becomes i n t e r e s t i n g when i n f a c t the patient has already been named, i . e . , one i s already supposed to know who the patient i s . ?The patient's name as an i d e n t i f i e r i s often not s u f f i c i e n t information to i d e n t i f y the patient to p a r t i c i p a t i n g members. S i m i l a r l y , a problem with t h i r d party references i n the conversation between speaker A and speaker B above i s when A makes reference to person C not known to speaker B.. This requires that speaker A se l e c t a r e f e r e n t i a l l y adequate category device appropriate to the occasion It i s apparent that FN + LN does not always provide enough i n -formation to s u c c e s s f u l l y i d e n t i f y a patient. Doctor A i n U6 produced a medically relevant c h a r a c t e r i z a t i o n of the patient. This d e s c r i p t i o n allowed other p a r t i c i p a n t s to i d e n t i f y the patient, at le a s t f o r a l l p r a c t i c a l purposes. Consider the following data: Doctor A. But I think that would be 'aowofethwhile one j u s t to sort of get your signals coordinated between you and Karen on i t . Ah Terry Martin Doctor B. This i s a g i r l with abdominal pains Doctor A. Doctor B. Okay, Beverly Jones This i s a g i r l Judy has been seeing f o r anxiety 123 In addition to themame, some further characterization i s usually called for. What w i l l be used i n the construction of such a characterization i s interesting since the patient's history i s immediately available. Such a characterization, I suggest, i s constructed to provide p a r t i c i -pants with a grasp of the C l i n i c ' s current concerns with that patient. By proposing that a patient i s "a g i r l with abdominal pains", or i s "being seen for anxiety", the person i s providing a characterization that i s medically and organizationally relevant to the C l i n i c ' s transactions with the patient rather than just any description which happens to come to mind. One of the in t e r a c t i o n a l features of such medically relevant characterizations i s that they can provide good organizational reasons for adducing a patient's reason for coming to the C l i n i c . That i s , given the fact that the s t a f f are reviewing the charts of those patients who are to be seen l a t e r that day, the characterizations used can be monitored by the participants to formulate a patient's reasonCs) for coming to the C l i n i c on this day. Thus, i n the above data, "has been seeing for anxiety" suggests that the patient i s s t i l l coming to the C l i n i c because she has problems with anxiety. S i m i l a r l y , s t a f f can conclude that Terry Martin has "abdominal pains" and i f he did not have, he would not be v i s i t i n g the C l i n i c . U6 constitutes a medically relevant characterization of the patient. Whether this characterization provides adequate grounds for establishing a patient's reason for coming to the C l i n i c w i l l be examined i n the next section. Thus f a r , however, i t should be apparent that the examination 124 of small segments of conversational materials can be u t i l i z e d to d i s -cover some of the ongoing properties of settings and occasions. The Reason f o r a V i s i t : I The reason f o r a v i s i t constitutes an organizational problem f o r members of the s t a f f . I t i s intended that the problems which a v i s i t or series of v i s i t s e n t a i l w i l l be, at le a s t i n part, resolved during chart rounds. U6 i s a medically relevant c h a r a c t e r i z a t i o n of the patient. The ways i n which t h i s c h a r a c t e r i z a t i o n provides grounds f o r adducing a patient's reason for a v i s i t requires that theoongoing i n t e r a c t i o n a l structure which produced i t be examined i n further d e t a i l . The concern i s not simply whether or not U6 i s a medically relevant c h a r a c t e r i z a t i o n , but how such a char a c t e r i z a t i o n i s achieved. U6 seems to provide s u f f i c i e n t grounds f o r a v i s i t by l a b e l l i n g the patient with the disease term "constipated". To focus only on t h i s por-t i o n of the utterance, however, i s to ignore the organizational import of the f i r s t p o r tion, namely, "He's a routine baby". While apparently a non-medical characterization, I suggest that the segment "He's a routine baby," i s the operative portion of the utterance i n terms of providing the s t a f f with a relevant reason f o r a v i s i t . I s h a l l elaborate. Post-natal care at the C l i n i c involves a package of procedures which are conducted over a d e f i n i t i v e period of time. Such care usually con-tinues f o r about s i x and one-half months a f t e r b i r t h . During t h i s time, babies's growth, weight, height, neurological development and muscular coordination are checked thoroughly. In addition, u r i n a l y s i s , blood t e s t s , and vaccinations may be given. While a l l of these take place 125 during post-natal care, I should emphasize that the components of the package are arranged..inia s p e c i f i c way so that the baby i s not randomly checked each time he v i s i t s the C l i n i c . Instead, each v i s i t constitutes a step i n the developmental sequence of the programme of post-natal care. While the f i r s t v i s i t may only require that h i s weight and height be measured, the fourth v i s i t might require such things as the i n i t i a t i o n of p o l i o immunizations. The cha r a c t e r i z a t i o n "routine baby", then, i s something that can provide members of the C l i n i c with a set of organiza-t i o n a l parameters about why the patient i s coming to the C l i n i c . While the chara c t e r i z a t i o n "a routine baby" provides p a r t i c i p a n t s with some general parameters that could warrant a v i s i t , a further reason remains to be discovered. Compare th i s c h a r a c t e r i z a t i o n to one involving a r e l a t i v e l y serious medical ailment, e.g., a baby with a congenital heart defect. Any serious condition would expectably be mentioned i n the course of a review of the patient's chart and thus become a v a i l a b l e to p a r t i c i p a n t s as a possible reason f o r a v i s i t to the C l i n i c . Unlike characterizations involving a serious medical ailment, "routine baby" does not provide the p a r t i c i p a n t s with s u f f i c i e n t information to adduce the patient's reason f o r coming to the C l i n i c . The f i r s t portion of U6 may narrow the parameters involved i n accounting f o r the patient's coming to the C l i n i c but, t h i s f a r into the utterance, no other reason fo r a v i s i t has been formulated. What i s the i n t e r a c t i o n a l import of the second part of U6 "who's a b i t constipated"? Given the f i r s t part of U 6 , whatever i s appended to t h i s must constitute a minor complaint. To append a serious medical problem would negate the i n i t i a l c h a r a c t e r i z a t i o n of the patient. One of the two, that 126 i s , e i t h e r "He's a routine baby," or ("who has a serious disease") would not rest on warrantable grounds. In contrast, the addition of "who's a b i t constipated" to the part of the utterance reaffirms that the patient i s a "routine baby" f or the most serious problem that Doctor A can c i t e i s that he i s "a b i t constipated". Being constipated i s proposed as a standing condition and presumably the worst condition that can be said of t h i s p a r t i c u l a r patient. I t should also be noted that Doctor A does not propose that the patient i s currently being treated f o r constipation whereas such treatment could w e l l provide grounds f o r the patient's v i s i t to the C l i n i c . While U6 perhaps looks l i k e a formulation of a patient's reason fo r coming to the C l i n i c , i t only provides the possible parameters that could warrant such a v i s i t . The operative part of the utterance i s "He's a routine baby" arid not "who's a b i t constipated". U6 might be compared to,say, "He's a diab e t i c who's a l i t t l e depressed", where i t i s the diabetes that constitutes the medically relevant c h a r a c t e r i z a t i o n and "who's a l i t t l e depressed" constitutes some quasi-medical c h a r a c t e r i z a t i o n . The l a s t part of U6, while looking l i k e a possible reason f o r a v i s i t by the patient, glosses over the or g a n i z a t i o n a l l y relevant aspects of the char a c t e r i z a t i o n "routine baby". The ch a r a c t e r i z a t i o n "routine baby", then, i s one of a class of patients who are healthy but, because they are babies, have grounds f o r v i s i t i n g the C l i n i c . The reader w i l l notice that u n t i l U16, no grounds f o r a v i s i t by the patient have been proposed. Rather than consider U16 at t h i s time, I would l i k e to make a digression i n the analysis of how c l i n i c members 127 account f o r a patient's reason f o r a v i s i t and continue with the examina-t i o n of t h i s t r a n s c r i p t i n terms of some of i t s other organizational features. My reason for doing t h i s are twofold. F i r s t , i t w i l l fallow me to continue to work with the data i n a methodological fashion by attending to the order i n which i t was produced. Second, i t allows me to demonstrate how such dat'abeantB"eiutn!li'zedthtovun'coveBn6r.gahi>zationaT ~ features that we may not have been able to formulate, or assume as operable u n t i l we pay rigorous attention to t h e i r actual, situated production. A S o c i o l o g i c a l Treatment of Referring U6 i s inherently connected to the organizational features of the i -occasion, i . e . , the patient was ref e r r e d to i n a medically relevant manner. An examination of Us 7-9 shows an i n t e r a c t i o n a l exchange where-by the Nurse o f f e r s another c h a r a c t e r i z a t i o n of the patient i n order to allow Doctor B to i&dentify him. A noticeable feature of t h i s c h a r a c t e r i -zation i s i t s "mundaneness". By t h i s I mean that i t i s not immediately evident that i t i s or need be re l a t e d to a conception of medical p r a c t i c e . It i s the purpose of t h i s section to discuss how such a ch a r a c t e r i z a t i o n can r e f e r to the patient i n such a way as to su c c e s s f u l l y locate t". -: that person for Doctor B. One of the f i r s t things to notice with reference to Us 7-9 i s that Doctor B's U7, "That's ah the," i s not completed by him, and that the nurse's U8, "The commune," follows and completes i t . This utterance warrants consideration since i t i s only by v i r t u e of the f a c t that i t i s a completion of U7 that i t gets to be seen as a cha r a c t e r i z a t i o n . We are 128' concerned then with the f i t that t h i s utterance has within the ensuing conversation. Let me elaborate t h i s point. F i r s t off j-iHis there a way i n which we can account f o r a completion of U7 such that, i f there i s to be a completion by another speaker, i t w i l l be constrained by c e r t a i n s t r u c t u r a l features of the t a l k that preceeded i t ? Sacks remarks on t h i s phenomenon:^ Now i n f a c t , there i s p e r f e c t l y l o v e l y natural data which shows pretty w e l l that persons not only analyze utterances grammatically i n the course of those ut-terances, but, furthermore, they have the r e s u l t s of t h e i r a n a l y s i s , grammatical a n a l y s i s , a v a i l a b l e to them while that utterance i s yet going on. And can use i t furthermore, e i t h e r on the other's completion or even before i t s completion. Data consists of t h i s short of thing...what you get i s something l i k e A produces, i s engaged i n producing a sentence, at some point i n i t he h e s i t a t e s , pauses, and B s t i c k s i n quote the word he was looking f o r . Now i f we ask how i s i t that B could do that, then since at that point, leaving aside that B gets the r i g h t word, a l l that would be i n t e r e s t i n g i s that B gets the r i g h t class of words. That i s to say that he knows that what's being looked for i s a noun, perhaps a noun of a c e r t a i n sort i s being looked for so as to be able to s t i c k i t i n , what he has had to be doing i s to see that at that point i n an utterance he's analysing only, say, such a noun i s e l i g i b l e while the sentence would yet r e t a i n i t s grammaticality. Now as i t hap-hejns, i f you look at ordinary t a l k y o u ' l l f i n d that i t i s very frequent that so-far hearers i n t e r j e c t completions of the sentences of others i n a syntac-t i c a l l y coherent way and thereby show among other things that they understand the sentence s y n t a c t i c a l l y that they have been doing t h e i r understanding, doing the analysis that allows them to understand while the thing i s being produced, so as to have i t s r e s u l t s a v a i l a b l e to them while the sentence i s yet being produced. What then, i f any, are the s t r u c t u r a l constraints of U7 that provide f o r the type of production which occurs i n U8? In rather broad terms, the l i n g u i s t i c structure of U7 consists of a subject and predicate ("That's" s that i s ) and the d e f i n i t e a r t i c l e . 129 (Linguists relegate the "ah" i n U7 to the arena of l i n g u i s t i c perform-ance and, as such, something which i s not available for analysis.) However, we are not doing l i n g u i s t i c s here, but"* i n t e r a c t i o n a l analysis and I suggest "ah" i n U7 i s of importance i n describing the i n t e r -,13 actional structure of the conversation at hand. I w i l l return to a consideration of i t i n a moment. Given the l i n g u i s t i c structure of U 7 , p o s s i b i l i t i e s with refer-ence to i t s completion (either by the current speaker or by a "so-far hearer") are r e l a t i v e l y l i m i t e d . The subject of the sentence i s a demonstrative pronoun and, given that a d e f i n i t e a r t i c l e follows, either an adjective phrase or a noun phrase constitutesjpossible com-pletions. Thus there are good syntactic reasons for the Nurse i n U 8 to complete Doctor B's U 7 with a noun phrase as she did. However, there are also strong i n t e r a c t i o n a l reasons for t h i s . I t has been argued that, f i r s t , the use of a patient's name does not always provide enough information to id e n t i f y the patient. Second, that the use of a medically relevant characterization may also f a i l to ide n t i f y the patient for he can be "a routine baby who's a b i t constipated" regardless of who he i s . Thereby, the i d e n t i f i c a t i o n of the patient i s , for Doctor B, s t i l l problematic so that U7 may be seen as a search under-taken to extract the baby's i d e n t i t y . The Nurse completes this search by providing a characterization which resolves Doctor B's problem. This i s evidenced by U9. But, how i s i t that we are able to see U7 as part of a mental "search" and thereby to see U8 as a completion to this search. I suggest that the 1 3 0 answer l i e s at least i n part i n the hesitation implied by the use of the aforementioned "ah". A search has the character of a question, and questions are t y p i c a l l y followed by answers. Thus the doctor's hesitation can be heard by the Nurse both as grounds and as the proper place or s l o t for providing a characterization which might solve the problem. The formulation offered by the Nurse i n U 8 needs to be elaborated. Clearly, we hear i t as a characterization of the patient as something which refers back to "the baby". That U 8 i s a characterization i s s e l f -evident. How i t i s constructed so.that i t refers and i d e n t i f i e s a par t i c u l a r patient i s problematic. What we seem to be dealing with i s 6 the type of situ a t i o n ?Strawson discusses: The application of the phrase ' i d e n t i f i c a t i o n of par t i c u l a r s ' which I s h a l l f i r s t be concerned with i s t h i s . . Very often, when two people are ta l k i n g , one of them, the speaker, refers to or mentions some par t i c u l a r or other. Very often, the other, the hearer, knows what, or which, p a r t i c u l a r the speaker i s talking about; but sometimes he does not. I s h a l l express this alternative by saying that the hearer either i s , or i s not,, able to iden- t i f y the p a r t i c u l a r referred to by the speaker. Among the kinds of expression which we, as speakers, use to make references to particulars are some of which a standard function i s , i n the circumstances of their use, to enable a hearer to id e n t i f y the part i c u l a r which i s being referred to. Expressions of these kind include some proper names, some pro-nouns, some descriptive phrases beginning with the def i n i t e a r t i c l e , and expressions compounded of these. When a speaker uses such an expression to refer to a p a r t i c u l a r , I s h a l l say that he makes an iden t i f y i n g reference to a p a r t i c u l a r . I t does not follow, of course, from the fact that a speaker OH a given occasion, makes an id e n t i f y i n g reference to a p a r t i c u l a r , that his hearer does i n fact iden-t i f y that p a r t i c u l a r . I may mention someone to you by name, and you may not know who i t i s . But when a speaker makes an id e n t i f y i n g reference to a 131 p a r t i c u l a r , and his hearer does, on the strength of i t , i d e n t i f y the pa r t i c u l a r referred to, then I s h a l l say, the speaker not only makes an ide n t i f y i n g re-ference to, but also i d e n t i f i e s , that p a r t i c u l a r . So we have a hearer's sense, and a speaker's sense of ' i d e n t i f y ' . 6 Strawson i s c l e a r l y into sociological t e r r i t o r y when talki n g about a speaker's versus hearer's sense of " i d e n t i f y " , "expressions", "the circumstances of their use'!, and/or the negotiated character of par t i c u l a r s . The crux of what I take Strawson to be saying i s that, when individuals interact with one another, they make references and, whether or not such references succeed i n accomplishing an "identification':' must be nego-tiated between speakers and hearers over the course of their exchange. Note that while philosophical l i t e r a t u r e recognizes that 'referring and ' i d e n t i f i c a t i o n v are accomplished i n the course of various speech s i t u a -tions, i t tends to subsume description under some general theory rather than focus upon i t as a s i t u a t i o n a l l y constructed accomplishment. In contrast to t h i s , our concern i s with the l a t t e r , s p e c i f i c a l l y , here, with accounting for how U8 i d e n t i f i e s the patient i n a unique way. U3 uses a patient's name to id e n t i f y the patient to the s t a f f . When th i s f a i l s , a medical characterization i s used: U6. When this a l s o s f a i l s , another type of characterization i s offered. This charac-t e r i z a t i o n "The commune", could have been constructed without any medical expertise. That i s to say, i t could have been constructed by any com-petent c u l t u r a l member. Let me begin to elaborate by attending to the semantic referents of the preceeding utterances. The relationship between names and pronouns i s a rather strai g h t -forward one that i s , a pronoun can stand for a name. Interactionally, 132 h o w e v e r , " H e ' s " must be r e c o g n i z e d as t h e p r o d u c t o f some o p e r a t i o n on " J o h n D o e " — a n o p e r a t i o n i n t e r m s o f p e r s o n and number . S i m i l a r l y , we may a s k t h e q u e s t i o n : What i s t h e r e f e r e n t o f " T h e Commune"? We c a n assume t h a t " T h e Commune," " H e ' s a r o u t i n e b a b y w h o ' s a b i t con^ s t i p a t e d , " " J o h n D o e " i n U 5 , "Who?" and " J o h n D o e " i n U3 a l l r e f e r t o t h e p a t i e n t . N o t e t h a t , w h i l e d e a l i n g wthh t h e i s s u e o f i d e n t i f y i n g a p a r t i c u l a r p a t i e n t , we have come upon a more g e n e r a l i z a b l e f e a t u r e o f i n t e r a c t i o n . The w o r l d i s f u l l o f n o t i c e a b l e and i d e n t i f i a b l e f e a t u r e s , and i t a p p e a r s ' t h a t p e r s o n s a r e a b l e to o r i e n t t o , p i c k - u p - o n , and u t i l i z e t h e s e i n d e -p e n d e n t o f any p r o f e s s i o n a l t r a i n i n g o r e x p e r t i s e . I d e n t i f y i n g a p a t i e n t v i a " T h e Commune" seems to be no d i f f e r e n t t h a n a s k i n g , . " I s t h a t t h e guy who owns t h e V o l v o s t a t i o n wagon?" T h i s r o u t i n e , common s e n s e way o f r e f e r r i n g to some p e r s o n o r t h i n g i s o f t e n s u f f i c i e n t t o j o g m e m o r i e s , c l a r i f y r e f e r e n c e s , and make n e c e s s a r y i d e n t i f i c a t i o n s . Such c h a r a c t e r i -z a t i o n s seem to be a b l e t o do t h e j o b t h a t t h e y a r e i n t e n d e d f o r . T h u s , " T h e Commune" i s n o t a u n i q u e m e d i c a l c h a r a c t e r i z a t i o n , y e t i t seems s u f -f i c i e n t f o r t h e p u r p o s e s a t h a n d . T h i s p o i n t w i l l be d e v e l o p e d l a t e r . R e t u r n i n g t o t h e d a t a , n o t e t h a t " T h e Commune" c a n , i n and by i t -s e l f , be t a k e n as t h e name o f a p a r t i c u l a r p l a c e . A n o t h e r p o s s i b i l i t y i s t h a t t h e u t t e r a n c e c a n be expanded t o s a y s o m e t h i n g l i k e , " t h e b a b y who comes f r o m t h e commune". I t i s i m p o r t a n t t h a t I have r e t a i n e d t h e d e f i n i t e a r t i c l e f o r , i t i s n o t j u s t a baby who l i v e s i n " a " commune b u t t h e baby who l i v e s i n " t h e " commune. T h u s , I am t r e a t i n g " T h e Commune" as a p l a c e name. P l a c e names c a n , g i v e n c e r t a i n c i r c u m s t a n c e s , be u s e d t o i d e n t i f y phenomena w h i c h a r e n o t , i n t h e s t r i c t s e n s e o f t h e 133 term, places. Here are a few pertinent examples from Schegloff who t e l l s us that: ...place terms can be used to formulate occupation: A: You uh wha 'dijuh do, f e r a l i v i n g ? B: Ehm, I work inna d r i v i n g school They can be used to formulate "stage of l i f e " : A: When did t h i s happen? B: When I was i n Junior High School. They can used to formulate a c t i v i t i e s : *A: What's Jim doing? B: Oh, he's at the ballpark. *Indicates invented data: here the answer could ind i c a t e e i t h e r work or l e i s u r e a c t i v i t i e s depending on'Jim's" occupation. Where a place term i s used to formulate some-thing other than l o c a t i o n , the f i r s t question may betnot how that term was selected out of the set of terms that are correct f o r that place, but rather how a place term came to be used to do a non-place formulation.^ I f I am r i g h t i n regarding "The Commune" as a place name, then, following Schegloff i's recommendation, I would l i k e to consider how i t comes to r e f e r to a p a r t i c u l a r person. To t h i s end, I w i l l provide the reader with some background information about t h i s . p a t i e n t . The C l i n i c provides medical care for a group of f a m i l i e s , the Smiths, the Jones, and the Does, who l i v e i n a nearby commune. These fa m i l i e s constitute "The Commune". I t i s not merely the fac t that they l i v e i n a commune that i s i n t e r e s t i n g , but that t h e i r l i v i n g i n t h i s way has provided members of the C l i n i c a s u i t a b l e term applicable to any member or members of the commune. Of course, t h i s i s not to say that an i n d i -v i d u a l member can properly be c a l l e d by the unit's name. By t h i s I mean 134 that the name "John Doe" i s not synonymous with, i . e . , replaceable by "The Commune". What I am saying i s that whereas "John Doe" did not adequately i d e n t i f y the patient, the term, "The Commune," was intended to and did locate him. since membership i n the commune was both from the point of view of the nurse (speaker) and Doctor B (hearer) an ade-qMlstni4§e-t^fy-Mgi*ef§Eefi(S6. patient. References are strongly connected to the shared biographies of speakers and hearers. That i s , i t i s up to the speaker to choose an i d e n t i f y i n g reference and the nature of that reference i s constrained both by the nature of the occasion and by what he can assume that :.,he and h i s conversational partner(s) know i n common about the phenomenon referred to. Sacks elaborates upon t h i s i n the following discussion about the construction of a story: ...Now she could e a s i l y handle that by having said "Ruth Henderson and I drove down to see Mary Smith who l i v e s i n Ventura" but there are some problems about that. I f she was going to see somebody that the other person doesn't know, then itf-could cause a complication to say "We went down to see Mary Smith yesterday" "Oh, whois she?" "She's a f r i e n d of mine who l i v e s i n Ventura." "Oh, I see." But anybody knows that when somebody uses, instead of the name of the person they went to see, a place, then they're t e l l i n g you among other things, 'you don't know who I'm t a l k i n g about', e.g., "I went to a party at La Marian l a s t night" t e l l s you among other things, 'you don't know the person I wentttoosee'. Where i f you knew who they went to see they would t e l l you who they went to see.8 For us, however, the problem i s the reverse of that faced by Sacks. Doctor B has not been able to i d e n t i f y the patient e i t h e r by name, or af t e r obtaining a medical c h a r a c t e r i z a t i o n of him. Rather, i t was a char a c t e r i z a t i o n of the patient's residence that f i n a l l y enabled an i d e n t i f i c a t i o n . 135 Us 3, 6 and 8 have been treated as "further information," designed to enable Doctor B to i d e n t i f y the patient. U9, i t has been argued, com-pletes t h i s sequence for i t i s here Doctor B f i n a l l y manages to i d e n t i f y the patient. U8 leads to an adequate i d e n t i f i c a t i o n of the p a t i e n t . This i s evidenced by U9. In Strawson's terms, U9 i s the utterance where-byetherspeaker " i d e n t i f i e s the p a r t i c u l a r referred to." On the one hand, th i s seems to s a t i s f y Strawson's model of a speaker i d e n t i f y i n g a p a r t i -cular, on the other, i t provides for the p o s s i b i l i t y that the e n t i r e seg-ment, i . e . , Us 3-9, i s not an instance of r e f e r r i n g but constitutes a case of 'remembering' and 'recognition'. *We have been t r e a t i n g the patient's name as something mentioned to a p a r t i c i p a n t who does not know what the p a r t i c u l a r i s that the speaker i s t a l k i n g about. U9 casts doubt on t h i s assumption. How i s t h i s so?-The 'Oh yeah' of U9 s i g n i f i e s recognition of s u c c e s s f u l l y a t -taching a patient to a name. The 'John Doe' i s the operable portion of the utterance i n that i t s i g n i f i e s that the Doctor knew a l l along who was being talked about. That i s , i t i s not the f i r s t time he has heard the name. I suggest that U9 i s not an instance of Doctor B i d e n t i f y i n g 'John Doe' and, hence, net an example of r e f e r r i n g . Rather, U9 provides us with rather strong grounds f o r assuming that Doctor B has known a l l along who the patient i s but had forgotten and has been made to "remember." The sequence under analysis i s thus one of remembering and rec o g n i t i o n rather than r e f e r r i n g . If I am correct i n the analysis of U9, what e f f e c t does t h i s have on the previous analysis of Us 3-9? To begin with, l e t us consider the bureaucratic s i t u a t i o n facing p a r t i c i p a n t s to chart rounds; Those personnel who r o u t i n e l y come into contact with patients are engaged i n a r e l a t i o n s h i p whereby, because of 136 the nature of C l i n i c business, they must or at least should remember who patients are. Because the size of the patient population tying names to patients i s an omnipresent problem for the s t a f f . Medical personnel are under a strong obligation to remember whoipatients are when dealing with them. Staff discussions about patients place a sim-i l a r obligation on those f a m i l i a r with a patient to be able to t i e patient names to patient problems. Staff are concerned not only that some patient has some medical problem, or that some patient has a problem, but with which patient has which problem. Rounds i s not merely an occasion to discuss the medical problems of various patients but an opportunity to discuss and to orient to the problems associated with each par t i c u l a r patient. At the same time, some of the participants are not acquainted with the patient who i s being discussed. One of the organizational problems of the C l i n i c i s tying patient names to the problems which constitute the organizational business of the C l i n i c . Chart rounds i s an occasion where such business should be discussed. With these features i n mind, l e t us return to an examination of our data. U6, while a medically relevant characterization, i s also inherently connected to the business at hand. I mean that i t i s , at least i n some ways, adequate for the purposes at hand and w i l l do for any "routine baby who's a b i t constipated") regardless of i t s biography. I t i s a characterization usable,to any personnel i n general; one that does not require members know the patient's name i n order to find i t usable. As such, i t i s tied to the bureaucratic concerns for getting things done. Following the name references, Us 3 and 5, Doctor A proceeds to state the organizational business that the C l i n i c has with t h i s p a r t i c u l a r patient. 137 Such business need not be concerned with who the patient i s , but only with the ways i n which he i s t i e d to the organizational concerns of the C l i n i c . Because Doctor A i s the patient's physician, the ch a r a c t e r i z a -t i o n provided by U6 need not be seen as a construction designed to 'help' Doctor B locate the patient. Instead, i n a rather strong way, i t seems to in d i c a t e that the Nurse's formulation, "John Doe" i s r e f e r e n t i a l l y adequate, that i s , a non-problematic matter of routine to the business at hand so that p a r t i c i p a n t s can proceed with a review of the chart. However, t h i s does not undercut the e a r l i e r analysis of how the use of a patient's name allows those f a m i l i a r with him to recognize him and affords those who are not f a m i l i a r with an opportunity to become f a m i l i a r with h i s name and problem. In the f i r s t case, the name i s used f o r the benefit of those who know the patient whereas, i n the second, i t s use allows those who are unfamiliar with the name, problem and/or organization concerns thereof, to become f a m i l i a r with them. With reference to Strawson's remark, "I may mention someone to you by name, and you may not know who i t i s , " i t i s now evident that he i s neglecting the i n t e r a c t i o n a l consequences of such name dropping. One does not mention a name to someone unless they assume that that name w i l l have some meaning for them. People usually make t h i r d party references to hearers who they assume w i l l know the mentioned party. In such a case, one i s not making an i d e n t i f y i n g reference to a hearer so that the hearer may, on the strength of i t , be able to i d e n t i f y the p a r t i c u l a r r e f e r r e d to, but rather, i n making such a reference, the 138 speaker assumes that the hearer w i l l remember the person referred to. Where a t h i r d party reference i s made and the participants do not know who i t i s , as i s the case i n our present analysis, circum-stances warrant that the name be connected to some category rather than to a pa r t i c u l a r patient. That i s , i t i s obvious that the name i s the name of a patient and a l l that now i s required of those who are present but unfamiliar with the name i s that they associate i t with a part i c u l a r patient. The name i s not being used as'information to allow anyone to id e n t i f y someone who they do not know. In opposi-tion to Strawson, i t i s not the case that when people mention someone to you they expect you to know who that someone i s ; instead they only require that you know who that someone i s i n terms of some category or class, e.g., a patient. For a l l p r a c t i c a l purposes, the category of patient serves to i d e n t i f y any pa r t i c u l a r patient mentioned. For some purposes mentioning someone's name need not require that you know "who" he i s , but merely "what" he i s i n order to id e n t i f y him for the purposes at hand. Given our reformulation of the data, the fact that the Nurse repeated the patient's name i n U5 can be taken to substantiate our claim that the name i s posited as adequateiinfdrmatrfcontfor. thehtask at hand. I t i s assumed ttiattDdetortB's "Who?" i s a "request for a repeat" rather than for further id e n t i f y i n g d e t a i l s . The name alone i s adequate for anyone fam i l i a r with the patient, and anyone not fam i l i a r with the patient knows at least that the name i s tied to a patient. So what we have i n U3 i s the name, i n U6 a statement of organizational business 139 with reference to t h i s patient. U6 treats Us 3 and 5 as providing s u f f i c i e n t information for Doctor B to i d e n t i f y the patient and thereby proceeds to the tasks at hand, namely, a review of the chart, and moreover, the scheduled completion of t h i s session of chart rounds. Thus, i n U 9 , i t i s not that Doctor B has i d e n t i f i e d the patient v i a the information provided i n Us 3 , 6 and 8 alone. Rather, he has remembered who the patient i s for he knew him a l l along. The connection i s one between a name and a known patient and not a case of some amount of i d e n t i f y i n g information that would allow someone to e s t a b l i s h the i d e n t i t y of the p a t i e n t . Such information only allows a hearer to remember what he has forgotten, and does not allow him to i d e n t i f y p a r t i c u l a r i n d i v i d u a l s i n the sense that, say, p o l i c e descriptions do. How i s i t that some items can be seen as "rememberable" such that they can be used as a resource when a t h i r d party reference that should be recognized but i s no^t can come to be remembered? In t h i s case, how <-can Doctor B draw upon h i s knowledge of the mentioned party, and the r e l a t i o n s h i p which obtains between t h i s party, the speaker and himself i n such a way that the mention of "The Commune" f-aeiibitafeesshiisrr-.eGO-gnizMg what heoshouflidshaveiknown and, i n f a c t , did know a l l along. Our concern, now, w i l l be i n e x p l i c a t i n g how "The Commune" can serve as a rememberable item about t h i s patient. E a r l i e r , i t was stated that a group of patients were known c o l -l e c t i v e l y as "The Commune" and that t h i s c h a r a c t e r i z a t i o n was also ap-p l i c a b l e to each member of the commune. I t i s not only the case that t h i s group of patients are or become known as "The Commune," further i t i s what they are or become remembered f o r , i . e . , belonging to a 140 commune. Let us consider the relationship between "being (or becoming) known" and "being (or becoming) remembered f o r " . Becoming known as a patient can result from one's association with any part of an extensive l i s t of items which concern medical p r a c t i -tioners, one can have a broken leg, be a diabetic, "a routine baby who's a b i t constipated'," etc. While any of these may be a way of getting known, they may or may not be adequate i n terms of the i r remem-b e r a b i l i t y , e.g., there may be numerable routine babies who are consti-pated. I t i s unlikely that the s t a f f w i l l remember an i n d i v i d u a l patient simply because he suffers from some common ailment since there are numerous patients who have the same complaint and receive the same kind of attention. However, that this patient i s a member of "The Commune" i s somehow a "rememberable" feature. A lay notion of how doctors routinely remember thei r patients might assume that they remember them v i a the i r aches and pains. I t turns out, however, that they remember patients i n the same way that any other member of society might remember a phenomenon, i . e . , by as-sociating i t with some attribute that i s unique to them. Thus, "The Commune" i s a rememberable feature, and by l i n k i n g the patient to i t , Doctor B i s able to remember what he knew a l l along. This section began by treating Us 3-9 as an instance of what Strawson called "referring to p a r t i c u l a r s . " This analysis, however, was re-evaluated and deemed inadequate,for a second examination of the data suggested that i t may better constitute an instance of remembering and recognition. What could be more private than an individual's 141 memory? As i t turns out, memory i s not the product of i n d i v i d u a l awareness along, but i s shaped v i a the relations that obtain between the item to be remembered and the ways i n which individuals can be helped to remember. The process of remembering i s not s o l e l y a product of the workings of one mind, but a socially-organized phenomenon. ^O'Egar^zMlsnal Treatment of an Organizational Problem An encounter between patient and physician i s usually arranged through an intermediary such as a secretary. Scheduling accomplishes coincidence between physician and patient. I f the patient comes i n at time "x", he w i l l see Doctor "y". I f circumstances prohibit his seing Doctor "y", another doctor w i l l see him. Both patients and physicians are aware of this p o s s i b i l i t y . The fact of scheduling allows physicians to consult the secretary's appointment log p r i o r to chart rounds so as to have some idea of who i s scheduled to see whom that day. This does not mean that a physician always does t h i s , however, the' p o s s i b i l i t y always e x i s t s . Since our data comes from a session of chart rounds where the charts belong to those patients who are to be seen l a t e r on i n the day, a discussion of scheduling problems seems to be i n order for they constitute an area of concern for the personnel involved i n chart rounds. Before addressing this issue, however, I would l i k e to draw the reader's attention to the manner i n which the forthcoming discussion w i l l r e l y for sense upon those features of c l i n i c organization referred to i n the opening section of the dissertation. S p e c i f i c a l l y , i t w i l l require that the reader remember and use certain facts from this section, 142 e.g., the fact that the c l i n i c operates on an appointment system. At the time that these materials were presented, I stated that I did not know how such de t a i l s would come to be usable for whatever subsequent analysis was presented. Despite t h i s , I r e l i e d and s h a l l r e l y upon the reader to make use of these materials i n order to inform the analysis to be presented. While somewhat of an aside from our present concern, i t i s interesting how not only does th&sssubstantiate our e a r l i e r analysis of the standard ethnographic format, but also i l l u s t r a t e s some of the ways un which these i n i t i a l materials come to constitute the background for subsequent materials. Noting how such i n i t i a l materials are used as a resource for our appreciation of some subsequent analysis reinforces the i n i t i a l section and contributes as w e l l 1 t o the analysis at hand. Let us now return to our transcript and to an analysis of the scheduling problem. Continuing; with our data, U l l constitutes both an organizational ; problem, i . e . , which physician w i l l see the patient given that Doctor A i s unable to do so? and a proposed solution to t h i s problem. Our con-cern i s with how U l l handles the problem of who should see the patient. To begin with, l e t us consider the possible hearings members could en-gage i n . 1. The beginning of a complaint. I t i s the secretary's job to allocate appropriate time slot s for meetings between doctor and patient. The secretary knows which physicians are available at what times and i t i s her job to schedule appointments accordingly. Thus, the beginning section of U l l , "They've put him a b i t early for this afternoon," could 143 well constitute a complaint, i . e . , given Dr. A's schedule, the patient was scheduled for too early a time s l o t and, further, that "They," the secretary (or the c l i n i c i n general) should have known better than to make an appointment for that time. Put crudely, the beginning of U l l provides for the p o s s i b i l i t y of a f f i x i n g r e s p o n s i b i l i t y or blame to some organizational member who should have scheduled the patient at a time la t e r than that a l l o t e d . We can assume that Doctor A had consulted the appointment schedule prior to rounds and i s , thereby, i n a position to know when the patient i s scheduled .-2. ; A contingency i n Doctor A's schedule has developed. Another possible hearing for the beginning part of U l l i s that 'this afternoon' i s d i f f e r e n t from any afternoon because something has arisen i n Doctor A's schedule. Something which the secretary could not have known about. The 'bit early' seems to suggest this p o s s i b i l i t y since i t undercuts . the notion of making a complaint about, e.g., the ef f i c i e n c y of secre-t a r i a l scheduling. I f one i s going to make a complaint, i t i s not that the secretary made the appointment "a b i t early", but that she made the appointment "too early". 'Bit early' implies a temporal period short enough i n duration not to be problematic with reference to coincidence between physician and patient. Regardless of which possible hearing i s correct (for our business i s not one of deciding h i s t o r y ) , either hearing provides that the beginning of U l l establishes an organizational problem with reference to the speaker. The patient i s "a b i t early for this afternoon" only with reference to Doctor A's whereabouts. Doctor A i s not making some 144 statement about scheduling procedures i n general where e.g., there would not be anyone at the C l i n i c to see the patient. Given the group character of the c l i n i c , the beginning of U l l establishes the organiza-t i o n a l problem of "Who should see the patient?" The organizational problem provides those other physicians present with the p o s s i b i l i t y of seeing another and unexpected patient. This, however, increases their patient load. As such, the beginning of U l l , while an organizational problem for the C l i n i c , allows those candidates for another patient to/orient to that fact i n terms of either accepting another patient or constructing a possible excuse for not accepting another patient. What constitutes an organizational problem can also be seen by physicians as a personal problem that i s , seeing another patient i n an already busy work day. What we are dealing with then, i s both an organizational concern, i . e . , someone has to see the patient, and the personal Goncems:.of oDcctfor. A and the other physicians. U l l pro-vides us with an instance of how the organization of the work day i s attended to by the ongoing practices employed by members of the setting. Given that U l l i s preceeded by the Nurse's U10, how i s i t that Doctor B hears himself as the referent to the pronoun 'you' i n "I don't know whether he's coming to see me or to see you..." Again we are dealing with p o s s i b i l i t i e s , although i n this instance my f i e l d notes w i l l serve as a piece of history. 1. Eye contact. One p o s s i b i l i t y i s that Doctor A has spoken the utterance while looking at Doctor B providing thereby, i n addition to a verbal display, a pa r a l i n g u i s t i c means for speaker selection. 145 2. Medical s p e c i a l t y . Doctor A i s a p a e d i a t r i c i a n while Doctor B i s a family physician. The d i s t i n c t i o n being that, while a paedia-t r i c i a n s p e c i a l i z e s i n c h i l d r e n , a family physician treats the family as a whole. However, e i t h e r physician could t r e a t the patient and the secretary could have scheduled him to see eit h e r of them. 3. Past medical encounters. By providing a medical c h a r a c t e r i -^ . — zation of the patientv(inaU:6,PDoct0)r . A gives us warrantable grounds f o r assuming that he has seen the patient previously. Although we have no data to substantiate t h i s claim, f.oritteis.aequally possible that the patient has been seen previously by Doctor B, Us 7-9 a t t e s t to the fact that Doctor B i s at l e a s t f a m i l i a r with the patient. 4 . P a r t i c i p a n t s to the occasion. That the 'you' i n U l l r e f e r s to Doctor B can be derived from the fac t that only Doctor A, Doctor B, the Nurse, and myself were present at t h i s time. Since patients are scheduled to see physicians, the only candidate f o r the 'you' i s Doctor B. Note how p a r t i c i p a n t s o r i e n t to such contingencies when making or when hearing an utterance. Doctor B i s now i n a p o s i t i o n to see that he w i l l have to deal with the patien t . Although the p o s s i b i l i t y has not yet been e x p l i c i t l y proposed by Doctor A, I suggest that i t has been established here. Note another i n t e r e s t i n g feature of the segment "I don't know whether he's coming to see me or to see you", i . e . , i n some s t r i c t sense, the patient i s not "coming to see anyone" since he i s a baby and capable of no such independent act. Rather, he i s being brought to the C l i n i c . However, for.the purposes at hand, he i s a patient and patients are said t o 146 "come to the doctor" regardless of whatever else they do. The remainder of U l l reads "...but I s h a l l be sort of squeezed I think to get back i n time you deal with i t " . This i s both an e x p l i -c i t formulation of the problem and a possible solution for i t , i . e . , Doctor B should see the patient should Doctor A be unable to do so. Notice that Doctor A i s not refusing to see the patient but establishing good grounds for such a p o s s i b l i t y , i . e . , he has business elsewhere. The "I think" then sets up this as a p o s s i b i l i t y rather than a certainty, i . e . , the p o s s i b i l i t y exists that Doctor A w i l l be busy elsewhere and/ or unable to make it . back i n time to see the patient. Although he pro-vides a solution to the problem, namely "you deal with i t " , this may not be satisfactory to the physician so delegated. Let me elaborate this point. One way of handling the present sit u a t i o n would be to look at i t through some t r a d i t i o n a l s o c i o l o g i c a l concept such as status. Thereby, Doctor A could be viewed as a senior physician, e n t i t l e d to s p e c i f i c rights and duties from junior physicians such as Doctor B. When contin-gencies prohibit Doctor A from seeing a patient, he can, as a matter of v--course, assign that patient to a less senior physician. However, were the s i t u a t i o n reversed, i t would be harder for Doctor B to assign a patient to Doctor A. Such a view would be concerned wholly with how various medical personnel r e l a t e to each other i n terms of power and would s h i f t our attention away from the actual, ongoing sequences of interaction i n and through which members produce and sustain for one another their d a i l y a f f a i r s . To treat U l l i n such a manner would be to 147 ignore the interactional structure of the occasion. The problem of who should see the patient involves the ways i n which the problem i s ;. something produced and attended to by participants, and the answers to these concerns are much more complicated than notions such as status and the rest provide for. A resolution to the'problem can be achieved i n many dif f e r e n t ways — i t can be done t a c t f u l l y , rudely, gracefully, etc. The i n t e r -actional structure of the resolution i s another interesting feature here. U l l j i s not merely an instance of a senior physician passing the buck to a junior physician. Ratherm i t i s s p e c i f i c a l l y designed to undercut the notion that one doctor i s ordering another to see a patient. Doctor A establishes a reasonable excuse for having to assign the patient to another physician. I t i s not merely that he does not want to see the patient, but rather that he provides for the p o s s i b i l i t y that he may not be able to do so and, therefore, warrantable grounds for assigning him to another physician. That a patient i s assigned to another physician does not mean that that physician need accept the patient, nor need i t result i n a refusal to do so. U14 i s an example of how an attempt to re-assign the patient can be f o r e s t a l l e d by reformulating the bases of the problem; that i s , i t i s not that there w i l l be no physician available to see the patient at the appointed time, but rather that the patient i s not the problem here. The patient i s a baby and, whether Doctor A or Doctor B:is available or not i s not a matter of concern for him. The problem and possible solution l i e s i n the fact that the person bringing the baby to 148 the doctor i s h i s mother who w i l l have to wait. Doctor B has transformed the \'he''s" of U l l into the appropriate category of person for whom i t would be a problem were Doctor A not a v a i l a b l e . At the same time, he provides a c h a r a c t e r i z a t i o n of the patient's mother that undercuts Doctor A's concern that he may not be able to get back i n time by pro-posing that "Mother's a patient woman". This i s not a mere c h a r a c t e r i -zation of the patient's mother, but i s t i e d to the reasons why Doctor A might not be able to see the patient on time. Doctor B has undercut these grounds rather than refuse to see the patient. Note that such a r e f u s a l could have severe consequences, e.g., an argument might ensue. Thus, f o r the moment, Doctor A i s s t i l l responsible for seeing the patient. What gets treated i n the l i t e r a t u r e as status and r o l e r e l a t i o n -ships and r i g h t s and duties with reference to such r e l a t i o n s h i p s , can t e l l us l i t t l e about the ways i n which members come up with solutions to t h e i r everyday problems (problems which I suggest, f a l l under the heading of "the p o l i t i c s of everyday l i f e " ) . That people are r o u t i n e l y placed i n s i t u a t i o n s providing them with some degree of s a t i s f a c t i o n or d i s s a t i s -f a c t i o n i s something one need not be a s o c i o l o g i s t to attend to. How such problems come to be negotiated i n everyday i n t e r a c t i o n , i s , how-ever, a topic worthy of s o c i o l o g i c a l inquiry and one that w i l l not be answered by providing glosses of the very phenomena investigated. The p o l i t i c s of everyday l i f e i s a topic f o r research i n v e s t i g a t i o n and not for t h e o r e t i c a l speculation. In attempting to handle the data as i t was produced,Iilhave made 149 two diversions from the analysis of a patient's reason f o r a v i s i t . F i r s t , I have discussed Us 3-9 as an instance of memory and recognition. Second, I have attempted to elaborate how an organizational problem i s handled by the practices employed by membersrinhandoover ithetcourse of the occasion i n which i t i s '.roduced. At t h i s point, I w i l l return to an analysis of a patient's reason for a v i s i t to the C l i n i c . The Reason for a V i s i t : II U n t i l U15, no grounds f o r the patient's reason f o r coming to the C l i n i c had been proposed. I t should be remembered t h a t U 6 only provides us with the parameters that could warrant the patient's v i s i t . In U15, the Nurse begins to formulate the reason. Although, i n p r i n c i p l e , a patient can see a physician for a wide v a r i e t y of reasons,, members of the C l i n i c do not engage i n guessing games to account f o r a patient's reason f o r a v i s i t . I t i s an inherent feature of medical p r a c t i c e that c e r t a i n treatments may require repeat v i s i t s to a physician. Given t h i s feature, members of the C l i n i c are able to formulate possible grounds for a present v i s i t on the basis of the patient's past v i s i t s to the C l i n i c . What we are dealing with, then, i s that patients can come to have careers as patients. I w i l l address t h i s issue i n a moment. In U15, the Nurse has apparently found some grounds, v i a r e c a l l or by consulting the chart, which allow her to formulate a possible reason for the patient's coming to the C l i n i c today. Doctor A, i n U16, does not simply f a i l to wait for the Nurse's formulation to be completed, but rather o r i e n t s to the Nurse's a c t i v i t y of f i n d i n g a reason f o r a v i s i t . The "Oh yeah" i n U16 does not corroborate the Nurse's f i n d i n g (as of yet she has not proposed a possible reason for a v i s i t ) , but 150 rather by seeing that the Nurse i s attempting or about to produce some, reason for the v i s i t , Doctor A'.via hisimemo.r^yof the patient, produces that reason and does so. The structure of U16 i s complex and warrants further comment. Nowhere i n the utterance i s i t e x p l i c i t l y stated that the patient i s coming to the C l i n i c for a shot. Yet, I take i t that t h i s i s what i s being proposed. The patient had a " l a s t shot" and i s coming for h i s "next shot". The elegance here l i e s not only i n remembering that the patient received a shot, but remembering that the patient received a shot as part of a s e r i e s of shots i n a course of treatment, and that the shot received during a p r i o r v i s i t was not the f i n a l shot i n the s e r i e s . The use of " l a s t shot" invokes the notion of a " s e r i e s " of shots i n a rather strong way. In addition, I suggest, i t serves to r e a f f i r m the e a r l i e r c h a r a c t e r i z a t i o n of the patient as a "routine baby" where the features of such a c h a r a c t e r i z a t i o n provide f o r such shots. As i t turns out i n Us 22-25, the shots are a s e r i e s of immuni-zations . I t has been demonstrated that members of the C l i n i c are able to formulate grounds accounting for the p a t i e n t s ' forthcoming v i s i t . E m p i r i c a l l y , however, the adduced reason for a v i s i t may be proved wrong.in the actual encounter between patient and physician. The baby could have become s e r i o u s l y i l l and that i l l n e s s could be the grounds for coming to the C l i n i c . Nevertheless t h i s p o s s i b i l i t y never a r i s e s i n t h e i r discussion. The parameters of a v i s i t to the C l i n i c are, for members of the C l i n i c , an issue decided and decidable by reference to 151 their knowledge of the patient and current organizational concerns. Thus what was o r i g i n a l l y thought to be an organizational problem with reference to doctor-patient scheduling, Us 11-14, i s now seen as some-thing which may only require the attention of a nurse, for routine immunizations are given by the Nur-se and the patient need not see a doctor i n order to receive them. The above analysis i s but one instance of participants to chart rounds formulating or attempting to formulate a patient's reason for coming to the C l i n i c . This i s a regular and recurrent feature of the occasion. I would l i k e to make some general comments concerning the accomplishment of t h i s . While a patient's reason for a v i s i t i s generated from his chart and the accumulated knowledge of the participants, there are various ways i n which the patient's relationship to the C l i n i c i s u t i l i z e d i n this accomplishment. 1. Use of the chart for programmed information. Consider the following pieces of data: ONE 68. Doc. A Mrs. Jones. I take i t she i s recently married. Condyloma  podophyllin return i n one week. (Condyloma i s a disease term for veneral warts, and podophyllin i s the medication used i n treatment) 69. Doc B Ah oh Steve Schwartz had been see-ing them applying podophyllin. 70. Doc. A Um well ah she must be back for more. 152 TWO 131. Doc A Miss Joan Summer wishes I.U.D. period  f i n i s h e d to go take p i l l and return  when she's menstruating., I take i t she i s coming back now.. 132. 132. Doc B ( ) 133. Doc A For an I.U.D. i n s e r t i o n The above constitute instances of how the s t a f f use information about what took place on a patient's l a s t v i s i t to the C l i n i c i n order to account for what w i l l take place today. A written record of what took place previously i s placed i n the patient's chart and a v a i l a b l e during chart rounds. The patient's chart may contain information such as "return i n one week," "return when she's menstruating," etc. Note that formulating a patient's reason f o r a v i s i t i s an accomplished a c t i v i t y and i s not merely discovered by reading the chart. While a chart may contain programmed information, e.g., "return i n one week," i t must be established why the patient was to l d to "return i n one week". C l e a r l y , the charts are not s e l f - i n t e r p r e t i n g . Even i n the case of such a sim-ple i n s t r u c t i o n , the s t a f f faces the task of fi n d i n g some correspondence between the i n s t r u c t i o n and the ramifications that follow from i t . The drawing up of charts i s a members' s accomplishment. Those who produced them knew that they may come to be u t i l i z e d at some l a t e r point. Thus, I would l i k e to examine the underlined portions i n the above pieces of data as produced to be able to be u t i l i z e d s u c c e s s f u l l y at a l a t e r point. That i s , the underlined portions have an order and that i s t i e d to some notions of proper and improper accounts of what transpired be-tween physician and patient. I am tre a t i n g these instances as routine 153 accounts of previous contacts which p a r t i c i p a n t s to chart rounds use to decide a patient's reason for a v i s i t . Such accounts, however, can bepproblematical and commented upon. There are r i g h t ways and wrong ways of describing what transpired between patient and physician. Consider the following: 36. Doctor And here's Mr.sr. Heather Moore who's f i f t y - o n e . 37. Medical student Yes I remember her ah Doctor Marsh and I saw her 38. Doctor Is her presenting problem ah um Dr. Marsh hasn't learned the terse b r e v i t y of The C l i n i c yet? (Dr. Marsh i s a new physician) sometimes i t ' s a b i t ( d i f f i c u l t ) to know ex-a c t l y (5.0 sec. pause) pigmented a l l over including her ah ( )_ mucosa with a normal blood pressure 39. Medical student I think her presenting problem was r amenorrhoea 215. Doctor Irene Coombs, s t i l l on meloral (11.0 sec. pause) Lot of s o c i a l s t u f f (7.0 sec. pause S t i l l on mesec,?.lpause) S t i l l on meloral, she's b a b y s i t t i n g at home on meloral same dose, more meloral same dose ( ) (present medication) Aside from the f a c t that she's bored and does some occasional b a b y s i t t i n g from time to time I haven't found out why she got on meloral. Do you know Mrsi Irene Coombs, Judy? 216. Judy (the Nurse) She's a schizophrenic 217. Doctor ~ Well now that's the reason th2re_ we are-• • The above instances, i l l u s t r a t e how,^describing what took place be-tween physician and patient i s t i e d to c e r t a i n organizational concerns 154 of what an adequate d e s c r i p t i o n would e n t a i l . From these two instances, we may decide that such a d e s c r i p t i o n should be brief,- describe the patients problem, and account for c e r t a i n treatment procedures, e.g., the administration of drugs. How then do the underlined portions of our data constitute adequate descriptions usable for deciding a pat i e n t ' reason f o r a v i s i t ? To get at t h i s , I w i l l present one further i l l u s t r a t i o n . I t i s an instance where the physician makesea mistake i n reading the chart. From t h i s mistake, we may gain i n s i g h t into the organization of our data. 346. Doctor Mrs. Ch i l d , f e e l s much better coughs much better. Pardon me, f e e l s w e l l  cough much bet t e r . Her pneumonia's  cured, treatment n i l 347. Doctor-B. Mary was seeing her We may begin by noting that the error made by the Doctor i n U346 i s an error i n sequencing, i . e . , the f i r s t underlined portion does not provide an adequate account. The "coughs much b e t t e r " denies the ground for " f e e l s much better". The doctor recognizes t h i s error i n sequencing and provides a c o r r e c t i o n . He reads i t again, t h i s time, he reads cor-r e c t l y what was written i n the chart: " f e e l s well cough much b e t t e r " where "cough much better" provides grounds f o r " f e e l s w e l l " . The issue of sequencing and record-making has been discussed by R a f f e l . The general problem for members i s to get some sequence to a set of sentences. To sequence i s one aspect of making a record as a f a c t u a l account of what happened. To sequence i n c e r t a i n ways would be to c a l l i n t o question the f a e t u a l i t y of the account...^ Examining the sequencing of the underlined portions of our data, what 155 would be the consequences of reordering, e.g., the underlined portion of U68 to "return i n one week condyloma podophyllin". One p o s s i b i l i t y i s that the patient i s returning to the C l i n i c for determining whether or not she has condyloma and, i f she does, the treatment i s podophyllin. Such an account would s t i l l leave i n question what i n fact transpired between the patient and physician at the time the entry was made into the chart. Why couldn't she be examined and treated then? The "return i n one week" provides for the fact that the i l l n e s s and accompanying treatment account for her reason for a next v i s i t . The patient i s made out to be a medical case, requiring v i s i t s u n t i l the course of treatment i s over and she no longer suffers from the i l l n e s s . The f i r s t part of U131, "wishes I.U.D.", establishes that the patient did not i n fact receive an I.U.D. on her l a s t encounter. "Wishes" establishes that the request was not f u l f i l l e d on the l a s t encounter and constitutes the grounds for t h i s current encounter. Compare th i s to, e.g., "wished I.U.D. period finished to go take p i l l and return when she's menstruating" where 'wished' would then provide the p o s s i b i l i t y that the patient had since changed her mind. The patient wanted an I.U.D. and s t i l l wants one. I.U.D.s are usually inserted when the patient i s menstruating. That the patient was instructed to return "when she's menstruating", must be read that she i s returning, not because she i s menstruating, but for an I.U.D. to be- inserted. Consider the underlined portion of U131 were i t reorganized i n the following way: "period finished to go take p i l l and return when she's menstruating wishes I.U.D." Such a reordering provides the p o s s i b i l i t y that she i s coming, 156 not for an I.U.D. ins e r t i o n , but for an examination to determine i f such an insertion i s possible. 2. Consulting the organizational policy of the C l i n i c . The C l i n i c ' s policy requires e.g., that a Pap Test (a test for cancer of the cervix) be administered to women who want b i r t h control p i l l s . A patient unable to have the test on a given day can schedule an appoint-ment to return at a l a t e r date. When the patient's chart i s reviewed, this policy can be u t i l i z e d i n constructing the reason for the v i s i t . Consider the following: 187. Doc. A Charlen Pinch ah wants b i r t h control p i l l , EhliTsI was i n December, ah taking a n t i -anxiety p i l l s when she cannot sleep, one p i l l every two nights approximately. She must be ah yeah she's a Youth night program 188. Doc. B Umm hum 189. Doc. A Given one month supply of b i r t h control p i l l s and told to return within a month  for a Pap so I guess she's i n for p i l l s The patient wants b i r t h control p i l l s and she has to go through a Pap Test i n order to get them. The Pap i s an organizational policy of f • Test i n order to get themPapTie Eapoisaanzorganizat-i!onalr policy atUthe C l i n i c while her own reason for coming to the C l i n i c , however, i s not for a Pap Test, but for p i l l s . That st a f f can decide on a patient's reasons for v i s i t i n g the C l i n i c i s an essential feature of chart rounds. Chart rounds, I suggest, run contrary to layanotions of medical practice. Such a notion might be formulated as, e.g., "the physician should always expect the worst when seeing a patient ( i . e . , be f u l l y attentive for any possible mani-festations of disease.)" Contrary to this lay conception, physicians 157 find t y p i c a l courses of action that can account for the patient scheduling a v i s i t to the C l i n i c . They:do not t y p i c a l l y view the v i s i t as an open f i e l d of contingencies. Rather, once a reason for a v i s i t i s found, i t i s treated organizationally u n t i l or unless further notice should prove i t wrong as the reason for the patient's v i s i t . The medical history of the patient i s held i n equilibrium with reference to the or-ganizational concern for the patient's presence at the C l i n i c . This suggests then, that physicians emerge from chart rounds with a provisional orientation to the problems of the day's incoming patients. Of course, t h i s i s not to say that these provisional orientations are not f u l l y retractable or that, upon encountering patients, physicians do not bring th e i r f u l l medical s k i l l s and attention to bear. ^ Conclusion ' Conclusion This chapter has attempted to present a detailed analysis of the oc-cation of chart rounds. I have proposed that this occasion i s one designed for and accomplished by talk by c l i n i c members. I have discussed some of the a c t i v i t i e s that are accomplished through talk and have discovered some of the self-organizing features of this occasion v i a an analysis of trans-criptions of actual meetings. I have dealt with the progression problem, the reason for a patient's v i s i t , the adequacy of patient names, and other matters related to the ove r a l l organiza£t±cuva>l!. structure of conversations. Without claiming that t h i s i s a l l that there i s to find or that I have produced an exhaustive analysis of chart rounds, the findings presented i n this chapter stand as ethnographic findings, responsive to our concern for maintaining the i n t e g r i t y of the occasion while responding to i t s s e l f -158 organizing features. Over the course of producing this analysis of chart rounds, i t has hopefully been evident that I have i n fact followed a "standard ethno-graphic format" insofar as I have made use of those i n i t i a l background materials provided i n an e a r l i e r section of this report. At the time of the i r construction, however, I did not know that theywwould come to have th i s kind of prospective value and i t can be assumed the reader did not see the significance of these materials either. This seems to be a general feature of the construction of detailed ethnographic description. We may also note that the in t e r a c t i o n a l and conversational approach used here has allowed us to i l l u s t r a t e some of the self-organizing features of chart rounds. Such analysis, however, also works the other way round fo r , by examining some of the data from chart rounds, we have discovered some generalizable features of interaction that operate across scenes and settings. Thus, while engaging i n a description of chart rounds, the analysis pertains also to areas beyond the confines of the research setting. 159 Footnotes: Chapter Three 1. The unpublished work of Harvey Sacks must be mentioned as an out-standing source of i n t e l l e c t u a l and research stimulation. Since much of h i s material i s only a v a i l a b l e i n a ser i e s of unpublished, transcribed lectures given to h i s classes at the U n i v e r s i t y of C a l i f o r n i a , Irvine, the reader should note thatiLt often has a chatty and casual character rather than that of material submitted for p u b l i c a t i o n . While the s t y l e of these l e c t u r e materials i s casual, the ideas put f o r t h are our main concern. Rather than attempt to paraphrase or condense these references I have chosen to present them as they are w i t h i n the l e c t u r e s . This allows the reader to see how conversational materials are u t i l i z e d i n the production of a conver-s a t i o n a l a n a l y s i s . 2. Harvey Sacks, unpublished l e c t u r e no. 3, October 16, 1968, p. 4. 3. I b i d . , p. 20. 4. Certain settings and occasions provide for the accomplishment of "core a c t i v i t i e s " and the t a l k that occurs within these settings and occasions must be responsive to their t f"core a c t i v i t i e s " . This i s not to say that the t a l k that occurs must only be about the core a c t i v i t y , but that such t a l k cannot be absent without some re-evalua-t i o n of the character of the occasion. I t i s i n t h i s sense that we can speak of "co n s t r a i n t s " on t o p i c a l t a l k . For a more d e t a i l e d discussion see Bruce Katz, Conversational Resources of Two-Person Psychotherapy, unpub. M.A. Thesis, Un i v e r s i t y of B r i t i s h Columbia, Vancouver, 1971. 5. Harvey Sacks, unpublished l e c t u r e . 6. P.F. Strawson, Individuals: An Essay i n Descriptive Metaphysics, (tton'donr.L aMetfiuenaand Company, 1969), > pp. 15-16. 7. c f . Emanuel Schegloff, "Notes on a Conversational P r a c t i c e : Formula-t i n g Place" i n David Sudnow, e d i t o r , Studies i n S o c i a l Interaction, (Hew York: The Free Press, 1972),, pp. 82-83. 8. Harvey Sacks, unpublished l e c t u r e , A p r i l 24, 1968, p. 6. 9. Stan R a f f e l , "Notes on Time as a Method to Sequence Sentences'.', un-published working paper, Domingez H i l l s College, C a l i f o r n i a , 1969, p. 2. 160 CHAPTER FOUR THE RESEARCHER AND THE RESEARCH SETTING Introduction Throughout t h i s report we have been concerned with i n t e r a c t i o n and the procedures one could employ to study i n t e r a c t i o n . Chapter two was addressed to some of the ways i n which a researcher, having gained access to the C l i n i c , could a c t u a l l y do h i s analysis. This chapter w i l l be dedicated to an examination of the r e l a t i o n s h i p between the researcher and the research s e t t i n g . S p e c i f i c a l l y , i t w i l l be concerned with those features which confront the researcher i n the a c t u a l doing of f i e l d work. I t w i l l focus upon some of the contingencies that a f i e l d researcher must deal with i n and over the course of h i s work. Since much of these ma-t e r i a l s i s r e l a t e d to those issues discussed i n chapter two, I would l i k e to go over the major points r a i s e d i n that chapter. Chapter two began with a consideration of some of the ways i n which a medical s o c i o l o g i s t might conduc(t research i f given access to the C l i n i c . I t was suggested that h i s approach would involve a predecided set of r e -search questions and that the C l i n i c would serve as the locus from which answers could be obtained. I argued that such an approach would not, i n -deed, could not, respect the i n t e g r i t y of the research s e t t i n g . I pointed out that the a c t u a l , ongoing behaviour would be seen and used as data sup-r porting or r e f u t i n g some research hypothesis. This fa c t alone would pre-clude any rigorous methodological concern with or a t t e n t i o n to the members' point of view and/or with the s e l f - o r g a n i z i n g featured of the C l i n i c . : 161 Next, I considered t r a d i t i o n a l ethnographic d e s c r i p t i o n which has, as a fundamental concern, an analysis of how members organize t h e i r d a i l y a f f a i r s . This looked more promising. However, a closer examination revealed that ethnographies often incorporate what may be c a l l e d "standard p r o f e s s i o n a l concerns" — matters such as kinship organization, r e l i g i o n and magic, and p o l i t i c a l organization — into t h e i r analyses. Such con-cerns c o n s t r i c t ethnographers i n much the same way as a research hypothesis l i m i t s our medical s o c i o l o g i s t f or they tend to channel, observations, about d a i l y l i f e into preconceived abstractions of s i n g u l a r l y p r o f e s s i o n a l i n t e r e s t . This weakness was noticed not only by me but by those anthropologists who promulgated an a l t e r n a t i v e to standard ways of doing ethnography. This new approach, c a l l e d cognitive anthropology, has as i t s focus the production of a d e s c r i p t i o n which "understands the organizing p r i n c i p l e s underlying behaviour." In t h i s respect, i t i s concerned not only with a setting's organizational features but with maintaining what I have c a l l e d the i n t e -g r i t y of the research s e t t i n g as w e l l . I t i s aimed at a c u l t u r a l descrip-t i o n which would allow the reader to behave i n ways that would be deemed c u l t u r a l l y appropriate by members of the studied culture. I t c r i t i c i z e d t r a d i t i o n a l ethnography on the grounds that the questions that i t asked and thus .the answers that i t obtained were not responsive to the organi-zation of the culture under observation. Frake characterized t h i s d i f -ference between.the two approaches i n the following manner: The onl y . e x i s t i n g f i e l d manual for ethnographers Notes and Queries on Anthropology presents a l i s t of queries that an investigator can take to the 162 f i e l d , present to h i s informants, and thereby produce a set of responses. His ethnographic r e c o r d , then, i s a l i s t of questions and answers. (The t r a d i t i o n i n modern anthropology, however, i s not to make such a r e c o r d p u b l i c but to p u b l i s h an essay about i t . ) The image of ethnography we ( c o g n i t i v e a n t h r o p o l o g i s t s ) have i n mind a l s o i n -cludes l i s t s of q u e r i e s and responses, but w i t h t h i s d i f f e r e n c e : both the queries and t h e i r responses are to be discovered i n the c u l t u r e of the people being s t u d i e d . The problem i s not simply to f i n d answers to questions the ethnographer b r i n g s i n t o the f i e l d , but a l s o to f i n d questions that go w i t h the responses he observes a f t e r h i s a r r i v a l . - * -While attending to the i n t e g r i t y of s e t t i n g s and occasions t h i s new a p -proach to ethnographic d e s c r i p t i o n has a l s o advocated the goal of being able to s p e c i f y "the grammar of a c u l t u r e . " Rather than p r e d i c t beha-v i o u r , the goal of c o g n i t i v e anthropology i s somewhat l i k e that of the l i n g u i s t who faces the task of c o n s t r u c t i n g the grammar of a language: The aims of ethnography, then, d i f f e r from those of s t imulus-response psychology i n at l e a s t two r e s p e c t s . F i r s t i t . i s n o t , I t h i n k , the ethnogra-p h e r ' s task to p r e d i c t behaviour per se, but r a t h e r to s t a t e r u l e s of c u l t u r a l l y a p p r o p r i a t e behaviour. In t h i s respect the ethnographer i s again a k i n to the l i n g u i s t who does not attempt to p r e d i c t what people w i l l say but to s t a t e r u l e s f o r c o n s t r u c t i n g utterances which n a t i v e speakers w i l l judge as grammatically a p p r o p r i a t e . The model of an ethno-graphic statement i s not: " i f a person i s confronted w i t h stimulus X, he w i l l do Y , " but: " i f a person i s i n s i t u a t i o n X, performance Y w i l l be judged ap--p r o p r i a t e by n a t i v e a c t o r s . " The second d i f f e r e n c e i s that the ethnographer seeks to d i s c o v e r , not p r e s c r i b e , the s i g n i f i c a n t s t i m u l i i n the s u b j e c t ' s w o r l d . He attempts to d e s c r i b e each act i n terms of the c u l t u r a l s i t u a t i o n s which a p p r o p r i a t e l y evoke i t and each s i t u a t i o n i n terms of the acts i t a p -p r o p r i a t e l y evokes.^ The g o a l of c o g n i t i v e anthropology i s i t s e l f commendable, however, i t was p o i n t e d out that no d e s c r i p t i o n could p o s s i b l y al low the reader to act i n an ongoing c u l t u r a l l y a p p r o p r i a t e way. The b a s i s f o r t h i s 163 c r i t i c i s m derives from the inescapable f a c t that any description requires f i r s t , that the researcher r e l y upon his own common sense knowledge of s o c i a l structures when producing a d e s c r i p t i o n of a society and, second, that readers use t h e i r own common sense to i n t e r p r e t the researcher's d e s c r i p t i o n . Thereby, a d e s c r i p t i o n that would s a t i s f y the goals of cognitive anthropologists would require the ethnographer to give more d e t a i l than would be contained i n any s e t t i n g or domain from which the d e s c r i p t i o n i s generated. An example may help to c l a r i f y t h i s feature of producing descriptions. The previous analysis of chart rounds i s not intended as a d e s c r i p t i o n that would enable anyone reading i t to act i n c u l t u r a l l y ap-propriate ways. Rather, i t i s a d e s c r i p t i o n that i s responsive to the s e l f - o r g a n i z i n g features of t h i s occasion. To transform the previous analysis of chart rounds into an analysis that s a t i s f i e s the goal of cognitive anthropology would necessitate that 1 inform the reader about many other features of the occasion. For example, I would be obliged to t e l l him that the s t a f f are usually seated during the occasion, that i t i s permissible to smoke, that i t would be inappropriate to "make"'faces"i and so on and so forth.. I t i s apparent that a v i r t u a l l y i n f i n i t e number of items could be added to t h i s or indeed to any d e s c r i p -t i o n . That i s , as G a r f i n k e l has pointed out, the inherent problem for any such d e s c r i p t i o n i s the problem>iof(fcKemecessary appendage of an et cetera 3 clause. For, as a p r a c t i c a l matter of f a c t or procedure, i t i s impossible to c i t e a l l of those things that any reader would need to know i n order to be able to act i n a c u l t u r a l l y appropriate manner. 164 I t can be assumed that no one treats cognitive anthropology as a d i s c i p l i n e which should or even could achieve i t s expressed goal. I am not advocating a contrary p o s i t i o n , but noting that the goal i s more arduous and complicated than may f i r s t seem to be the case and, f i n a l l y , that i t i s pragmatically impossible to achieve such a goal. To require that a d e s c r i p t i o n be responsive to "everything one would need to know i n order to act i n and to be seen as someone who i s acting i n c u l t u r a l l y appropriate ways" i s to ask for the impossible for i t i s impossible to describe that "everything". This synopsis of chapter twoiiillustrates that cognitive anthro-p o l o g i s t s have proposed a c e r t a i n research goal towards Which t h e i r c u l t u r a l descriptions are oriented. The s o c i a l s c i e n t i s t i n the f i e l d has, s i m i l a r l y , some conception of h i s r e l a t i o n s h i p to the research s e t t i n g and the ends towards which h i s descriptions are directed. Where-as cognitive anthropologists specify the goals or i d e a l s towards which th e i r studies are directed, s o c i o l o g i c a l l i t e r a t u r e often attempts to give advice and/or d e t a i l e d i n s t r u c t i o n s about c e r t a i n ways i n which recognizably good s o c i a l ethnographies are to be accomplished. For 4 instance, there i s much l i t e r a t u r e e x p l i c a t i n g the roles that the researcher can and should play while studying a community or an organization. In general, such l i t e r a t u r e attends to the idea that the researcher should make himself minimally d i s r u p t i v e and thereby be maximally productive i n terms of the actual c o l l e c t i o n of data. An e n t i r e l i t e r a t u r e concerns i t -s e l f with the problems afforded the researcher by h i s r o l e i n the research v" s e t t i n g . I t could not be reviewed here. However, a considerable part 165 attempts to provide the analyst with i n s t r u c t i o n s on how to act competently while i n the research s e t t i n g . I t i s somewhat i r o n i c that, on the one hand, cognitive anthropolo-g i s t s specify a goal which t h e i r descriptions should a t t a i n to but pro-vide no l i t e r a t u r e o u t l i n i n g the way or ways i n which t h i s goal i s to be achieved. While, on the other hand, we have s o c i o l o g i c a l f i e l d manuals which attempt to i n s t r u c t the s o c i a l researcher i n appropriate f i e l d methods but espouse no f i x e d goal which he should attempt to achieve. In sum, while cognitive anthropology has ignored the p o s s i b i l i t y (or i m p o s s i b i l i t y ) of achieving i t s proposed goal, s o c i o l o g i s t s have no proposed goal but have made the actual doing of f i e l d work into a metho-do l o g i c a l problem. The advice offered i n s o c i o l o g i c a l f i e l d manuals i s by and large of a kind that could be r e a d i l y characterized as "boy scout" advice. The researcher i s instruc t e d to be " t a c t f u l " , "non-disruptive","adopt a r o l e " , and so f o r t h . I t i s not that such advice cannot be followed but that i t does not t e l l the researcher i n the se t t i n g how to act i n the manner prescribed. Instead, every i n d i v i d u a l i n every p a r t i c u l a r research s e t t i n g i s required to make p r a c t i c a l research decisions for the purposes at hand so as to follow such advice. By t h i s , I mean that what w i l l or w i l l not constitute being " t a c t f u l , " "non-disruptive" or whatever w i l l have to be decided within an actual i n t e r a c t i o n a l context. F i e l d methods texts tend to ignore the i n t e r a c t i o n a l context of the researcher and the research s e t t i n g and to present t h e i r readers with a set of vacuous i n s t r u c t i o n s that have to be transformed into p r a c t i c a l 166 accomplishments i n the f i e l d s i t u a t i o n . While the goal of cognitive anthropology i s as a p r a c t i c a l matter of fact unobtainable, the instruc-tions offered by research manuals are of a problematically empty char-acter. Admittedly, the advice that they offer to f i e l d researchers i s , i n some sense, demonstrably good advice, however, the manner i n which that advice i s to be implemented by the researcher i n the research setting i s never i t s e l f a topic for examination; thence, the vacuous character of f i e l d research manuals. Neither the proponents of cognitive anthropology nor those concerned with f i e l d work methodology have provided us with a thoroughgoing account of how the members of p a r t i c u l a r research settings manage the properties of a setting (including the presence of the researcher). Nor have they studied the ways i n which the researcher manages his f i e l d experiences i n the setting. In.the following pages, i t i s my intention to examine this relationship between the analyst and the research setting by con-sidering my own research experiences at the C l i n i c . Instead of treating my presence i n the f i e l d as an essen t i a l l y methodological problem, I s h a l l look at some of the ways i n which i t must be regarded as a necessary part of the description of the C l i n i c . The Sociologist as Cultural Stranger Sociological f i e l d work manuals t y p i c a l l y attempt to deny the sociologist the benefit of his own c u l t u r a l expertise. By t h i s , I mean that he i s often treated as an "i n t e r a c t i o n a l buffoon" who has to be instructed i n such things as the proper ways of entering a research setting, i d e n t i t y management, role,playing, and role selection. I t seems odd that 167 the adult layman going to a new setting should require a manual of instructions on how to be inoffensive, unobstrusive, and/or non-dis-ruptive."' Furthermore, the very act of giving such instructions could be seen as an implication that the author, the reader or both regard the person seeking instruction as socially incompetent. Be that as i t may, concerns about methodological proprieties occupy a central focus in the literature of f i e l d research. These very methodological issues have seemingly denied the sociologist that which he (in essential con-trast to the anthropologist) has in common with the people and society he i s investigating, that i s , his own cultural competence as a bona-fide member of the society he i s studying. Instead, he is cast in the role of a cultural stranger. There is something i n t r i n s i c a l l y strange about the assumption that we should instruct a sociologist in proper procedures for the doing of f i e l d research. If the sociologist i s denied his cultural competence and regarded instead as a stranger to a setting, whatever instructions he may be provided with w i l l not show him to behave in appropriate ways since, paradoxically, this very set of instructions trade upon the assumption that he is a competent cultural member in order to deny that he has this competence. Rather than treat him as a stranger, we should attempt to explicate the relationship obtaining between sociological topics and our resources for the investigation of those topics. Thus, Turner has stated that: It i s increasingly recognized as an issue for socio-logy that the equipment that enables the ordinary member of the society to make his daily way through 168 the world i s the equipment available for those who would wish to do a "science" of that world....'' F i e l d work methodology treats everyday features of i n t e r a c t i o n — entering a new s i t u a t i o n , being inoffensive, being t a c t f u l , etc., — as a suitable topic for investigation by incorporating into i t s pro-positions our own common-sense knowledge of how these methodological problems are ;resolved on an i n t e r a c t i o n a l basis without every making the researcher's c u l t u r a l competence i t s e l f a topic of s o c i o l o g i c a l inquiry. Often after tedious discussions of role selection, p a r t i c i -pant observation and research strategy the f i e l d researcher encounters what I c a l l the "et cetera clause of f i e l d work methodology." An ex-ample of t h i s et cetera clause i s found i n Junker's c l a s s i c on f i e l d work: It i s not possible to specify the combinations and conditions and thence to write prescriptions for role choices to match s o c i a l science problems, i f only because f i e l d workers vary so greatly i n respect to i d e n t i t y and s e l f that each must learn to solve these problems as they crop up. More-over, the a b i l i t y to find such solutions and to reject impossible f i e l d work tasks doubtless develops as each f i e l d worker learns more about se l f and the repertory of roles possible and g even most congenial for him, given who i s i s . After any discussion about the methodological problems which are said to confront the f i e l d worker, his "ultimate strategy" b o i l s down to the i n -escapable fact that he can make use of his everyday common sense about how to act i n or react to any new strange or problematic s i t u a t i o n which he may meet within the course of his work. Therefore, while such methodological discussions may be interesting, they seem to have l i t t l e r e l a t i v e u t i l i t y for persons doing s o c i a l ethnographies. 169 Let us now turn our attention to an examination of some of the everyday contingencies which are part and parcel of any research. F i e l d research i s regarded as a p r a c t i c a l accomplishment. In order to under-take an adequate investigation of some of i t s properties, i t seems ap-propriate that we examine actual instances of data from f i e l d situations. Many of my experiences at the C l i n i c have been preserved on audio tapes. I t i s my intention to examine my tape recordings and f i e l d notes i n order to explicate some of the contingencies that may confront one i n the f i e l d . I w i l l consider three s p e c i f i c aspects of my f i e l d research at the C l i n i c : (1) participant or non-participant observation; (2) the manner i n which C l i n i c s t a f f i d e n t i f i e d me to patients during the course of various medical encounters; and (3) some e t h i c a l considerations revolving around the ways i n which I was i d e n t i f i e d to patients. On Participant-Non-participant Observation There i s a prevailing notion i n so c i o l o g i c a l f i e l d work that the researcher has a choice about how he w i l l conduct himself once his presence, as a s o c i a l researcher, i s known to the credentialed members of the setting. He can elect to be a participant observer or a non-participant observer, or various combinations and permutations thereof. While methodologists acknowledge that these two characterizations are ideal types so that i t i s impossible for the sociologist to be wholly one or the other, so c i o l o g i c a l l i t e r a t u r e continues to posit the d i s t i n c t i o n between the two as an issue of consequence for those engaged i n f i e l d research. However, the d i s t i n c t i o n i s neither consistently clear nor free from contradictions. The following f i e l d note comes from my research at the Clinic. It i s apparent that i t can not be easily classified in terms of participant or non-participant observation! I had just finished recording a medical inter-view when one of the physicians (Doctor X)c.asked me i f I had ever seen a cyst removed. I replied that I had not. Doctor X then gently pushed me into another examination room and told me that I should "Have a look". I found myself in the presence of Doctor Y, a part-time physician who came to the Clinic every other week. He was preparing the patient for a minor surgical operation. Doctor Y was familiar to me and with my presence at the Clinic and I assumed that he knew I was a sociological researcher. I was not introduced to the patient. Doctor Y proceeded to remove the cyst. He asked me to hand him certain instru-ments from a nearby medical stand. I often did this when observing medical examinations since i t was a\yway of doing something that I thought might be helpful. Doctor Y then showed me the cyst which was located on the patient's stomach. He then made an incision into the cyst and i n -serted a hemostat (a pair of blunt scisor-like prongs) into the .cut in order to spread the patient's skin. Next he asked me to hold the hemostat (which was s t i l l inserted in the cyst) while he proceeded to wipe the wound with cotton. He asked me to spread the skin a bit more in order to get a l l the pussout. I did as requested. After the procedure was over and the patient had l e f t the examination room I asked Doctor Y i f he knew that I was not a medical student. He said that he thought I was a medical student and that he wanted me to have a good look at the procedure. It appeared that the director of the Clinic had not informed Doctor Y about my research project and that he had assumed I was a medical student. Nothing was made out of this incident and, on subsequent occasions, Doctor Y would allow me g to observe his medical encounters with patients. This experience is not merely some "cute example" of one of 171 those unusual or unexpected contingencies t y p i c a l l y encountered arid related by those who have done some f i e l d work. Rather, i t i l l u s t r a t e s how f i e l d researchers face certain demand characteristics by vir t u e of the fact that they are accountable parts of an ongoing setting. By demand chara c t e r i s t i c s , I am referring to what Turner has described as the " s i t u a t i o n a l and contextual features which persons (in this instance f i e l d researchers) engaged i n everyday routines orient to as governing and organizing their activities.""'"^ Thus, rather than regard this f i e l d note as an ind i c a t i o n of an instance when a researcher who was a non-participant observer became a participant observer, I would l i k e to ex-amine some of the exigencies which i t so c l e a r l y i l l u s t r a t e s . These are an inescapable part of any.section of da i l y l i f e , f i e l d work of course included and, because this i s so, a thorough reconsideration of the u t i l i t y of the categories of participant and non-participant observer may be i n order. I would l i k e to begin our inquiry by noting that I came to view the operation on the cyst by chance rather than by any purposeful ef-fo r t on my part. Since I had told the sta f f of the C l i n i c that my research was concerned with doctor-patient communication, I assume that theyivknew that the observation of the removal of a cyst would not f a c i l i t a t e my research. At this point, i t i s important that the reader understand how my research interests were formulated to and for members of the s t a f f . For this reason I would l i k e to present the reader with the research description that I had constructed for the C l i n i c . I know that the aforementioned "Doctor X" had read the 172. following research proposal prior to the incident with the cyst: Research Proposal As a consequence of my interest in basic communica-tion processes and because I must satisfy my thesis requirement for the Ph.D. degree in the Department of Anthropology and Sociology, I have decided to focus on certain basic communication processes em-ployed in medical situations. It is hoped that the outcome of the analysis w i l l prove to be of interest to physicians (although this may not be evident at the outset of the research). Medical practice is not a mechanical operation in which patients enter the doctor's office, are ex-amined and treated, and then depart. Rather, the talk that occurs between a doctor and a patient constitutes an essential component for the effective implementation of medical care. It is this talk, a basic communicative process, which i s the proposed area of investigation. The medical consultation ex-emplifies the situation of parties who have d i f -ferent knowledge and different vocabularies for talking about matters that are of serious import to both of them. How is "adequate" communication achieved under these conditions? More importantly, what constitutes adequate communication between such parties, given that they have different stakes in the process and i t s outcome? While many forms of communication are operative in face-to-face interactions (for example, verbal cues, gestures, and f a c i a l movements), the focus of my research is on the talk which occurs in interaction. The study takes as i t s fundamental position that the talk which occurs in various interactional situations (between a doctor and a patient) contributes to the social organization of such situations. Talk is much more than the common-sense notion of exchanging "packets" of information or messages; people, when engaging in talk, also perform ac t i v i t i e s , and i t is these conversational activities performed by both doctor and patient in the course of their interactions, which are my main concern. Thus I am not using a "Telephone Company" notion of communication but rather an interactional one. Doctors and patients interact with one another and such interaction is socially 173 organized v i a the t a l k that occurs between the p a r t i -cipants. Hence I am hot engaged i n evaluating doctor performance. Rather i t can safe l y be assumed that doctors have acquired the competence with which to treat patients and, indeed, have learned to t a l k long before becoming physicians. However, the t a l k that does occur between doctor and patient has not been sub-jected to analysis. I t i s my in t e n t i o n to do t h i s . In order to accomplish t h i s task, i n October of 1971 I began a study of basic communication processes employed i n medical setti n g s . The members of the medical centre generously allowed me to enter t h e i r domain and observe the operation of a medical p r a c t i c e . At that time my research strategy provided f o r a period of time to ac-quaint myself with a new s e t t i n g and equally to provide time f o r the members of the centre to adjust to having a s o c i o l o g i s t i n t h e i r midst. While such f a m i l i a r i t y with a s e t t i n g i s an asset, the study of basic communication processes requires a c e r t a i n degree of p r e c i s i o n i n data a c q u i s i t i o n . In studying t a l k as a communicative process, i t i s e s s e n t i a l to have a corpus of precise data from which to perform an analysis. When in d i v i d u a l s engage i n conver-sation, i t i s possible to make reference to "what was said i n a previous conversation" without being able to produce a verbatim account of the en t i r e i n t e r a c t i o n . Indeed, to spontaneously produce a l i t e r a l account of what was said would seem strange. However, while the r e l i a n c e on one's memory for the reporting of conversational exchanges i s adequate f o r everyday encounters, such a procedure as a methodological technique f o r studying conversation i s hardly appropriate. The study of the communicative pro-cesses employed i n a complex i n t e r a c t i o n — as that be-tween doctor and patient — requires a de t a i l e d record of what was said. For t h i s reason I use tape-recordings as my source of data.-'- The procedure i s long and time con-suming. The r e s u l t , however, i s a corpus of data that constitutes a written record of a conversational encounter. It i s from such records that a study of basic communication processes can proceed. Since my concern i s with the doctor-patient r e l a t i o n -ship, i t would be advantageous to secure a corpus of data consisting of t r a n s c r i p t s of recorded doctor-patient i n t e r a c t i o n s . Data would therefore be Due to the c o n f i d e n t i a l nature of the data required, t h i s proposed research has been cleared and approved by Dr. A. of the Department of X and the Ethics Committee of the Faculty of Medicine. obtained from those s i t u a t i o n s involving medical personnel i n t e r a c t i n g with patients. This would include data obtained from medical consultation, doctor-student i n t e r a c t i o n s , Youth Night C l i n i c i n t e r a c t i o n s between doctors,students, and patients, as w e l l as doctor-patient i n t e r a c t i o n s of the day-time p r a c t i c e . I t i s hoped that such a broad focus w i l l also elaborate the mechanisms whereby medical diagnosis i s accomplished. I t should be made clear at t h i s time that I am not engaged i n an evaluative study of the medical centre. The centre provides a s e t t i n g from which the data may be obtained. I am extremely g r a t e f u l and express my thanks to the members of In order to f a c i l i t a t e the a c q u i s i t i o n of data, Dr. Tough asked that I present an inventory of the quantity and type of medical i n t e r a c t i o n s that I wish to examine. The following l i s t w i l l serve as a guideline with reference to the a c q u i s i t i o n of data: 1. 30 medical i n t e r a c t i o n s between a medical student and a patient i n which a patient's medical h i s t o r y i s obtained. These materials would be obtained from the Youth Night C l i n i c , and w i l l prove useful when I compare them to those i n t e r -actions i n which a doctor e l i c i t s a patient's medical h i s t o r y . 2. 25 interviews between doctor and patient. These interviews should be both the patient's and the physician's i n i t i a l contact with each other. It i s i n the i n i t i a l encounter between patient and physician that one may expect to f i n d problems i n communication. For example, d i f -ferefierentavaeabu'laries of language use. Such interviews are of considerable t h e o r e t i c a l i n t e r e s t . 3. 40 interviews between doctor and patient obtained from the day-time o f f i c e p r a c t i c e . These w i l l provide a comparison with those interviews con-ducted during the Youth Night C l i n i c . 4. 40 interviews between medical teams i n t e r a c t i n g with patients. These interviews w i l l be obtained 175 from the Youth Night C l i n i c and w i l l provide the comparison set of interviews to those obtained from the day-time practice. Admittedly my research constitutes a new area of i n -vestigation and, from a s o c i o l o g i c a l perspective, a departure from a t r a d i t i o n a l s o c i o l o g i c a l approach. While the research i s exploratory, i t i s acceptable to my Ph.D. Committee. I am sure that my supervisor, Dr. Roy Turner of the Department of Anthropology and Sociology would be happy to attempt to answer any questions you might have concerning the proposed research. In presenting this research proposal, I hope to accomplish three things: F i r s t , i t allows the reader to see what I, as a sociologist i n the f i e l d s i t u a t i o n , told C l i n i c s t a f f about my research. (This i n -formation i s seldom offered to the reader of a research report.) Second, i t allows the reader to understand what I meant by the "demand cha r a c t e r i s t i c s " faced by the f i e l d researcher i n a f i e l d s i t u a t i o n . This research proposal was produced at the request of the C l i n i c ' s director. I t s contents are directed s p e c i f i c a l l y at s a t i s f y i n g his request for a research proposal that would specify both the character of my research and the type and quantity of tape recorded medical i n -teractions that I required. As such i t represents a s i t u a t i o n a l l y constructed account of my proposed research at the C l i n i c rather than a formal "academic" research proposal. Thus, for example, the numbers of medical interviews that I requested were not generated out of any " s c i e n t i f i c " concerns with having a representative sample of medical interactions, but were generatedr solely out of my abiding concern with being allowed to remain i n the research setting for an extended period of time. I t was thought that, by specifying a large number of 176 medical i n t e r a c t i o n s , i t would be possible to obtain sustained access to the C l i n i c for a longer period than i f the quantity of medical i n t e r -views was of a les s e r number. As stated e a r l i e r i n t h i s report, I did not have a preconceived research hypothesis about doctor-patient com-munication, but th i s absence of a s p e c i f i c research hypothesis and research methodology did not p r o h i b i t the construction of a research proposal f o r the p r a c t i c a l purpose of s a t i s f y i n g members of C l i n i c s t a f f . Third, t h i s proposal should allow the reader to recognize that, when Doctor X ushered me into an already ongoing medical i n t e r a c t i o n , he was not r e a l l y a s s i s t i n g me i n my research. Not only was there no time i n which to set up my tape recorder, but I was also entering an ongoing s i t u a t i o n without knowing what had occurred p r i o r to my en-trance. In essence, I was being shown a medical procedure rather than being afforded with an opportunity to tape-record a medical i n t e r a c t i o n . Objectively, watching the removal of a cyst did not contribute to my understanding of doctor-patient communication. However, I did not ind i c a t e that I was not interested i n watching the removal of a cyst when Doctor X indicated that he would l i k e me to do so nor did I object when he placed me i n an examination room with another physician and a patient. That i s , I did not t e l l Doctor X that I was not p a r t i c u l a r l y interested i n watching a cyst removed or that I was s p e c i f i c a l l y i n -terested i n tape-recording i n t e r a c t i o n s rather than j u s t observing them. My reason or reasons f o r not r e s i s t i n g Doctor X's i n v i t a t i o n are not hard to fathom. As a researcher i n the f i e l d , I f e l t that I should be p o l i t e towards C l i n i c s t a f f . Regardless of whether or not Doctor X 1 7 7 had a correct understanding of my research project a f t e r having read my research proposal, I f e l t that i f he thought I might be interes t e d i n seeing a cyst removed or that watching t h i s medical procedure would benefit my research i n some way, then i t was incumbent upon me to demonstrate some i n t e r e s t i n t h i s operation. I t would not have been courteous or expedient to have thwarted any possible i n t e r e s t which Doctor X might have i n me or i n my research by informing him that he did not understand what i t was that I was tr y i n g to do. Furthermore, to have done t h i s might have had the r e s u l t that I would not see any future medical examinations. While i t i s true that I was unable to record t h i s p a r t i c u l a r encounter, to gain legitimate access to the examination room was, i n th i s period of the research, a step forward f o r me. Whatever i t was that motivated Doctor X to show me the "cyst removal" i t was ap-parent that my t h e o r e t i c a l s o c i o l o g i c a l i n t e r e s t s were of l i t t l e or no concern to him. It i s apparent that the subjects i n the s e t t i n g under i n v e s t i g a -t i o n can have various views about the purposes of the researcher's project. Instead of treating t h i s as a r e s u l t of some f a i l u r e or reluctance on the part of the researcher to provide an adequate p o r t r a y a l of his research i n t e r e s t s , i t may be better t i e d to the f a c t that members of the se t t i n g can, and i n some sense nec e s s a r i l y , operate with diverse and sometimes discrepant views of "matters of f a c t " including ideas about what the researcher i s doing. Furthermore, any attempt to r e c t i f y these discrepant conceptions r e s u l t i n more i n t r i n s i c problems than s o l u -tions . 178 Note that neither Doctor X nor Doctor Y f e l t that my presence i n the examination room was something that required further explanation. Further, they saw no necessity that I be introduced to the patient. Furthermore, I saw no need to o f f e r a s e l f - i n t r o d u c t i o n or s e l f - i d e n t i -f i e r . I did not say, for example, "I am Bruce Katz the s o c i o l o g i s t , " or "Hi, I am Bruce Katz from U.B.C." I did not engage i n a s e l f - i n t r o -duction for several reasons. However, i t i s important to note that the s t a f f decided that i t was the physician who should properly introduce me to the patient. At t h i s point, I would l i k e to make clear that I am reporting neither my psychological f e e l i n g s nor psychological motivations at the time of the operation; rather I am proposing good organizational or structured i n t e r a c t i o n a l reasons for not o f f e r i n g cany/ s e l f - i n t r o d u c -t i o n . These were my overriding concerns on t h i s and other occasions. To have done a s e l f - i n t r o d u c t i o n on t h i s p a r t i c u l a r occasion would not only have been inappropriate, i t may have proved to be div e r s e l y and i n t r i c a t e l y problematic;as w e l l . I suddenly found myself i n a s i t u a t i o n i n which a patient was already on the examination table and about to have an i n c i s i o n made into a cyst on his stomach. I did not know whether the patient would be w i l l i n g or happy to have a socio-l o g i s t i n the examination room at th i s time. For me to have created a s i t u a t i o n i n which there was some p o s s i b i l i t y of the patient becoming upset seemed to be s t r i k i n g l y inappropriate. Instead, I allowed the sett i n g to fur n i s h an i d e n t i t y for me. That i s , I presume that the patient thought that I was a medical student. The grounds that I had 179 for not engaging i n a self-introduction at this time were based on my concerns for (1) the p o s s i b i l i t y of a problematic s i t u a t i o n developing between patient and physician due to the fact that I was a sociologist and not a medical student and, (2) the p o s s i b i l i t y of jeopardizing my own position as a soc i o l o g i c a l researcher within the C l i n i c , and (3) my general concerns for the patient. To have engaged i n a s e l f - i n t r o H l ' duction might have caused in t e r a c t i o n a l problems for this p a r t i c u l a r s i t u a t i o n and lead to further general conclusions about the problems created by the presence of a soc i o l o g i s t . Obviously, these must be avoided. My recognition of the possible problems and repercussions that could have arisen from a self-introduction did not originate i n my having acquired any special s o c i o l o g i c a l competence gleaned from f i e l d research manuals. My rationale for acting as I did was based on my own common-sense notions of s i t u a t i o n a l proprieties. That i s , I was relying and was able to rely on everyday common-sense notions about "how the so c i a l world operates" i n order to manage my role i n this and other situations. Although one could ask whether I was a participant or non—partici-pant observer i n this p a r t i c u l a r s i t u a t i o n , i t vfcss obvious that a "yes" or "no" answer to such a question would t e l l us l i t t l e which would be of use to a researcher i n a f i e l d s i t u a t i o n . This incident i l l u s t r a t e s the absurdity of the notion that we can easily define either a participant or a non-participant observer. The role of the f i e l d researcher, l i k e that of any other members of the world of daily l i f e , i s not something 18Q which admits to any easy, f i x e d d e f i n i t i o n . The range of i n t e r a c t i o n a l circumstances i n which he w i l l f i n d himself during the course of h i s work admits to no hard and f a s t c l a s s i f i c a t i o n . To categorize the researcher i s often to l i m i t the scope and nature of his operations. I t i s to ignore the r i c h contextual f i e l d of a l l of our d a i l y a f f a i r s . While such ex-ercises may be interesting,, they often hide much more than they reveal. How, for instance, could one c l a s s i f y the above i n t e r a c t i o n between my-s e l f and Doctor Y? Am I t h i s at one time and that at another? Situations must be dealt with on an ad hoc basis i n and over the course of t h e i r development. They cannot be prepared f o r , accounted f o r , or ultimately constructed p r i o r to t h e i r actual occurrence. Because t h i s i s so, any abstract concern with the r o l e of the f i e l d researcher i n the research s e t t i n g i s em p i r i c a l l y empty. While i t i s possible to discuss r o l e s e l e c t i o n proo'rjto cor aside from the ac t u a l doing of any such discus-sion has very l i t t l e connection to the p r a c t i c a l and common-sense sol u -tions that a f i e l d researcher must attend to when a c t u a l l y engaging i n the d a i l y contingencies of a researcher i n a f i e l d s i t u a t i o n . Since t h i s i s the case, ©he may. s t a r t to view the methodological concerns with the proper r o l e s e l e c t i o n as pragmatically useless and t h e o r e t i c a l l y empty. Consider the following f i e l d note: Before chart rounds onetoftiMae secretaries or one of the nurses usually makes coffee. The coffee machine i s one of those i n d u s t r i a l coffee makers. Afte r spending some time at the C l i n i c , I started to make the morning coffee i f I a r r i v e d a b i t before rounds started. One day I j u s t made coffee. No one objected to my doing so nor did they spe-c i f i c a l l y require that I do so. I t j u s t happened. In the future, I often made coffee for C l i n i c s t a f f when I arr i v e d f or morning rounds. 181 Although a simple and mundane feature of my f i e l d experience, t h i s piece of data i l l u s t r a t e s two s p e c i f i c features, one of these i s p r a c t i c a l , the other i s t h e o r e t i c a l . F i r s t , the f i e l d researcher i s not generally incorporated into the d a i l y a c t i v i t i e s of the society that he i s studying. By t h i s I mean that, as a researcher, one does not have a s p e c i f i c task to perform other than that of observing others at t h e i r work and forming c e r t a i n opinions from these observations. However, th i s i n i t s e l f can create some very p r a c t i c a l problems. For example, as a sort of t h i r d wheel at the C l i n i c , I did not have orga-n i z a t i o n a l space which I could c a l l my own. Unlike physicians or nurses, I did not have a desk or an o f f i c e where I could do any work that I had to do. I purposefully spent a good deal of my time at the C l i n i c wandering around or s i t t i n g e i t h e r i n the lunch room or i n an empty examination room. whenever I was allowed to view a medical ex-amination I t r i e d to be as h e l p f u l as p o s s i b l e . For example, I would f i l l out laboratory information sheets, hand instruments to the physi-cian, take urine specimens to the laboratory and so f o r t h . I attempted to do things that Lofland has described as an "exchange of s e r v i c e s " : In terms of "exchange of s e r v i c e s " the pure observer r o l e involves a highly imbalanced r e l a t i o n to the p a r t i c i p a n t s . They l e t him watch, but he does nothing f o r them i n return (except i n the most long-term and abstract way, i n "doing s o c i a l science"). More immediate r e c i p r o c i t i e s are necessary. Indeed, i n a wide range of emergent circumstances, i t w i l l seem highly p e c u l i a r i f the observer does not volunteer his help...people need r i d e s , loans, messages car r i e d , coffee brought, advice, opinions, defense, i l l e g a l goods held, l i e s i n t h e i r behalf, and so on, through the e n t i r e range of normal f r i e n d l y r e l a t i o n s 182 t y p i c a l to organized s o c i a l l i f e . The observer must necessarily engage i n such things, unless he i s w i l l i n g to give off the impression of being a very odd, cold withdrawn fellow, "indeed.H Lofland would regard performance of such a c t i v i t i e s as a feature which i s compatible with the pure observer r o l e . He would point out that the researcher must do such things as these to give the impression that he i s a right fellow. In contrast to t h i s , my experience at the C l i n i c taught me that such a c t i v i t i e s are not so much a component of the observer role as a consequence of the fact that any party involved i n an ongoing sit u a t i o n for a long period of time — and this includes any researcher i n a f i e l d s i t u a t i o n — has to engage i n some a c t i v i t i e s i n order to account for his continued presence i n the setting. The performance of a c t i v i t i e s i s not connected solely to the observer r o l e , but constitute an essential part of those demand characteristics which are unavoidable i n a f i e l d s i t u a t i o n . Secondly, while the performance.of. these a c t i v i t i e s may be classed as aniexchange of services, their very necessity leads us to question the v a l i d i t y of the theoretical d i s t i n c t i o n between the participant and non-participant observer. What w i l l be taken as an instance of p a r t i -cipation or non-participation? For example, i s the fact that I some-times made the morning coffee going to be indica t i v e of an exchange of services ( i . e . , non-participation) or i s i t going to be viewed as a sign that I was, i n fact, a participant i n the research setting? What theoretical status obtains between my helping during a medical exam-ination as opposed to my making of the morning coffee? When does the researcher engage i n an a c t i v i t y that makes him a participant as opposed 183 to a mere observer? If we cannot specify whether or not some a c t i v i t y i s i n d i c a t i v e of e s s e n t i a l p a r t i c i p a t i o n , what i s the actual status of th i s d i s t i n c t i o n ? Is i t not lacking any worthwhile substance? Researcher I d e n t i f i c a t i o n : Accepting Staff Accounts The previous section alluded to the f a c t that the s o c i a l resear-cher i s someone who i s not a regular member of the research s e t t i n g . For example, my presence as a s o c i o l o g i s t was not a part of the formal plan or regular workings of the C l i n i c ' s a f f a i r s . The researcher's presence can create a host of problems f o r regular members of the research s e t t i n g and the nature of and the soluticnsi f o r these problems are not necess a r i l y dependent on any c a l c u l a b l e thing that the resear-cher does. This was i l l u s t r a t e d time a f t e r time i n the manner i n which my i d e n t i t y was managed by the s t a f f when they introduced me to patients .during a medical examination. Consider the following t r a n s c r i p t : 1. Doctor: Do you mind i f Mr. Katz s i t s i n with us? 2. 3. 4. Patient: No no by a l l means Researcher: Great Doctor: 5. Patient Doctor: ( ) t h i s room r i g h t here. Have a seat Tissue (Note: the patient had asked f o r a tissue) Mri Katz i s working with ah the Department of Medicine Faculty of Medicine f o r the next few months and he's doing ah study of communications and we wondered i f i t would be a l l r i g h t i f he taped what we said to each other i t ' s j u s t f o r h i s use Patient: Sure.. V 184 I t was d e c i d e d t h a t p h y s i c i a n s w o u l d i n t r o d u c e me to t h e i r p a t i e n t s and s e e k t h e i r c o n s e n t b e f o r e a l l o w i n g me to t a p e a m e d i c a l i n t e r v i e w . However , an e x a m i n a t i o n o£:ti£Lcbcta:'is p o r t r a y a l o f my r e s e a r c h ( u t t e r a n c e 6) shows s e v e r a l n o t a b l e f l a w s i n t h e c h a r a c t e r i z a t i o n w h i c h he o f f e r e d to t h e p a t i e n t . F i r s t o f a l l , I was n o t w o r k i n g w i t h t h e F a c u l t y o f M e d i c i n e as i s i m p l i e d h e r e . T h a t i s , I was n o t a c e r t i f i e d member o f t h e F a c u l t y o f M e d i c i n e b u t was o n l y g i v e n a summer s t u d e n t r e s e a r c h s t i p e n d f r o m t h e D e p a r t m e n t o f to e n a b l e me to do a s t u d y o f d o c t o r - p a t i e n t c o m m u n i c a t i o n . C l i n i c s t a f f knew t h a t I d i d n o t have a m e d i c a l d e g r e e and was n o t a m e d i c a l s t u d e n t . They were aware t h a t I was a P h . D . s t u d e n t i n s o c i o l o g y . G i v e n my r e s e a r c h p r o -p o s a l , i t seems odd t h a t p h y s i c i a n s c o u l d be m i s i n f o r m e d a b o u t my i d e n t i t y . T h u s , an a c c u r a t e a c c o u n t o f my p r e s e n c e i n t h e e x a m i n a t i o n room m i g h t more r e a s o n a b l y be e x p e c t e d to r e s e m b l e t h e f o l l o w i n g : M r . K a t z i s w o r k i n g f o r t h e D e p a r t m e n t o f F a c u l t y o f M e d i c i n e o v e r t h e summer. He i s d o i n g a s o c i o l o g i c a l s t u d y o f d o c t o r -p a t i e n t i n t e r a c t i o n f o r h i s P h . D . d i s s e r t a -t i o n i n S o c i o l o g y a t U . B . C . We wondered i f i t w o u l d be a l l r i g h t w i t h y o u i f , h e t a p e d what we s a i d to e a c h o t h e r . I t ' s j u s t f o r h i s u s e . W h i l e s u c h a c h a r a c t e r i z a t i o n s m i g h t i n d e e d be more a c c u r a t e , i t c o u l d a l s o d e l a y o r be o t h e r w i s e p r o b l e m a t i c f o r t h e s u c c e s s f u l a c c o m p l i s h m e n t o f t h e i n t e r v i e w . C l i n i c p h y s i c i a n s had to s e e a. l a r g e number o f p a t i e n t s o v e r t h e c o u r s e o f any w o r k i n g d a y . My p r e s e n c e i n t h e e x a m i n a t i o n room was f o r them an a d d i t i o n a l f e a t u r e t h a t t h e y were now r e q u i r e d to a t t e n d t o . They had to manage my p r e s e n c e i n t h e e x a m i n a t i o n room i n s w a y s t h a t w o u l d s t i l l a l l o w them to a c c o m p l i s h t h e i r 185 job i n a successful and expedient fashion. One way of coping with my presence would be to o f f e r an account of my i d e n t i t y s i m i l a r to the above example. However, t h i s might make things more d i f f i c u l t f o r the s t a f f and f o r me. To do so allows f o r the p o s s i b i l i t y that the patient might question the physician about the presence of a s o c i o l o g i s t i n the examination room. He might f e e l easy or uneasy about t h i s . He might ask questions about the purpose of my research, etc. Such questions would contribute nothing to the pragmatic task of t r e a t i n g the medical problem at hand. They c e r t a i n l y would not make the encounter any shorter. Indeed, the patient might balk at the idea or refuse to con-tinue the medical interview. I am proposing, then, that there were good organizational reasons for my having been introduced i n the way that I was, and to regard such an introduction as inaccurate or lacking i n i n -formation i s to neglect the f a c t that my presence i n the research set-ti n g i s , f o r the C l i n i c s t a f f , a problem that has to be resolved by them on an ongoing basis. Thereby, while i n some tec h n i c a l sense, the account quoted above may be i n c o r r e c t , i t would not be in c o r r e c t to say that the physician had, i n some way, introduced me to the patient. I n t e r a c t i o n a l l y , theidoctor's introduction furnished me with a credentialed reason for being i n the examination room. I n t e r a c t i o n a l l y , i t would not be in c o r r e c t f o r the patient to assume that I was a medical p r o f e s s i o n a l , f o r patients often orient to the presence of medical students i n such s i t u a t i o n s . Furthermore, while i t i s possible that I could have corrected the physician's p o r t r a y a l , the consequences of doing t h i s should be f a i r l y obvious. To correct h i s account would, no doubt, "set the record s t r a i g h t " , but i t could w e l l r e s u l t i n my being prohibited 186 from observing or recording any further encounters. My concerns with accuracy would not coincide with h i s pragmatic concern f o r seeing a large number of patients with as l i t t l e wasted time as possible. Instead of introducing me to a patient, C l i n i c physicians would often allow the research s e t t i n g to define my i d e n t i t y f o r the pa t i e n t . Since the medical interviews were to be recorded, I would simply p o s i t i o n the tape recorder and then inform the physician that I was recording. At t h i s point the physician would c a l l the patient into the examination room. Consider the following piece of data: 1. Patient: (walking towards the examination room) 2. Researcher: Hello 3. Patient: Hi 4. Doctor: Well ah how you doing? 5. Patient: Oh I think I'm j u s t about as good as I'm going to be 6. Doctor: uh good, i t ' s quite a b i t better 7. Patient: Yeah 8. Doctor: Oh that's good. A l l r i g h t , now ah you know that we want to cut down the Prenason ah that the urn not the Anasec not the Tedral the other one that you started three a day.... This interview continued without my i d e n t i t y or purpose i n the examination becoming a topic.of conversation. I presumed that the patient' i d e n t i f i e d me as a medical student f o r the s e t t i n g provided for t h i s c h a r a c t e r i z a t i o n . While i t had been s t i p u l a t e d that physicians should introduce me to t h e i r patient and ask for the patient's consent 187 before I would be allowed to do any recording, the procedure was. rrt .always adhered to. One way i n which C l i n i c physicians managed my presence was to say nothing at a l l about my id e n t i t y and allow the patient to assume that I was a medical student. In the above s i t u a t i o n , for example, the doctor and the patient were acquainted with one another although I had never met the patient. I t i s customary for a party who knows two other persons who do not know each other to introduce the two people. 'However, no introduction was forthcoming, nor was the patient informed of the presence of the tape recorder. What was I to do i n this situation? To have introduced myself as a sociologist would have been con-trary to the d e f i n i t i o n which the physician had allowed to develop. This would be problematic i n i t s e l f but, further, were I to interrupt, the physician and introduce myself as a sociologist i t would be possible for the patient to conclude that the doctor had purposefully withheld this information from him. Again, although I could have interrupted the physician to remind him of the presence of the tape recorder and/or the requirement that we obtain the patient's consent to have the medical examination recorded, to have done this could have caused some trouble for this p a r t i c u l a r occasion and have unpleasant ramifications for future encounters as w e l l . I did not think that I should inform the patient about those things that should properly have been conveyed to him by the doctor. Indeed, i t seemed more trouble to challenge or disagree with the developing character of the encounter than to allow the physician's unstated tutimaMiest^deMhi-tion BgfbeisuSlai-nedv sae-en* 188 r e s u l t of th i s encounter was that both myself and the physician operated as a team i n order to maintain a routine i n which my i d e n t i t y was for a l l intents and purposes that of a medical student. As a researcher interested i n creating as few troubles as possible, I found i t necessary that I o f f e r no s e l f - i n t r o d u c t i o n or mention of the presence of the tape recorder. E t h i c a l Considerations I had to secure approval from the Faculty of Medicine Ethics Committee before doing my research at the C l i n i c . Many of the p r e l i m i -nary obstacles were the r e s u l t of a concern which the C l i n i c s t a f f had about the e t h i c a l implications of my research. In retrospect, i t seems paradoxical that many of these same physicians, when confronted by the sit u a t i o n s described i n t h i s paper did not inform t h e i r patients of my i d e n t i t y or that they were being recorded. Consider the following two instances. They are t y p i c a l of the way many of the physicians handled my presence during the medical i n t e r a c t i o n . I - 1. Doctor: I don't know i f I ' l l even t e l l her that t h i s thing i s on 2. Researcher: Umm mm 3. Doctor: I think I'd better not 4. Researcher: Umm 5. Doctor: I don't know how s h e ' l l take i t so l e t ' s leave i t on s 6. Researcher: Um mm 7. Doctor: She saw two students before so she's used to students 189 8. Researcher: Okay, maybe I should just turn i t the other way (reference to tape recorder) I don't think i t makes any difference leave that l i k e that she's not gonna 9. Doctor: Yeah ah okay (patient entering o f f i c e ) Well Jane how are you. You're looking a l o t better than you did the other night 10. Patient:] Yeah I I — 1. Doctor: Mrs. Jones (pause) Mrs. Jones (the patient i s being summoned from the waiting room) Here (doctor i s referring to the examination room) 2. Patient: Well w e l l how many doctors have I got (Note: i n addition to myself there was a medical student present) 3. Doctor: Do you mind i f Dr. Katz 4. Patient: Now I can't hear very good you know 5. Doctor: Do you mind i f Dr. Katz and Dr. X (the medical student) 6. Patient: 7. Doctor: 8. Patient: 9. Doctor: Not at a l l ah stay i n here No I don't mind Fine.... Note that these are actual occurrences. They are part of the corpus of transcriptions which grew out of my work at the C l i n i c . No doubt the reader appreciates the e t h i c a l implications contained therein. In the f i r s t instance, the fact that I was not introduced or i d e n t i f i e d to the patient was not simply an oversight, i . e . , "a f a i l u r e to give a proper introduction," rather i t must be interpreted as part of a calcu-lated strategy to allow my i d e n t i t y to be furnished for the patient by 190 the s e t t i n g . I assume that the patient was supposed to and did i n f a c t assume that I was a medical student. Indeed, my assumption seems to be borne out by the second instance i n which the physician s p e c i f i c a l l y 12 introduced me to the patient as "Dr. Katz." Note too that patients were not informed that there was a tape recorder on or that they were taking part i n a s o c i o l o g i c a l study. While i t seems important that f i e l d researchers consider the e t h i c a l implications involved i n dtheir studies, there are few, i f any, descriptions of the e t h i c a l problems which f i e l d researchers encounter i n the course of t h e i r work. I sug-gest that by examining these two instances we can'ibegin to understand that whatever a researcher's own e t h i c a l position,there are everyday contingencies inherent i n the f i e l d s i t u a t i o n that p r o h i b i t him from exercising h i s personal i n c l i n a t i o n s i n a u n i l a t e r a l way. The choices open to the f i e l d researcher are o r g a n i z a t i o n a l l y determined by the f a c t that he i s a f i e l d researcher i n ongoing!*1 s i t u a t i o n s and are not dependent on some "abstract" adherence to a set of e t h i c a l p r i n c i p l e s . The f i e l d researcher has gained access to the research s e t t i n g as a p r i v i l e g e granted to him and does not possess an ongoing r i g h t to be i n the research s e t t i n g . Throughout one's research, i t i s an omnipresent p o s s i b i l i t y that that access could be terminated. With reference to my own research at the C l i n i c I had proposed a project that would require that I be present i n the research s e t t i n g f or over a year. This proposal however was always subject to termination by C l i n i c s t a f f i f I was, for example, causing trouble. Trouble could Constitute anything that s t a f f considered problematic for t h e i r everyday occupational 191. routines. One of the concerns of C l i n i c s t a f f was with t h i s concept of t r o u b l e , s p e c i f i c a l l y the e f f e c t my presence might have on p a t i e n t s . The C l i n i c was an experimental medical f a c i l i t y and, as such, one of t h e i r outstanding concerns was that of acquiring a large patient population. They were always on the a l e r t f o r anything that might cause that patient population to decline. Needless to say, the presence of a research s o c i o l o g i s t was a poss i b l e source of trouble, something that could have an adverse e f f e c t on the absolute numbers of the patient population. My research into doctor-patient communication, while t h e o r e t i c a l l y i n t e r e s t i n g , could lead to c e r t a i n complications since I was not a medical p r a c t i t i o n e r and/or, i n addition to t h i s , I would be using a tape recorder. Given t h i s information, what was I to do? I knew that from a s t r i c t l y e t h i c a l standpoint, the physician should have informed the patient of my true identity,my purposes and the presence of the tape recorder. However, I found myself i n an under-standable quandary about an appropriate course of action i n th i s s i t u a t i o n . Let me elaborate by r e f e r r i n g to the two t r a n s c r i p t s c i t e d above. In the f i r s t t r a n s c r i p t the physician ( i n utterance 1) i n f e r s that the tape recorder should be l e f t on and decides not to inform the patient that the interview i s going to be recorded. The physician making these propositions has ostensibly "good medical grounds" f o r doing so. By t h i s , I mean that the physician has made a dec i s i o n about the use of the tape recorder i n terms of the possible repercussion that i t might have f o r the interview. As he stated i n utterance 5: "I don't 192 know how s h e ' l l take i t so l e t ' s leave i t on." I f e l t i t was inappro-p r i a t e to disagree with the physician. I could have suggested that he t e l l the patient about the tape recorder. 1 f e l t that to do so would have created 1) immediate problems f o r the s i t u a t i o n at hand. I t would cause undoubtable embarrassment for the doctor and possible con-sternation for the patient as w e l l , and .2) a s i t u a t i o n i n which my stay at the research s e t t i n g or at l e a s t my working r e l a t i o n s h i p with t h i s p a r t i c u l a r physician would be placed i n jeopardy. Obviously, I did not want to do anything that could create a s t r a i n i n the working r e l a t i o n s h i p that I would have with t h i s and with other physicians. I f he f e l t that i t was best to conduct the interview i n t h i s manner, I did not f e e l i t was my p o s i t i o n to t e l l him that he was engaging i n procedures which might be l a b e l l e d as unethical. I t was he, the doctor who should have f i n a l say i n matters of the doctor-patient r e l a t i o n s h i p . Here, I was only the researcher. As a researcher I had to o r i e n t to the demand c h a r a c t e r i s t i c s faced by C l i n i c s t a f f . Thus, physicianSs working conditions were part of the constraints bearing upon my actual research procedures. There-by, while I could have engaged i n a discussion with the physician about his decision, to have done so would have i n t e r f e r e d with the ongoing concern that the physician should attend to the patient i n the l e a s t possible amount of time. (Note: this does not mean that the patient should receive inadequate medical care. Rather, i t comes from the f a c t that physicians are busy with a number of patients and do not have time for matters not s p e c i f i c a l l y r e l a t e d to the examination at hand.) 1 9 3 Physicians have a job to do and, from t h e i r point of view, they should accomplish i t i n as short a time as i s p r a c t i c a l l y p o s s i b l e . As such, t h e i r primary o r i e n t a t i o n was dire c t e d towards the f a c t that these i n -terviews could be done with or without the tape recorder. Although i t would have been possible f o r me to have ra i s e d these issues at C l i n i c s t a f f meetings, to point out that some physicians had not introduced me to t h e i r patients, informed them that I was a s o c i o l o g i -c a l researcher rather than a medical student,and that I wanted to tape-record t h e i r interviews would portray c e r t a i n physicians as unethical and would surely have resulted i n the termination of either my research at the C l i n i c or of the good working r e l a t i o n s h i p which held between myself and the s t a f f . I saw no reason to do th i s since i t was apparent that the staff was happy with things as they were. In the second instance of data, I was introduced overtly as "Dr. Katz". This c h a r a c t e r i z a t i o n was both f a l s e and d e l i b e r a t e l y misleading. What was I to do i n th i s situation? To make the necessary c o r r e c t i o n during the interview ( i n front of the patient) seemed grossly inappro-p r i a t e and to correct him a f t e r the interview also seemed to be inap-propriate. Further, note that the medical student was also introduced as a doctor, although he was j u s t a student. I t seems from other ex-periences at the C l i n i c that t h i s i s the way i n which students are t y p i c a l l y introduced to patients and the physician assumed that, were he to manage my presence i n the room i n t h i s way there would be as few problems as possible. While the two instances quoted above are examples of some of the 194 e t h i c a l problems that a researcher might encounter i n the f i e l d , they also show how such problems take place within a s i t u a t i o n a l context. To speak of e t h i c a l considerations i n the abstract asione i s to neglect the s i t u a t i o n a l and contextual features of f i e l d research. I had done everything possible to assure that my research would be conducted i n an e t h i c a l manner. Indeed, t h i s was not only my concern alone, i t was also of c e n t r a l concern to C l i n i c s t a f f . I t i s i r o n i c that a researcher who sought the approval of the Faculty of Medicine Ethics Committee before s t a r t i n g his project should f i n d himself v i o l a t i n g c e r t a i n e t h i c a l considerations. However, as I pointed out, t h i s v i o l a t i o n was motivated by the inescapable contingencies faced by a researcher confronting an actual ongoing s i t u a t i o n rather than by any personal choice alone. I t would appear that any discussion on the topic of ethics and f i e l d research i s indeed empty i f i t f a i l s to consider the p r a c t i c a l contingencies that evolve over the course of any f i e l d research. I t may w e l l be the case that the researcher's own e t h i c a l p o s i t i o n w i l l come to be c u r t a i l e d and transformed by the members of the s e t t i n g to which he has access. Conclusion In the previous chapter we examined some of the s e l f - o r g a n i z i n g properties of chart rounds oriented to by p a r t i c i p a n t s . We did not ad-dress the r e l a t i o n s h i p between c o l l e c t i o n of data and the researcher's presence i n and af the research s e t t i n g . While t h i s r e l a t i o n s h i p i s often regarded as the "other s i d e " of ethnographic d e s c r i p t i o n , t h i s chapter has attempted to reconsider t h i s formulation by considering some of the writer's experience during his research af the Community C l i n i c . 195 Research manuals often provide the analyst with a set of instruc-tions on how to act during his stay i n the research setting. He i s supposed to select the role which w i l l most successfully allow him to accomplish his research goals. Ideally, he s«should try to be non-dis-ruptive, unobtrusive, and so f o r t h . This chapter has attempted to point out the falacious character of this formulation for the resear-cher -is nbtsmerely i n but also becomes a part of the setting and how he i s to act i s not something which he can control i n advance. Rather, whatever the advice he may acquire about how to act i n the f i e l d , that advice has to be negotiated with the r e a l i t i e s of every setting. The essential demand characteristics of the f i e l d s i t u a t i o n remain unspe-c i f i e d i n f i e l d research texts. We focused primarily upon three features of doing f i e l d research: participant-non-participant observation, how I wdsinideribrOf iedpfcbipa.tients of the C l i n i c , and certain e t h i c a l considerations a r i s i n g out of these i d e n t i f i c a t i o n s . While such features are often treated by methodolo-gis t s as separate topics, I have attempted to demonstrate that each of these can properly be examined i n conjunction with actual instances of f i e l d data, i . e . , that they become substantive topics only when they -are responsive to those i n t e r a c t i o n a l occasions i n which they occurred. 196 Footnotes: Chapter Four 1. Charles 0. Frake, "Notes on Queries i n Ethnography", i n Stephen Tyler, Ed., Cognitive Anthropology, (New York: Holt, Rinehart and Winston, 1969), p. 123. 2. Ibid., p. 124. 3. Harold G a r f i n k e l , Studies i n Ethnomethodology, (Englewood C l i f f s , N.J.: Prentice H a l l , 1967), p. 73. 4. For example, Raymond L. Gold, "Roles i n S o c i o l o g i c a l F i e l d Obser-vations", S o c i a l Forces, Vol. 36 (March 1958), Benjamin D. Paul, "Interview Techniques and F i e l d Relationships" i n A.L. Kroeber, Ed., Anthropology Today, (Chicago: U n i v e r s i t y of Chicago Press, 1969), Morris S.Schwartz and Charlotte Green Schwartz, "Problems i n Par-t i c i p a n t Observation", American Journal of Sociology, Vol. LX (January 1955), George Spindler, Ed., Being an Anthropologist, (New York: Holt, Rinehart and Winston, 1970), and Thomas R. William, F i e l d Methods i n the Study of Cultures, (New York: Holt, Rinehart and Winston, 1967). Also see, Aaron V. Cic o u r e l , Method,- and Measurement i n Sociology, (New York: The Free Press, 1964) e s p e c i a l l y chapter two. 5,ii I recognize that there are materials such as etiquette manuals dealing with appropriate ways of behaving i n various settings and occasions and that people do ask "advice" when going to new and strange places. These constitute lay exceptions to t h i s formulation. The point however remains v a l i d f o r any " i n s t r u c t i o n s " they receive acquire t h e i r substance when the person has to attend to the organi-z a t i o n a l structure of that they r e f e r him to. The type of advice and i n s t r u c t i o n s offered i n such manuals i s not s e l f - f u l f i l l i n g , that i s , i f someone says "you do x when you go there" i t s t i l l requires that one follow that advice w i t h i n some orga n i z a t i o n a l context and how that advice should be c a r r i e d out within such an organizational context. 6. The same point has been made using data from a d i f f e r e n t s e t t i n g , namely, grade school testing procedures. I t was found that to suc c e s s f u l l y accomplish a serie s of tests designed to assess the competence of grade school chi l d r e n , students already need possess the very competence which the testing procedure was designed to as-sess. See, Robert MacKayi' f"Conceptions of Children and Models of S o c i a l i z a t i o n " i n Hans Peter D r e i t z e l , Ed., Recent Sociology No. 5: Childhood and S o c i a l i z a t i o n , (New York: Macmillan Company., 1973), pp. 27-44. 7. Roy Turner, "Words, Utterances and A c t i v i t i e s " , i n Jack Douglas, Ed., Understanding Everyday L i f e , (Chicago: Aldine Publishing Co., 1970), p. 169. 197 8. Buford Junker, F i e l d Work; An Introduction to the Social Sciences, (Chicago: University of Chicago Press, 1960), p. 39. 9. Author's f i e l d note. 10. In the previous chapter reference was made to the "demand charac-t e r i s t i c s " required of participants to chart rounds. This term i s equally applicable to the researcher who must treat his stay within the research setting i n a sim i l a r way, i . e . , as his job. As such, i t w i l l have certain features that he must attend to i n consequential ways. 11. John Lofland, Analyzing Social Settings. (Belmont, Cal.: Wads-worth Publishing Co., 1971). 12. Technically speaking, medical students are not yet medical physi-cians. I t appears, however, that when referring to these students physicians address them as "doctor". 198 CHAPTER FIVE CONCLUSION Summary and Further Research In t h i s d i s s e r t a t i o n I have departed from a standard model of ethnographic analysis i n that I have chosen to formulate as a topic matters customarily treated as features of an i n t e r p r e t i v e schema shared by ethnographers and laymen, and used by them as resources i n the construction and i n t e r p r e t a t i o n of ethnographic reports. That i s , I have focused attention upon some of the methodological and substantive issues which underlie the production of a d e s c r i p t i o n . Chapter one began with a de s c r i p t i o n of the C l i n i c . I discussed how I had come to sel e c t t h i s p a r t i c u l a r s e t t i n g and how t h i s s e l e c t i o n arose from a fundamental pragmatic need for a s e t t i n g for my d i s s e r t a -r t i o n rather than from any previous experience or s p e c i a l i n t e r e s t i n medical sociology. Next, various d e s c r i p t i v e c h a r a c t e r i s t i c s of the C l i n i c were presented so that the reader might acquire a "sense of the s e t t i n g . " Of p a r t i c u l a r importance here was the fac t that the C l i n i c operates as a group medical p r a c t i c e so that there i s always the p o s s i b i l i t y that a patient w i l l be seen by a physician other than his own, regular physician; and therefore, i n order to f a c i l i t a t e patient care, s t a f f review p a t i e n t s ' medical charts i n a routine session known as chart rounds. These i n i t i a l materials also contained an account of the procedures I had to follow i n order to gain access to the s e t t i n g . The reader was informed that, while the C l i n i c appeared i n i t i a l l y to be receptive to>?»sociological research, gaining access proved to involve 199 certain elaborate procedures. F i n a l l y , however, I not only gained ac-cess but was allowed to tape-record sessions of chart rounds and other instances of medical interactions. The transcripts made from these recordings would come to constitute the majority of data for t h i s report. This i n i t i a l description was intended as a necessary component of an ethnography of the C l i n i c . By t h i s , I mean that i t was expected that I provide the reader with some general information about the problems of research access and the characteristics of the C l i n i c p r i o r to a more detailed and a n a l y t i c a l study of i t s organization. At this point, however, chapter one took a r a d i c a l departure. U t i l i z i n g a procedure followed throughout most of this study, t h i s i n i t i a l descriptive material was taken as a topic i n i t s own r i g h t . That i s , I examined the ways i n which i t came to be a recognized and recognizable descrip-tion. My concern was not with those features peculiar to my own des-c r i p t i o n , but was directed towards discovering the generalizable features of any such ethnographic material. A comparison of my i n i t i a l description with the opening sections of other ethnographic works suggested that the construction of an ac-credited ethnography follows a recognizable structure which was char-acterized as a "standard ethnographic format". That i s , an ethnogra-phic report t y p i c a l l y presents the reader with a corpus of i n i t i a l materials as an introduction to the subsequent a n a l y t i c a l sections that are to follow. The f i r s t part of our task was to specify, the relationship which obtained between these sections. I t was found that although these i n i t i a l materials provide the 2 0 0 reader with a sense of the research s e t t i n g , the connection between them and the subsequent sections of a report was not one of l o g i c a l necessity. By t h i s I mean that the reader's understanding of sub-sequent sections of the ethnography i s not dependent on his f i r s t having read these i n i t i a l materials; Such materials seem to occupy the p o s i t i o n that they do i n order to s a t i s f y a presentational format rather than to s a t i s f y any c r i t e r i o n for the l o g i c a l ordering of ethno-graphic materials. Furthermore, i t was shown that the construction of these materials i s not based on any s p e c i a l s c i e n t i f i c competence that the ethnographer may or must possess. Rather, he seems to be able to r e l y upon h i s own common sense to provide h i s readers with a sense of the research s e t t i n g . These.observations pointed to a rather curious f a c t , i . e . , while the main sections of ethnographies are often seen as sections containing issues of t h e o r e t i c a l i n t e r e s t , these prefatory sections, although they are standard components of ethnographic reports, are seldom regarded as worthy of examination or ana l y s i s . The next part of chapter one was directed towards an e x p l i c a t i o n of the importance of these i n i t i a l materials f o r the construction of an ethnographic d e s c r i p t i o n . T r a d i t i o n a l l y , i n v e s t i g a t i o n has been focused upon the substantive content of ethnographic reports rather than on the way i n which reports are constructed. In t h i s respect, the chapter focused attention upon a strangely neglected area. These i n i t i a l materials were shown to do c e r t a i n work for the reader with reference to the organization of ethnographic d e s c r i p t i o n s . F i r s t , they underscore the p r i v i l e g e d p o s i t i o n of the ethnographer 2 0 1 v i s - a - v i s the reader of the report. By presenting such materials the author establishes himself as someone who possesses expert knowledge about the culture under investigation. Second, while these descriptive materials may constitute a set of resources that the reader may, or should use to inform his reading of l a t e r parts of the report, the reader i s not provided with a set of instructions on how to u t i l i z e these materials when reading subsequent sections. While there i s not S a l o g i c a l a p r i o r i connection between these i n i t i a l materials and sub-sequent section of the report, they seem to occupy the place that they do so that the report as a whole w i l l be seen as a competent piece of ethonographic material. I t was demonstrated that th e i r construction,although conse-quential for the ethnography, was i t s e l f founded i n a common-sense set of-'-relevancies. The features that are incorporated into the i n i t i a l description are selected by the ethnographer after considering such things as the type of audience that the report i s intended f o r , etc. To say that the ethnographer r e l i e s on common—sense procedures i n constructing the prefatory sections of his report i s to argue that such i n i t i a l materials are condemned to be common-sense rather than s c i e n t i f i c constructions. This, however, i s not a c r i t i c i s m f o r , rather than view i t as an inadequacy of ethnographic description, i t may be considered simply an interesting, invariant property of an ethnographic report. Chapter one not only provided an analysis of the i n i t i a l descriptive materials of an ethnographic report, i t also contained an i n i t i a l .. 202 description of the C l i n i c . This was the opening section of my ethno-graphy of the C l i n i c . The reader, here, could properly expect a more an a l y t i c a l description of C l i n i c organization. However, chapter two took as i t s point of departure a consideration of the relationship between the researcher and the research setting. Thus, i t did not provide the expected a n a l y t i c a l description of an aspect of C l i n i c organization, but rather turned to an examination of some of the methodological pre-suppositions that account for the analysis of chart rounds presented i n chapter three. Chapter two began by considering how a medical sociologist might treat access to the C l i n i c . I t was proposed that such an approach could regard the setting as a mere location from which to gain i n f o r -mation for some preconceived hypothesis. This approach was shown to be incapable of describing the organization of the C l i n i c since i t would neither respect the i n t e g r i t y of those aspects of C l i n i c organization observed nor be responsive to the type of data collected from the d a i l y organizational routines of C l i n i c l i f e . These points need further c l a r i f i c a t i o n . As a researcher at the C l i n i c I was i n a privileged position to observe and record various aspects of C l i n i c organization. To simply present the reader with the data which I collected at the C l i n i c would not constitute an adequate ethnography. What then, should an analysis be responsive to with reference to the data and the s o c i a l origins of that data? To speak of the i n t e g r i t y of the research setting was to note that data does not exist independent of a s o c i a l context from which 203 i t i s collected. My own data i s not just from the C l i n i c but from a medical interview, from a session of chart rounds, or a lunch con-versation, and so forth. To neglect this contextual feature i s to disregard a large part of the inte r a c t i o n a l background expectancies that members (including the sociologist) use and display i n th e i r routine i n t e r a c t i o n a l encounters. To say that a medical sociology approach would not respect the i n t e g r i t y of the research setting i s to say that i t treats the stream of C l i n i c behaviour as something independent of the contextual situations i n which i t was produced. Such an approach would not be concerned with C l i n i c behaviour per se but rather, with some preconceived research hypothesis which would allow the researcher to see various behaviours as items that would support or refute his orientation. Such an approach would disregard the context from which the data was collected as i t s e l f being a constituent feature of any analysis of that data. To speak of one's analysis as dependent on the context from which the data comes i s to note that i t should be responsive to that context. By t h i s I mean that the researcher should be able to handle the det a i l s of actual occurrences. He should be able to do this i n abstract ways, but, ultimately, his analysis should be responsive to actual s o c i a l interactions. From the standpoint of an a n a l y t i c a l description of C l i n i c organization, i t i s clear that an approach, such as that used by the medical s o c i o l o g i s t , would contribute l i t t l e to such a description for i t would not be concerned with how the members of the C l i n i c organize their ongoing s o c i a l a f f a i r s . 204 An a l t e r n a t i v e research procedure would be to regard such a c t i v i t i e s and occasions as phenomena having a structure and s e l f - o r g a n i z i n g char-acter which are open to and worthy of empirical i n v e s t i g a t i o n . To f o l -low such a research strategy would require one to respect the i n t e g r i t y of the research s e t t i n g . T r a d i t i o n a l ethnography portrays i t s e l f as having t h i s concern and for t h i s reason became a topic of i n q u i r y . A consideration of materials from research into the s o c i a l psychology of experiments showed how t r a d i t i o n a l ethnographies, while somewhat better than the t r a d i t i o n a l s o c i o l o g i c a l approach, could not maintain t h e i r claim to respect the i n t e g r i t y of other c u l t u r a l s e t t i n g s . I proposed that such ethnographic reports are often constructed around precon-ceived topics and t h e o r e t i c a l issues which remove them from the matrix of everyday l i f e from which they ult i m a t e l y o r i g i n a t e d . The new ethnography (or, cognitive anthropology) was then con-sidered since i t not only made pertinent c r i t i c i s m s of t r a d i t i o n a l ethnographic d e s c r i p t i o n , but also proposed a new research strategy. It t r i e s instead to produce a d e s c r i p t i o n that would enable the reader to act i n c u l t u r a l l y appropriate ways. The d i r e c t i o n of the new ethno-graphy seemed to be a recommendation towards the production of a des-c r i p t i o n of some aspect of c l i n i c a c t i v i t y , but i t s goal seemed to be unattainable. In chapter one i t was demonstrated that i t i s impossible to provide a d e s c r i p t i o n that w i l l completely inform a reader since any d e s c r i p t i o n r e l i e s on a set of u n s p e c i f i a b l e features that the reader must n e c e s s a r i l y u t i l i z e i n order to "make-sense-of" what he i s reading. The next task was the s e l e c t i o n of a c l i n i c a c t i v i t y from which to 205 produce a detailed analysis. Chart rounds was selected because i t constitutes a recurrent and bounded a c t i v i t y within the C l i n i c . I then produced a description which I characterized as "an inadequate description" since i t did not attend to the self-organizing features of the occasion. Given that chart rounds are s p e c i f i c a l l y designed for t a l k about patients, I proposed that, by examining transcribed material from tape recorded sessions, i t would be possible to discover some of their organizational features. Since chart rounds are a routine i n t e r a c t i o n a l and conversational a c t i v i t y , such transcripts should display relevant features of the self-organizing character of the occasion. Thus, instead of attempting to do a description that would enable one to act as a competent member to t h i s occasion, I would attempt to construct an analysis responsive to the self-organ-izingffeatures of the occasion by examining some properties displayed i n the talk of c l i n i c participants. Chapter four also examined the relationship between the researcher and the research setting, but this time with a different perspective than that of chapter two. I t focused on some of the day-to-day deci-sions that confront a researcher i n the f i e l d s i t u a t i o n and on how he might be expected to conduct himself i n and over the course of a variety of situations. I t was not the purpose of th i s chapter to provide a manual or a set of instructions for f i e l d researchers. Indeed, i t was the hiatus which exists between the goals of ethnographic description and the nature of the instructions offered i n f i e l d manuals that prompted thi s examination of my own f i e l d experiences at the C l i n i c . This was directed towards an explication of my own f i e l d experiences and, further, 206v towards an examination of these experiences as i n d i c a t i v e of the general problems faced by a researcher i n a f i e l d s i t u a t i o n . Throughout my research at the C l i n i c I was engaged i n a v a r i e t y of s i t u a t i o n s that provoked questions about the v a l i d i t y of many of the taken-for-granted assumptions I had held about the nature of f i e l d work. As a student, I acquired an o r i e n t a t i o n towards the successful accomplishment of f i e l d research. By t h i s I mean that I had become aware of the standard topics and problems associated with doing f i e l d work: the s e l e c t i o n of a research s e t t i n g , the problem of securing research access, the various s o c i a l r o l e s one would have to "play", the problem of being a p a r t i c i p a n t or non-participant observer, and so f o r t h . I regarded the doing of f i e l d research as something that I had to control and account f o r . I t seemed necessary for me to handle my presence i n f i e l d s i t u a t i o n s and i t was my r e s p o n s i b i l i t y to manage the problems associated with the r o l e of a p a r t i c i p a n t or non-p a r t i c i p a n t observer:. This p r i o r conception of f i e l d research was quickly shattered during my research at the C l i n i c . Such p r i o r concerns concentrated on the s o c i a l researcher and neglected the f a c t that h i s presence i s something that the members of the research s e t t i n g must also manage. In terms of my d a i l y l i f e i n the f i e l d , i t soon became apparent that whatever p r i o r conceptions of f i e l d work I had were vacuous and of l i t t l e pragmatic use when confronting the d a i l y contingencies of a researcher at the C l i n i c . Instead of presenting a discussion of r o l e s e l e c t i o n or ways of being accepted by C l i n i c s t a f f , I examined what I r e f e r r e d to as 207 the demand characteristics of a researcher i n a research setting. That i s , instead of giving the standard f i e l d work topics a pri v i l e g e d position, I placed those topics within the actual in t e r a c t i o n a l con-text of doing f i e l d research. The focus of the chapter was thus directed towards the examination of those s i t u a t i o n a l and contextual features i n which I found myself while a researcher at the C l i n i c . The reader w i l l remember that my own experience demonstrated that 1) the d i s t i n c t i o n between participant and non-participant observer lacked substance, 2) the manner i n which a researcher's i d e n t i t y i s developed may be dependent on the setting's members rather on the re-searcher, and 3) that this i d e n t i t y selection can lead to certain e t h i c a l problems. While i t i s possible to maintain the d i s t i n c t i o n between participant or non-participant observation or between e t h i c a l and non-ethical research practices, these may have to be discarded i f one i s to focus on the doing of f i e l d work and to investigate the da i l y demands placed upon the f i e l d researcher as they are translated into courses of action. Chapter four suggests that further research into the d a i l y con-tingencies of the f i e l d researcher and of the actual problems that r e -searchers encounter i n the i r a c t i v i t i e s could provide the appropriate basis for a discussion of how the research s i t u a t i o n can become a source of data for an investigation into the methodology of f i e l d work. In chapter three I presented an i n t e r a c t i o n a l analysis of chart rounds. A segment of transcript was examined and, from this apparently uninteresting, mundane ma t e r i a l , . i t was possible to discover the f o l -lowing general features of this occasion: 1) How C l i n i c s t a f f resolve 208 the termination of talk about one patient's chart and a progression to the next, thereby accomplishing a solution to what was termed the "progression problem", 2) A patient's name i s often not s u f f i c i e n t to r e f e r e n t i a l l y i d e n t i f y him to members of the s t a f f , 3) A patient's medical chart constitutes a document-in-use throughout the occasion of chart rounds, and can be consulted to determine his reason for a v i s i t to the C l i n i c , and 4) Physicians tend to view patients' medical careers as s t a t i c between v i s i t s even though such a view i s subject to transformation upon an actual medical encounter with the patient. That the C l i n i c s t a f f i s able to adduce a patient's reason for a v i s i t during the occasion of chart rounds provides some insight into the workings of organizations. The reader w i l l remember that the C l i n i c i s regarded by staff as a new and innovative type of medical treatment :•: f a c i l i t y . I t i s staffed by a group of highly-trained medical profes-sionals who are i d e a l i s t i c about the p o t e n t i a l i t i e s for community medical care. They regard the C l i n i c as something d i s t i n c t l y d i f f e r e n t from other, more conventional medical practices. Yet, despite t h i s pro-gressive ideologicalpperspective, closer examination shows that the C l i n i c displays some of the standard and invariant features of any or-ganization. Thus, during chart rounds, C l i n i c s t a f f routinely provide reasons for patient's seeking medical attention. Chart rounds i s not an occasion s p e c i f i c a l l y designed to adduce a patient's actual reason for a v i s i t to the C l i n i c . However, adducing a patient's reason for a v i s i t i s an organizational outcome of chart rounds. ^ This method of determining a patient's reason for a v i s i t 2 0 9 runs contrary to a lay notion of medical practice: "the physician should always expect the worst when seeing a patient," that i s , "be f u l l y attentive to any possible manifestation of disease." Contrary to this lay notion, physicians find t y p i c a l courses of action that can account for the patient scheduling a v i s i t to the C l i n i c . They do not t y p i c a l l y view the v i s i t as something generated by an open f i e l d of contingencies. Rather, once a "reason for a v i s i t " i s found, i t i s treated organizationally and " u n t i l further notice" as the reason for a v i s i t . Thus, despite the progressive ideology of the C l i n i c , the analysis of chart rounds found that the C l i n i c exhibits standard properties of organizations. The C l i n i c s t a f f constitutes a group of experts dealing with a c l i e n t e l e . As such, they have standard formats for r o u t i n i z i n g contacts with that c l i e n t e l e and ways of dealing with c l i e n t s that are economic i n terms of time and energy, etc. To propose t h i s as a feature of C l i n i c organization i s not to adopt a cynical attitude towards the C l i n i c or i t s operation, but rather to demonstrate that, even i n a set-ting which subscribes to an avant-garde concept of medical practice, one w i l l f i n d certain standard and invariant occupational routines and or-ganizational structures. I have paid r e l a t i v e l y l i t t l e attentionrto many of the substantive areas of l i f e within the Community C l i n i c ; areas such as doctor-patient interviews, physical examinations, laboratory procedures, medical d i a -gnosis, and so forth. This lack of attention i s not stated apologetically. As an ethnographer within the C l i n i c I had no theoretical framework that 210 provided me with a " s e r i a l " orientation toward ethnographic descrip-ti o n . In many ways th i s proved advantageous. Let me elaborate t h i s point. Traditional anthropolotical ethnographers attempt to study some peoplej group, tr i b e or society. The ethnographer i s regarded as havin an expertise with reference to such a group. The product of such ethno graphic research i s usually a monograph which consists of the componen-t i a l features of the culture. F i r t h , for example, i n his work on the Tikopia has chapters on marriage relationships, family, c i r c l e s , land tenure, and v i l l a g e l i f e . Either the fact that these components o r i g i -nate from the same setting provide a sense of unity, or else the ethno-grapher i s forced to find theoretical connections between these compo-nents which give the ethnographic report a sense of .unity. I did not have a research framework that would allow (or force me) to presume that a c o l l e c t i o n of topics from one substantive area would constitute an adequate ethnography of the C l i n i c , nor did I have a theoretical framework that would allow me to generate arguments for my ethnography to contain such a s e r i a l c o l l e c t i o n of descriptive topics. Admittedly, I could have proposed further analyses of other aspects of c l i n i c organization, but for what reason? From material discussed i n chapter one, i t should be apparent that to adopt such a conception of ethnographic description would be to adopt an unattain-able goal since no matter how much one attempted to describe, i t i s impossible to describe everything. I am not referring to the problem that psychologists might c a l l a stimulus overload, i . e . , that there i s 211 so much impinging on the human senses that i t i s impossible to des-cri b e a l l that our senses react to. Rather, I mean that, as analysts, we have no conception of what would be necessary to describe the "everything" of some c u l t u r a l s e t t i n g or occasion, whatever i s d i s -covered to be described ±s_ described and whatever set of i n t e r e s t s or relevancies the ethnographer has d i c t a t e s the character of that des-c r i p t i o n . As analysts, we do not have a sense of the d e s c r i p t i o n of a s e t t i n g standing i n r e l a t i o n s h i p to that sett ing i n the same way that the items of f u r n i t u r e of a room stand tQ that room. There i s no i n -ventory of the proper items to be described i n doing ethnographic des-c r i p t i o n ; and i t i s argued that to adopt a contrary notion i s not a vi a b l e way of looking at the world as an object of study. An a l t e r n a t i v e to t h i s s e r i a l strategy might be to examine a single bounded a c t i v i t y , s e t t i n g , or occasion and focus on i t i n some d e t a i l . This was the procedure followed i n our examination of chart rounds. I t i s apparent that, although we l i m i t e d our focus of attention to t h i s one a c t i v i t y within the C l i n i c , there was, nevertheless, an i n f i n i t e amount of d e t a i l to be discovered and attended to. Thus such a procedure should not be presumed to have a minimal amount of ethno-graphic i n t e r e s t . Because no exhaustive d e s c r i p t i o n i s possib l e , i t seems a reasonable procedure that we f i n d some describable feature of a s e t t i n g from which i t may be possible to discover features that are generalizable to other settings and occasions. The materials presented i n the analysis of chart rounds are iden-tdefv'ira&bly recurrent p a r t i c u l a r s f o r the members of the C l i n i c . They 212 are features oriented to by the participants to chart rounds as constituent features of the members' world within the research setting. Where do such findings now lead us? I t seems that the particulars d i s -covered v i a an examination of an occasion with this medical context may be the raw material of socially-organized a c t i v i t i e s that occur at any time or place. While they are located by the parti c u l a r s i n this medical setting, they seem to be instances of " c u l t u r a l l o g i c s " that materials from other settings and occasions could be organized around; that i s , they seem to have the capacity to organize other settings and occasions. Thus, from a detailed examination of one instance of c l i n i c a c t i v i t y , i t may be possible to engage i n further research into these c u l t u r a l logics rather than proceeding by examining further materials from other medical settings. An i l l u s t r a t i v e example of th i s l a t t e r point i s found i n Sudnow's analysis of "unit news" i n his ethnography Passing On: The Social Or-1 ganization of Dying. He found that once a death occurred within a family, n o t i f i c a t i o n of that death to other family members was a so-cially-organized phenomenon. However, the topic of "unit news" i s not re s t r i c t e d to the announcement of a family death nor to hospital set-tings but becomes a feature of everyday l i f e , available for other ethno-graphers to investigate v i s - a - v i s other settings. S i m i l a r l y , I am sug-gesting that the analysis of chart rounds has provided us with materials that have the capacity to organize other settings and occasions. I am not proposing,that one should compare th i s analysis of chart rounds with other analyses of s i m i l a r medical a c t i v i t i e s , but that further research 213 should be directed towards how features discovered from an examination of t h i s c l i n i c could be found operative i n other settings and occasions. Concluding Remarks A d i s s e r t a t i o n t y p i c a l l y ends by presenting the reader with a concluding chapter. The format f o r such a chapter u s u a l l y contains not only a summary of the main points of the d i s s e r t a t i o n , but also an assessment of t h e i r s i g n i f i c a n c e f o r the topic(s) under examination. It i s not uncommon to end with a discussion of p o s s i b i l i t i e s f o r f u r -ther research. The preceding materials of t h i s chapter conform to such expectancies for the ending of a d i s s e r t a t i o n . I have presented a sum-mary of the h i g h l i g h t s and findings of each of the chapters and some suggestions for further research. I f e e l , however, that t h i s does not constitute an appropriate way i n which to end t h i s report. Let me elaborate. While i t i i s p o ssible to regard the previous section of t h i s chapter as e x p l i c a t i n g the connections between each of the preceding chapters and as o f f e r i n g proposals f o r further research, to do so would hetnot only to disregard further possible discoveries about the standard ethnographic format, but also to misrepresent the findings of t h i s report as we l l . This report has looked back upon c e r t a i n of i t s sections as data from which to generate an analysis. I would therefore l i k e to end t h i s report by adopting t h i s procedure and considering the previous sections of t h i s chapter as data from which to derive further features of the standard ethnographic format. This procedure w i l l also allow me to ex-emplify the differences between t h i s report and a standard ethnographic d e s c r i p t i o n . 214 I t appears to be a standard feature of an ethnography that one's report ends with what may be described as a " s a t i s f y i n g " conclusion. By t h i s I mean that the ethnographer does not f i n d that h i s ethnography has, f o r example, no termination point, nor i s i t the case that i t leaves the ethnographer without any r e s o l u t i o n to h i s o r i g i n a l task or that he finds that there are more problems at the end of h i s report then when he started h i s research. I intend ho cynicism i n . r e f e r r i n g to t h i s conclusion as s a t i s f y i n g , but merely wish to note that a l l of the p o s s i b i l i t i e s noted above are p e r f e c t l y p l a u s i b l e and probable outcomes of an ethnographic report. Yet, the ethnographer i s somehow expected to end h i s work with a t i g h t - k n i t conclusion that allows'the reader to "see" the major findings and h i g h l i g h t s of the research. In pro-v i d i n g such a conclusion, the reader can view the ethnographic des-c r i p t i o n not only as a d e s c r i p t i o n of some c u l t u r a l s e t t i n g , but also as a piece of research having some o v e r a l l t h e o r e t i c a l relevance. When I look back upon the preceding chapters of t h i s report, I f i n d that they do not contain any r e a l termination points nor do they provide any resolutions to major issues. Rather, the chapters represent a s e r i e s of topics that I have considered as a r e s u l t of my experience i n the research s e t t i n g . A l l that these chapters have i n common i s that they were topics I'considered. Thus, the connections claimed i n the pre-ceding section of t h i s chapter constitute what I regard as "analysts' connections" rather than any necessary connection. In t h i s respect, my research report i s d i f f e r e n t from a standard ethnography and an examina-tio n of t h i s d i f f e r e n c e reveals 1) what those features of the standard 215 standard ethnographic format are, and 2) how my report d i f f e r s from these features. The standard ethnographic format seems to make two claims that this research report i s not making. F i r s t , ethnographies either i m p l i -c i t l y or e x p l i c i t l y claim that they have covered at least some feature of the i r setting with a reasonable degree of comprehensiveness and ex-haustiveness. That i s , the ethnographer has done enough research on some aspect of the setting to be i n a position to offer a coherent clear, and authoritative report of the topic he investigated. With reference to this f i r s t point, my own research at the C l i n i c does not follow such a format. While my research report contains some items that I have discovered i n the research se t t i n g , my report does not purport to be an exhaustive description of some feature of the C l i n i c . Rather, i t i s a discussion of two or three topics that were touched off by my being i n the setting -— topics that I f e l t I was able to write about i n an interesting way. These topics are collected i n the preceding pages. They do not have the relationship to one another that the standard ethnographic format would seem to require. That i s , that chapters are sequential and s e r i a l and b u i l t upon each other, or that one chapter concefns one aspect of the research setting and another chapter deals with some other aspect such that, when the reader has covered a l l of the material, he w i l l have a complete description of the setting. I have attempted to do neither. Instead I have talked about a few topics that were made available to me by vir t u e of having been a researcher at the C l i n i c . I make no apologies for these topics not having the 216 relatedness required by the standard ethnographic format. The second claim of the standard ethnographic format i s that i t contributes to the cumulative knowledge about some culture or p a r t i -cular feature thereof. That i s , an ethnographic report i s not viewed as just a description of some culture or features of a culture, but also as an int e g r a l part of the knowledge now available on a culture or cultural-feature. Hence, other researchers wishing to study that culture should read the ethnographic report since i t constitutes a component of the corpus of relevant l i t e r a t u r e on that which i s to be examined. Just as certain materials help the nuclear physicist to keep abreast of recent developments i n his f i e l d , so the ethnographer's report i s seen as con-t r i b u t i n g to a cumulative body of knowledge on some aspect of a culture's organization and should be read by other ethnographers embarking on re-search i n the same area. My research, however, does not have th i s cumulative character and thus departs from the standard ethnographic format. F i r s t , the topics discussed are not necessarily setting-related topics. By this I mean that anyone else doing an ethnography of a medical c l i n i c or setting need not read t h i s report since i t w i l l not necessarily t e l l them anything they should know i n order to conduct their own research. Secondly, I am proposing that what I have done, a l b e i t an a n a l y t i c a l account,is through and through a common-sense one which does not propose to have used a s c i e n t i f i c method whereby there i s some p o s s i b i l i t y of "cumu-l a t i v e " findings. Rather, this report consists of a series of an a l y t i c a l , accounts of various topics the usefulness of which remains to be 217 discovered. By t h i s I mean that although they are a n a l y t i c a l accounts of various topics, I cannot f o r e t e l l t h e i r u t i l i t y for subsequent readers; and f o r me to propose that they w i l l be useful would be to propose an incompleteness that could be remedied were some researcher to spend some time and energy pursuing the topics discussed i n t h i s report. I r e j e c t t h i s contention and regard the materials of the pre-ceding chapters as inherently incomplete. In t h i s respect I ' f i n d my-s e l f i n agreement with Blum and McHugh's conception of unfinished work. They state that: Another important matter i s the status of the phrase "unfinished work." That our papers are not f i n i s h e d does not d i s t i n g u i s h them from other pieces of sociology. Rather, the d i f f e r e n c e i s that our incompleteness i s grounded whereas t h e i r s i s treated as happenstance. Consider, for example, one notion of the future of f u n c t i o n a l a n a l y s i s . Committed f u n c t i o n a l i s t s w i l l often acknowledge, that functionalism has flaws. However, these flaws (a kind of incompleteness) are treated as things to be repaired i f only....If only f u n c t i o n a l i s t s had the wit, the experience, the f o r e s i g h t , or e s p e c i a l l y the money. The future for these people becomes the time — sooner or l a t e r -r~ when the money w i l l accumulate and tem-porary f a i l u r e s become permanent successes. F a i l u r e s are nothing to worry about because, by the nature of the case, they are temporary. A theory has defects only because the t h e o r i s t happens to be situated i n time, space, i n an economic structure. This r e l a t i v i z a t i o n to the conditions of f a i l u r e i s a perfect method for managing i n a Goffmanesque sense, but i t hardly comes to grips with the trouble. By a n t i c i p a t i n g termination, they think t h e i r work w i l l come to have the f i n a l character. They are oriented to the p o s s i b i l i t y of closure and i t i s i n terms of t h i s that they measure success and f a i l u r e . We say, on the contrary, that our work, because of the the nature of a n a l y s i s , w i l l always be i n need of r e p a i r . ^ 218 Throughout t h i s report I have proposed a c r i t i q u e of the standard procedures used i n the construction of ethnographic reports. 1 I have o f -fered some a l t e r n a t i v e s to u t i l i z i n g materials from research s e t t i n g s . I have been forced to reconsider many of the issues involved i n ethno-graphic d e s c r i p t i o n since, over the course of my ethnography, i t was evident that i t was not adhering to a standard ethnographic format. Thus I regard t h i s report neither as a "perverse" a l t e r n a t i v e to the standard ethnographic format, nor as a c r i t i c i s m of eitfaawography• Rather, I have taken the task of producing an ethnographic d e s c r i p t i o n s e r i o u s l y and have produced some r e f l e c t i o n s about the production of such descriptions that may be worth consideration not only by ethnogra-phers, but by'other s o c i a l s c i e n t i s t s as w e l l . Ihisum, while i t might be possible f o r the reader to assume that t h i s d i s s e r t a t i o n has been concerned with improving ethnographic f i e l d methods and p r a c t i c e s , t h i s i s not the case. Nor i s t h i s d i s s e r t a t i o n intended as a contribution to the substantive l i t e r a t u r e on medical sociology even though i t has examined materials from a medical s e t t i n g . Although i t has discussed ethnographic f i e l d work i n some d e t a i l , t h i s d i s s e r t a t i o n i s intended to be a contribution to a small but growing l i t e r a t u r e i n anthropology and sociology which treats the doing of . f i e l d work as the occasion f o r r e f l e c t i n g upon t h e o r e t i c a l issues. These issues have to do with the warranting of knowledge and the pos-s i b i l i t i e s of transcending everyday experience. 219 Footnotes: Chapter Five 1. David Sudnow, Passing On: The S o c i a l Organization of Dying, (Englewood C l i f f s , New Jersey: Prentice H a l l , 1967. (j^.u.5_Lfci< jijod C l i r f s , New .$ 2. Peter McHugh and A l l a n Blum et a l , On the Beginning of S o c i a l  Inquiry, (London: Routledge and Kegan Paul, 1974), p. 3. 220 BIBLIOGRAPHY Austin, J.L., P h i l o s o p h i c a l Papers, Second E d i t i o n . Oxford: Oxford Un i v e r s i t y Press, 1970. Berreman, Gerald D., "Anemic and Emetic Analysis i n S o c i a l Anthropology", American Anthropologist, Vol. 68, 1966, pp. 346-354. Berreman, Gerald D., " S o c i a l Categories and S o c i a l I nteraction i n Urban India", American Anthropologist, Vol. 74, 1972, pp. 567-586. Chomsky, Noam, Aspects of the Theory of Syntax, Cambridge: Mass.: The M.I.T. Press, 1965.• Cico u r e l , Aaron V., Method arid Measurement i n Sociology, New York: The Free Press, 1964.-Cohen, L.J., The D i v e r s i t y of Meaning, London: Methuen and Company, 1966. Conklin, Harold, "Ethnography" i n David S i l s , Ed., International Ency- clopedia of the S o c i a l Sciences, Vol, 5, 1968, pp. 172-178. Crowle, A.J., Post^Experimental Interviews: An Experiment and a S b c i o l i n g u i s t i c Analysis, Unpublished doctoral d i s s e r t a t i o n , University of C a l i f o r n i a , Santa Barbara, 1971. Evans-Pritchard, I.E., Witchcraft, Oracles and Magic Among the Azande, Oxford: The Claredon Press, 1937, F i r t h , Raymond, We, The Tikopia, Boston: Beacon Press, 1957. Frake, Charles, "Notes on Queries i n Ethnography" i n Stephen Tyler, Ed., Cognitive Arithropology, New York: Holt*Rinehart and Winston, 1969, pp. .123-137. Friedman, N e i l , The S o c i a l Nature of Psychological Research: The  Psychological Experiment as' a S o c i a l Interaction, New York: Basic Books, 1967. G a r f i n k e l , Harold, Studies i n Ethnomethodology, Englewood C l i f f s , N.J.: Prentice H a l l , 1967. Gold, Raymond L., "Roles i n S o c i o l o g i c a l F i e l d Observations", S o c i a l  Forces, Vol. 36 (March 1958). Goodenough, Ward H., " C u l t u r a l Anthropology and L i n g u i s t i c s " i n Paul Gavin, Ed., Report on the Seventh Annual Round Table Meeting-on L i n g u i s t i c s and Language Study, Georgetown University Monograph Series on Language and L i n g u i s t i c s , No. 9, 1957. 221 Grice, H.P., "Meaning", P h i l o s o p h i c a l Review, 1957. H i l l , Richard J . and Crittenden, K.S., Proceedings of the Purdue Sympo- sium on Ethnomethodology, Purdue Un i v e r s i t y : I n s t i t u t e f o r the Study of S o c i a l Change, Department of Sociology, 1968. Jay, Robert, "Personal and Extrapersonal V i s i o n i n Anthropology" i n D e l l Hymes, Ed., Reinventing Anthropology, New York: Pantheon Books, 1972, pp. 367-381. Junker, Buford, Fieldwork: An Introduction to the S o c i a l Sciences, Chicago: U n i v e r s i t y of Chicago Press, 1960. -Katz, Bruce A., Conversational Resources of Two-Person Psychotherapy", Unpublished M.A. Thesis, The University of B r i t i s h Columbia, 1971. Lofland, John, Analyzing S o c i a l Settings, Belmont, Cal.: Wadsworth Publishing Company, 1971. Louch, A.R., Explanation and Human Action, Los Angeles: University of C a l i f o r n i a Press, 1969. MacKay, Robert, "Conceptions of Children and Models of S o c i a l i z a t i o n " i n Hans Peter D r i e t z e l , Ed., Recent Sociology No. 5: Childhood  and S o c i a l i z a t i o n , New York: ' MacmilTan Company, 1973. McHugh, Peter, R a f f e l , Stanley, Foss, Daniel C , and A l l a n Blum. On the Beginning of S o c i a l Inquiry, London: Routledge and Kegan Paul, 1974. Morrick, Harold, Ed., Wittgenstein and The Problem of Other Minds, New York: McGraw H i l l , 1-967'. Nash, Dennison, "The Ethnologist as Stranger", Southwestern Journal  of Anthropology, Vol. 19, 1963, pp. 149-165. -Nash, Dennison and Wintrob, Ronald, "The Emergence of Self-Conscious-ness i n Ethnography", Current Anthropology, Vol. 13, No. 5, December, 1972, pp. 527-533. Orne, Martin T., "On the S o c i a l Psychology of the Psychological Ex-periment", American Psychologist, November 1962, pp. 776-783. P.-aml, Benjamin D., "Interview Techniques and F i e l d Relationships" i n Kruber, A.L., Anthropology Today, Chicago: University of Chicago Press. Pitcher, George, Ed., Wittgenstein: The P h i l o s o p h i c a l Investigations, London: Macmillan, 1968. R a f f e l , Stanley, "Notes on Time as a Method to Sequence Sentences", Unpublished paper, Domingez H i l l s College, C a l i f o r n i a , 1969. 222 Roe, Ann, "A Psychological Study of Eminent Psychologists, and a Comparison with B i o l o g i c a l and Ph y s i c a l S c i e n t i s t s " , Psychological Monographs, Vol. 67, 1952, pp. 1-55. Roe, Ann, "Analysis of Group Rorschachs of Psychologists and Anthropo-l o g i s t s " , Journal of Pro j e c t i v e Techniques, Vol. 16, 1952, pp. 212-224. Sacks, Harvey, Unpublished Lectures, The University of C a l i f o r n i a at Irvine. Schegloff, Emanuel, "Notes on a Conversational P r a c t i c e : Formulating Place", i n David Sudnow, Ed., Studies i n S o c i a l Interaction, New York: The Free Press, 1972. Scholte, Bob, "Toward a Reflexive and C r i t i c a l Anthropology" i n D e l l Hymes, Ed., Reinventing Anthropology, New York: Pantheon 1972, pp. 430-453. Schwartz, Morris.. S., and Schwartz, Charlotte Green, "Problems i n Pa r t i c i p a n t Observation", American Journal of Sociology, Vol. LX (January 1955). Searle, John, Speech Acts':1 An Essay i n the Philosophy of Language, London: Cambridge U n i v e r s i t y Press, 1970. Searle, John, "What i s a Speech Act" i n Max Black, Ed., Philosophy i n America, New York: Macmillan, 1969, pp. 221-239. Sharrock, W.W., "On Owning Knowledge" i n Turner, Roy, Ed., Ethno- methodology , London: Penguin Books, 1974. Speier, Matthew, How to Observe Face-to-Face Communication, P a c i f i c Palisades, C a l . : Goodyear Press, 1973. Spindler, George D., Ed., Being an Anthropologist, New York: Holt, Rinehart and Winston, 1970. Strawson, P.F. , Individuals': An Essay i n Descriptive Metaphysics, London: Methuen and Company, 1969. Turner, Roy, Ethnomethodology, London: Penguin Books, 1974. Turner, Roy, "Occupational Routines: Some Demand C h a r a c t e r i s t i c s of P o l i c e Work", Paper presented at the Annual Meetings of the CSAA, Toronto, June, 1969. Turner, Roy, "The Ethnography of Experiment", American Behavioral  S c i e n t i s t , Yb.l.A«er.nps.n8Be'Apri<kui.967Scientist Turner, Roy, "Words, Utterances and A c t i v i t i e s " i n Jack Douglas, Ed., Understanding Everyday L i f e , Chicago: Aldine Press, 1970. 223 Tyler, Stephen, Ed., Cognitive Anthropology, New York: Holt, Rine-hart and Winston, 1969. Werner, Oswald, "The Basic Assumptions of Ethnoscience", Semiotica, Vol. 1, 1969, pp. 329-338. Weider, D.L., T e l l i n g the Code: A Study of a Moral Order as a Persuasive  A c t i v i t y , Unpublished doctoral d i s s e r t a t i o n , The Un i v e r s i t y of C a l i f o r n i a at Los Angeles, 1969. William, Thomas R., F i e l d Methods i n the Study of Culture, New York: Holt, Rinehart and Winston^, 1967. Winick, Charles, The Dictionary of Anthropology, New York: P h i l o s o p h i c a l Library, 1956. Wittgenstein, Ludwig, P h i l o s o p h i c a l Investigations, Oxford: B a s i l Blackwell, 1963. Z i f f , Paul, Semantic Analysis, New York: Cor n e l l University Press, 1964. 

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