Research on medical interactions shows how the discursive construction of the clinical case impacts diagnostic reasoning and treatment recommendations. Drawing on an ethnographic study in an intensive care unit, we illustrate how this process is at play in a ward that adopts an extreme, guideline-divergent policy as to the use of antibiotics. The article focuses on how physicians assemble the case as ‘treatable’ or ‘not yet treatable’, and how in doing so they ‘talk into being’ two contrastive policies on antibiotics (...) and position themselves toward the one adopted in the ward. The analysis identifies the discursive resources displayed by physicians to both project an infectious disease diagnosis and resist this treatment-implicative trajectory. We argue that the physicians’ contentious discursive construction of the case has crucial consequences in the way the ward’s extreme policy is jointly accomplished as a highly reflexive process sensitive to the contingencies of any particular case. (shrink)

Medical records are documents of tremendous social importance. They have been the subject of much medical and sociological research, in particular regarding validity, accessibility and readability. This paper uses Conversation Analysis to add an aspect to the understanding of medical records that has been missing so far, namely how medical records are produced as interactional accomplishments; specifically, how hospital staff members during meetings conversationally negotiate and reach conclusions, treatment recommendations, and other types of consequential decisions. The process involves four steps: (...) assessing patients, interpreting implications, drawing conclusions, and dictating conclusions on tape. The key finding is that participants throughout the process orient towards a need for consensus, whilst at the same time acknowledging the doctors’ interactional leading roles. This insight can enhance our understanding of medical records in hospital settings as constructed and negotiated realities. (shrink)

This study investigates rehabilitation team members’ interactive accomplishments of their domains of work and responsibility in rehabilitation team conferences in Japan. A combination of membership categorization analysis and sequential analysis is adopted to systematically illustrate the situated productions of professional sense-making practices. Analysis focuses on the segment in which a physician asks a series of questions regarding a patient’s functional status and disability coded in the functional assessment record (FAR). A close examination of data shows that a physician does not (...) always choose a respondent with his or her gaze when asking a question because s/he is continuously reading the FAR displayed on a computer screen. Despite this, a physician’s mention of a topic generates a professional’s domain of work and responsibility in a local division of labor which is used by members to assume who the relevant categorial respondent is. Further, members demonstrate these assumptions by shifting their gazes toward the computer screen, back to the document on the desk, and turning toward co-participants, thus embodying professional roles and responsibilities in situ. This study utilizes the analyst’s ethnographic understanding of the routines and division of labor at the rehabilitation ward as a resource to explicate professional sense-making practices, thus utilizing Garfinkel’s ethnomethodological studies of work. Together with sequential and categorial resources offered by Sacks, this study elucidates inferences and normative expectations which rehabilitation team members bring together to reproduce the endogenous logic of rehabilitation culture in actual occasions of the institutional life. (shrink)

This paper gives a selective overview of studies in 'medical ethnomethodology'. It starts with the 1967 contributions by Garfinkel and Sudnow, which focus on medical action as accountable Then it discusses the many CA-inspired studies of doctor-patient inter-action published during the 1980s. Finally, it points to scattered studies that suggest several ways in which this latter approach can be deepened and enlarged. In this way, it formulates the contours of a program for ethnomethodological studies in the medical field.