This article deals with surgical practice as it is locally organized within the course of the operation; it focuses on the way in which surgical action shaping the body for the local purposes of the operation is organized in a timely, situated, interactive manner. In order to do that, I offer a systematic analysis of the instructions addressed by a chief surgeon to his assistant in the form of directives during a surgical operation, as well as of instructed actions of (...) the assistant following the directives of the surgeon. In this way, I aim to show how surgery is a methodic collaborative achievement, relying on finely tuned coordination between staff members. More generally, the article sketches a systematic and detailed analysis of instructions as situated accomplishments in time, and of instructed action as resulting from an embodied and indexical understanding of directives and requests as they are produced in time and in context. (shrink)

The present study examines the work of a group of medical scientists as they identify interpretative ‘pitfalls’ – recurrent sources of error – in the use of a new radiographic technique, formulate suggestions on how these pitfalls can be avoided and communicate their findings in the form of a scientific publication. The analysis focuses on a session in which previously diagnosed cases are discussed, and demonstrates the ways in which a certain source of diagnostic error gradually emerges as a taken-for-granted (...) in the interaction. An increased sense of recognition, recurrence and typicality is discernible in the treatment of the cases. Talk characterized by expansions and elaborations, displays of understanding in the form of reformulations, understanding checks, and so on, leave room for brief typifications and reifications of interpretative difficulties in characteristics of the imaging technique. Topical treatment of perception and interpretation, as well as embodied engagement, become decreasingly salient. It is argued that the abstracted formulations in the published text rely on the case-by-case working up of generality from particularity; from individualized accounts of why ‘I’ interpreted the image in a certain way to proffered generalizations achieved through articulated perceptions of a generalized ‘one’. If these proffers are ratified, a potential ground is established for the consensual formulation of a pitfall. The formulation of novel instructions is consequently made relevant, projecting a re-instructed diagnostic practice. (shrink)

Examining a fragment of interaction that occurred during a surgery at a teaching hospital, we explore how particular instructed experiences are produced for two trainees, a surgeon in the residency program and a medical student in a surgical clerkship. We are concerned with what is produced as learnable in each case. Stated slightly differently, we are interested in the ways in which the attending surgeon uses demonstrations as instruction and the ways in which recipients of that instruction, in this case (...) the resident and the clerk, respond with enactments of those demonstrated actions. The recipients of this kind of instruction participate in a form of experiential learning in which they enact their own versions of the instructor’s demonstrated actions to be observed and assessed by the instructor. These enactments provide learners with experiential access to the instructor’s demonstrated actions. They are designed to be experiences that learners may draw upon to make experientially warranted claims at some later time. (shrink)

Conversation analysts have noted that, in psychotherapy, formulations of the client's talk can be a vehicle for offering a psychological interpretation of the client's circumstances. But we notice that not all formulations in psychotherapy offer interpretations. We offer an analysis of formulations that are diagnostic: that is, used by the professional to sharpen, clarify or refine the client's account and make it better able to provide what the professional needs to know about the client's history and symptoms. In doing so, (...) these formulations also have the effect of shepherding the client's account towards subsequent therapeutic interpretation. In a coda, we notice that sometimes the formulations are designed discreetly. We examine one such discreet formulation in detail, and show how its very ambiguity can lead to its failure as a diagnostic probe. (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.