A collective clinical gaze: Negotiating decisions in a surgical ward

Authors

  • Gro Underland Diakonova University College
  • Aksel Tjora Norwegian University of Science and Technology

DOI:

https://doi.org/10.1558/cam.18432

Keywords:

decision-making, hospital, knowledgesharing, negotiations, redundancy, surgeons

Abstract

This article explores collaborative aspects of clinical decision-making, based on a focused ethnography and video recordings of meetings in clinical practices in two wards for gastro-intestinal diseases at the surgical department of a large Norwegian university hospital. By studying clinicians’ communication during patient introduction, handling uncertainties and surprises, collecting information, and negotiating acceptance, we elaborate on how collaborative teamwork in the hospital ward is developed. Further, by drawing on detailed studies of meetings, in which patients are not physically represented, we explore ways in which a ‘collective clinical gaze’ of each patient is constructed on the basis of documents, memory, and a consensus-directed discussion among clinicians who are present. Although electronic patient record systems and the like are expected to produce firm bases for clinical decision-making, our analysis suggests that more emphasis should be put on how clinicians in their daily practice establish collectively based validity of any decision being made.

Author Biographies

Gro Underland, Diakonova University College

Gro Underland is an Associate Professor at Diakonova University College, Norway. Her current research interest is organisational changes when implanting new information systems. knowledge production and knowledge exchange are an important part of this research.

Aksel Tjora, Norwegian University of Science and Technology

Aksel Tjora is Professor of Sociology at the Norwegian University of Science and Technology and manager of the Sociology Clinic in Trondheim. His research includes a wide range of themes such as organisations, public and semi-public spaces, technologies, and health and medicine, always with a special interest in material–social interaction.

References

Allen, D. (1997) The nursing-medical boundary: A negotiated order? Sociology of Health & Illness 19 (4): 498–520. http://dx.doi.org/10.1111/1467-9566.00065

Atkinson, P. (1995) Medical Talk and Medical Work. London: Sage.

Berg, M. and Bowker, G. (1997) The multiple bodies of the medical record: Towards the sociology of an artifact. The Sociological Quarterly 38 (3): 513–537. http://dx.doi.org/10.1111/j.1533-8525.1997.tb00490.x

Cabitza, F., Sarini, M., Simone, C. and Telaro, M. (2005) When once is not enough: The role of redundancy in a hospital ward setting. GROUP ’05: Proceedings of the 2005 International ACM SIGGROUP Conference on Supporting Group Work. ACM: New York. http://dx.doi.org/10.1145/1099203.1099234

Cicourel, A. V. (1990) The integration of distributed knowledge in collaborative medical diagnosis. In R. Galegher, F. Kraut and C. Egido (eds) Intellectual Teamwork: Social and Technological Foundations of Cooperative Work, 221–241. Hillsdale, NJ: Lawrence Erlbaum Associates.

Dingwall, R. (1997) Accounts, interviews and observations. In G. Miller and R. Dingwall (eds) Context and Method in Qualitative Research, 51–65. London: Sage. http://dx.doi.org/10.4135/9781849208758.n4

Emery, F. and Trist, E. (1972) Towards a Social Ecology. London: Plenum Press.

Hughes, D. (1977) Everyday and medical knowledge in categorising patients. In R. Dingwall, C. Heath, M. Reid and M. Stacey (eds) Health Care and Health Knowledge, 128–140. London: Croom Helm. http://dx.doi.org/10.1111/1467-9566.ep11340102

Hughes, D. (1988) When nurse knows best: Some aspects of nurse/doctor interaction in a casualty department. Sociology of Health & Illness 10 (1): 1–22.

Hutchins, E. (1990) The technology of team navigation. In J. Galegher, R. M. Krauss and C. Egido (eds) Intellectual Teamwork: Social and Technological Foundations of Cooperative Work. Hillsdale, NJ: Lawrence Erlbaum Associates.

Hutchins, E. (1995) Cognition in the Wild. Cambridge, MA: MIT Press.

Hutchins, E., and Klausen, T. (1996) Distributed cognition in an airline cockpit. In Y. Engeström and D. Middleton (eds) Cognition and Communication at Work, 15–34. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/cbo9781139174077.002

Knoblauch, H. (2006) Videography: Focused ethnography and video analysis. In H. Knoblauch, B. Schnettler, J. Raab and H.-G. Soeffner (eds) Video Analysis: Methodology and Methods. Qualitative Audovisual Data Analysis in Sociology, 69–83. Frankfurt am Main: Peter Lang.

Landau, M. (1969) Redundancy, rationality, and the problem of duplication and overlap. Public Administration Review 29 (4): 346–358. http://dx.doi.org/10.2307/973247

Luff, P., Hindmarsh, J. and Heath, C. (eds) (2000) Workplace Studies: Recovering Work Practice and Informing System Design. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511628122

Måseide, P. (2006) The deep play of medicine: Discoursive and collaborative processing of evidence in medical problem solving. Communication & Medicine 3 (1): 43–54. http://dx.doi.org/10.1515/CAM.2006.005

Måseide, P. (2007) Discourses of collaborate medical work. Text & Talk 27 (5/6): 611–632. http://dx.doi.org/10.1515/TEXT.2007.028

Melby, L. (2007) Prat, penn og papir: En sosiologisk analyse av medisinsk informasjonsbruk i en mobil praksis. Unpublished doctoral dissertation, Norwegian university of Science and Technology, Trondheim.

Morgan, G. (1986) Images of Organization. Beverly Hills, CA: Sage.

Sarangi, S. (2010) Healthcare interaction as an expert communicative system: An activity analysis perspective. In J. Streeck (ed.) New Adventures in Language and Interaction, 167–197. Amsterdam: Benjamins.

Sarangi, S. and Roberts, S. (1999) The dynamics of interactional and institutional orders in work-related settings. In S. Sarangi and S. Roberts (eds) Talk, Work and Institutional Order: Discourse in Medical, Mediation and Management Settings, 61–75. Berlin: Mouton de Gruyter. http://dx.doi.org/10.1515/9783110208375.1.1

Stein, L. I. (1967) The doctor-nurse game. Archives of General Psychiatry 16 (6): 699–703. http://dx.doi.org/10.1001/archpsyc.1967.01730240055009

Strauss, A. (1978) Negotiations. San Fransisco: Jossey-Bass.

Strauss, A. (1993) Continual Permutations of Action. New York: Aldine de Gruyter.

Strauss, A., Fagerhaugh, S., Suczek, B. and Wiener, C. (1997) Social Organization of Medical Work. New Brunswick, NJ: Transaction.

Strauss, A. L., Schatzman, L., Ehrlich, D., Bucher, R. and Sabshin, M. (1963). The hospital and its negotiated order. In E. Freidson (ed.) The Hospital in Modern Society, 147–169. New York: Free Press.

Suchman, L. (1994) Plans and Situated Actions: The Problem of Human–Machine Communication. Cambridge: Cambridge University Press.

Svensson, R. (1996) The interplay between doctors and nurses: A negotiated order perspective. Sociology of Health & Illness 18 (3): 379–398. http://dx.doi.org/10.1111/1467-9566.ep10934735

Tjora, A. (2000) The technological mediation of the nursing-medical boundary. Sociology of Health & Illness 22 (6): 721–741. http://dx.doi.org/10.1111/1467-9566.00228

Tjora, A. (2004) Maintaining redundancy in the coordination of medical emergencies. CHI Letter 6 (3): 132–141. http://dx.doi.org/10.1145/1031607.1031631

Tjora, A. (2009) Calls for Care: Coordination, Competence, and Computers in Medical Emergency Call Centres. Beau-Bassin, Mauritius: Verlag Dr. Müller.

Tjora, A. and Øverland, I.-T. (2008) The patient as talk. Paper presented at the 12th Biennial Congress of the European Society for Health and Medical Sociology (ESHMS), Oslo.

Tjora, A. and Scambler, G. (2009) Square pegs in round holes: Information systems, hospitals and the significance of contexual awareness. Social Science & Medicine 68 (3): 519–525. http://dx.doi.org/10.1016/j.socscimed.2008.11.005

Underland, G. (2010) When trustworthiness matters: How trust influences knowledge-production and knowledge-sharing in a surgical department. Communication & Medicine 7 (2): 187–196.

Wenger, E. (1998) Communities of Practice: Learning, Meaning, and Identity. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511803932

Published

2017-02-08

How to Cite

Underland, G., & Tjora, A. (2017). A collective clinical gaze: Negotiating decisions in a surgical ward. Communication and Medicine, 13(1), 23–35. https://doi.org/10.1558/cam.18432