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PublishedinDiscourseStudies2014,Vol.16(2)125129
DOI:10.1177/1461445613514671dis.sagepub.com
Thebodyinmedicalworkandmedicaltraining:Anintroduction
OskarLindwall,UniversityofGothenburg,Sweden
Withinethnomethodologyandconversationanalysis,thereisalongstandinginterestinthe
socialandpracticalorganizationofmedicalwork(seetenHave,1995).Astestifiedbyalarge
numberofpublications,encountersbetweenhealthcareprofessionalsandclientshavealso
proventobeagenerativedomainofempiricalresearch.Inparticular,therearemanystudies
ofthecommunicationbetweenphysiciansandpatientsinprimarycare.Throughdetailed
analysisoftalkininteraction,thesestudieshaveexaminedawealthoftopicsand
phenomena,includingthestructureofpatientinterviews,thedeliveryofdiagnosisandthe
managementofinteractionaltroubles(e.g.HeritageandMaynard,2006;Stivers,2007).This
specialissuedrawstogetherscholarsfromNorthAmerica,EuropeandJapanwhousevideo
recordstoanalysemedicalworkandmedicaltraining.Thecontributorsallinvestigate
settingsbeyondthedoctorpatientconsultation(Pilnicketal.,2009:790).Whilethestudies
buildonpreviousresearchonhealthcarecommunication,andtakeaninterestinthe
sequentialorganizationoftalk,theyalsoshareaconcernforthewaysinwhichvisual,
embodiedandmaterialfeaturesareconstitutiveoftheinvestigatedsettingsespeciallythe
variouswaysinwhichthebodybecomespartoftheworkplaceinteraction.
Foralmosttwodecades,ahandfulofresearchersandresearchgroupshaveexploredvideo
recordingsofoperatingtheatres(HindmarshandPilnick,2002;Koschmannetal.,2007,2011;
Mondada,2003,2011;PilnickandHindmarsh,1999;SanchezSvensson,2007;Sanchez
Svenssonetal.,2009;Zemeletal.,2011).Inthisissue,therearetwostudiesthatcontinueto
investigateinteractionsthatoccurduringsurgeries.Mondadaanalysesthecoordinationof
surgicalteamswithaspecialinterestforthewaysinwhichdirectivesandrequestsareused
andrespondedto.ZemelandKoschmannalsolookattheuseanduptakeofdirectives,butin
theircasethereisaparticularinterestinissuesoflearningandinstruction.Movingfrom
surgeriestodiscussionsaboutdiagnosticwork,Lymerandhiscoauthorsexaminehowa
groupofmedicalspecialistsattemptstoformulatepotentialpitfallsintheuseofanew
radiographictechnologyhow,forinstance,theprofessionalsdiscussthewaysinwhichthe
techniquerendersandrefractsbodilystructuresandentities.Twostudiesintheissue
addresstheinterplaybetweenstudents
127
andtutorsindentaleducation.Hindmarshetal.takeaninterestinhowissuesofrealismare
treatedaspartofinstructionalcorrections,whereasLindwallandLymerexaminequestions
thatareposedbystudentsinresponsetovideobroadcastsofdentaltreatments.Likemuchof
thepreviousworkoncommunicationinmedicalcare,Nishizakasstudyofobstetric
ultrasoundexaminationsconcernsanencounterbetweenahealthcareproviderandaclient.
Withhisfocusonthepracticesemployedtoinvitethepregnantwomentodifferentiatean
imageontheultrasoundmonitor,however,hisfindingsaretiedtothematerialandvisual
featuresoftheinvestigatedsceneandthusmovebeyondthoseusuallyfoundindoctor
patientencounters.
AllthestudiesinthisissueaddresswhatHeath(2006)referstoasbodyworkhow
professionalslookatorintoabodyandhowabodyisorganizedasasiteofclinicalactivity.In
thecollection,onefindsanaesthetizedbodies,simulatedbodiesandbodieswhosedetailsare
renderedvisibleinandthroughimages.Thesebodiesarenotactivepartiestotheinteraction.
Althoughtheyareacteduponandinteractedwith,theydonotactthemselves.Inthissense,
thebodyistreatedasaKrper,notaLeib.AsarguedbyHirschauer(1991:303)inthe
contextofsurgery,however,theremightstillbearelationshipbetweenthepatientsbody
andthepatientsperson,whichsurgeryasamedicalsciencehastoconsiderbecauseofthe
lifeworldesteemforitsobject.Whatthisrelationshippracticallyconsistsof,ifanything,
differsbetweensettingsandsituations.Itisonethingforprofessionalstodiscussanonymous
radiographsaspartofestablishingnewclinicalcriteria.Itisanotherthingtodiscussafoetal
imagewiththepregnantwomenwhoisbeingexamined.Theuseofradiographsand
sonographsalsoexemplifyhowbodyworkistightlyboundupwithtechnologiesand
techniques.Inordertodiscerntherelevantfeaturesofaclinicalobject,thereisaneedfor
anatomicalvisibility.Severalofthestudiesdemonstratetheimportantroleofimaging
technologies,suchasmicroscopes,endoscopiccamerasandultrasoundscanners,inthe
achievementofthis(seealsoLindwalletal.,2014;Mondada,2003;Nishizaka,2011;Rystedt
etal.,2011;Slacketal.,2007).
Throughoutthecollection,thereisaninterestinhowbodiesarepracticallyand
interactionallyorganizedassitesofmedicalworkandmedicaltraining.Butthenotionof
bodyworkdoesnotonlydirecttheattentiontowardsthepresenceofanatomicalbodiesand
technology.Italsoemphasizesthebodyinaction(Goodwin,2003;Streecketal.,2011)
especiallytheembodiedconductofthehealthcarepractitionerswhoaredoingthework.
Previousresearchhasinvestigatedthecoordinationofverbalandnonverbalbehaviour
betweenthedoctorandpatient(Heath,1984)andtheorganizationoftalk,gazeandactivity
inamedicalinterview(Psathas,1990;seealsoFrankel,1983).Continuingthislineofinquiry,
severalcontributionstakeaninterestinhowtalkiscoordinatedwithgesturesandother
embodiedconduct.Inrelationtotheinvestigatedsettings,thisapproachraisesanumberof
challenges.Giventhatconcurrentcoursesofactionsandoperationsmaybemoreorless
interwoventoaccomplishthebusinessathand,thesequentialorganizationisfarfrom
straightforward(GoodwinandGoodwin,1987;Mondada,2011).Neitherisitselfevidenthow
thebodilycomportmentandtheuseofinstrumentsaretobeincludedinthesequential
analysisofinteraction(Streecketal.,2011).Perhapsevenmoreimportantisthequestionof
whethermedicalwork,orinstrumentalactionsmoregenerally,canbeanalysedinsimilar
waystotalkininteraction.Performingsurgeriesorrootcanalfillingsarenotprimarily
communicativeorverbalactivities;theyconcern
128
theworkofeyesandhands(Latour,1986).Acentralissueisthustowhatextentestab
lishedwaysofanalysingsocialinteractionareapplicablewhentheinvestigatedactionsand
operationsareaimedtowardstheachievementsofclinicalproceduresratherthanthe
establishmentofintersubjectiveunderstandingsortheprogressionofcommunicative
exchanges.
Inhiscommentaryinthisissue,Macbethraisesanumberofconcernssimilartothis.Ashe
pointsout,thereisalwaysariskthatthedisciplinedanalysisofworkplaceinteractionmisses
theidentifyingdetailsoftheworkitaimstoinvestigate.Or,asnotedbyBjelicandLynchin
anothercontext,socialscientistsmightfinditmoresensibletoinvestigatehowdoctors
interviewpatientsorinformthemofdiagnosticoutcomesthantoinvestigatehowthey
organizediagnosis.Whatgetslostinthebargainaretheuniquelyidentifyingfeaturesofthe
workstudied(1992:76note3).Withasharedinterestintools,visualdisplaysandembodied
actions,thecontributionstothisissueallmovefromafocusoninstitutionaltalktoabroader
conceptionofworkplaceinteraction.Butfindingregularitiesinthewaysinwhichwords,
gestures,toolsandgazearecoordinatedisnotinitselfsufficientforcapturingthesituated
andemergentorganizationoftheactualwork.Professionslikesurgery,dentistryand
radiologyrelyonanextensivesetofskillsandalargeamountofknowledge.Withoutthe
relevantskillsandknowledge,itisimpossiblenotonlytoperformthework,butalsotofully
understandandappreciatewhatthepractitionersaredoing.Videorecordings,augmentedby
fieldstudiesandcollaborationswithmedicalpractitioners,haveprovidedaninvaluable
resourceforanalysis.Nevertheless,theinvestigatedsettingsallpresentchallengeswith
regardstotheintelligibilityandrecognizabilityofmedicalwork.
Ofcourse,theproblemoffollowing,understandingandpresentingmedicalworkisnot
primarilyoneforsocialscientists.Itisalsosomethingthathastobeaddressedinmedical
trainingandhasconsequencesforhoweducationinvariousprofessionsisorganized.Inorder
tolearnhowtoperformasurgeryorfindarootcanal,itisnotenoughtojustreadtextbooks
orlistentolectures.Atthesametime,novicescannotjuststartpractisingclinicalprocedures
withoutriskingthehealthandsafetyofthepatient.Thereisaneedforeducational
arrangementsthatsecureboththedevelopmentofprofessionalskillsandthesafetyof
currentandfuturepatients.Onecandidateisclinicaldemonstrationswhichallowstudentsto
seeanatomicalstructures,pathologicalfeaturesandcontingentenactmentsofformal
procedures.However,asdemonstratedinthisissueandelsewhere(Hindmarsh,2010;
Hindmarshetal.,2011;Lindwalletal.,2014;Mondada,2003,2011),itisonethingtoseea
medicalpractitionermovehisorherbodyincertainwaysandanotherthingtoseethese
movementsasmeaningfulclinicalactions.Novicesalsoneedtopracticetheirskillsunder
controlledformseitheronlivingpatientsorinsimulatedscenarios(Koschmannetal.,2011;
RystedtandSjblom,2012).Giventhatthismeansthattheyengageinclinicalactivitiesbefore
theyarefullyabletoseeandunderstandtheminprofessionalways,theiractionsare
regularlymonitored,assessedandguidedbyexperiencedpractitioners.
Thestudiesshowhowstudentmistakesoccasioninstructionalcorrections,howinstructional
demonstrationsarefollowedbyenactmentsofthedemonstratedactionsandhowstudent
questionsarerespondedtowithinstructionalaccounts.Inthetitlesofthestudies,thereare
phrasessuchasinstructionalcorrections,instructedperception,instructed
129
experienceandinstructableobservability.Notallreferencestoinstructionhavetodowith
theinteractionbetweenstudentsandteachers.InNishizakasstudy,thehealthcareproviders
canbesaidtohaveinstructedthepregnantwomaninhowtodifferentiatetheimageofthe
targetbodypartasafigurefromthebackground.Thereisalsoasenseinwhichinstructions,
asamoregeneraltermfordirectivesorrequests,havetodowithdivisionsoflabourrather
thandifferencesinknowledgeasinthefluentcooperationbetweenasurgeonandan
assistant.TheresponsetothesurgeonsinstructionsinMondadascontributionrelyonthe
professionalvisionandcompetentskillsoftheteammembers,constantlyscrutinizingthe
dynamicallychanginganatomytoidentifytherelevantdetailshereandnow,definingthe
intelligibilityofthedirectives.Thispointsbacktotheissueoftheuniquelyidentifying
featuresoftheworkstudiedhowthestudyofsuchfeaturesrequirestheexplicationofthat
onwhichtheworkplaceinteractionrelies.Concludingthisspecialissue,Macbethdiscusses
Garfinkelstreatmentofinstructedactionassomethingpriortosequenceorganizationand
turndesign(Garfinkel,1996;2002).Besidesprovidingacollectionofstudiesofbodyworkin
clinicalpractice,thisspecialissuethusofferscentralinsightsintothetopicofinstruction.
Acknowledgements
EarlyversionsofthestudieswerepresentedanddiscussedataworkshoponVideobased
studiesofinstructionandworkinmedicine,whichwasfinancedbytheLETStudioatthe
UniversityofGothenburg.SpecialthanksgotoLorenzaMondadaforallhervaluableinput.
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