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The body in medical work and medical training: An introduction

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Discourse Studies (ISSN: 1461-4456)

Citation for the published paper:

Lindwall, O. (2014) "The body in medical work and medical training: An introduction".
Discourse Studies, vol. 16(2), pp. 125-129.

http://dx.doi.org/10.1177/1461445613514671
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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

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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

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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

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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.
References
BjelicDIandLynchM(1992)Theworkofa(scientific)demonstration:RespecifyingNewtons
andGoethestheoriesofprismaticcolor.In:WatsonGandSeilerRM(eds)Textin
Context:ContributionstoEthnomethodology.London:SAGE,pp.5278.
FrankelRM(1983)Thelayingonofhands:Aspectsoftheorganizationofgaze,touch,andtalk
inamedicalencounter.In:FisherSandDundasToddA(eds)TheSocialOrganization
ofDoctorPatientCommunication.Washington,DC:CenterforAppliedLinguistics,pp.
1954.
GarfinkelH(1986)EthomethodologicalStudiesofWork.London:Routledge&KeganPaul.
GarfinkelH(2002)EthnomethodologysProgram:WorkingOutDurkheimsAphorism.
Lanham,MD:Rowman&Littlefield.
GoodwinC(2003)Thebodyinaction.In:CouplandJandGwynR(eds)Discourse,theBody
andIdentity.NewYork:Macmillan,pp.1942.GoodwinCandGoodwinMH(1987)
Concurrentoperationsontalk:Notesontheinteractiveorganizationofassessments.
PapersonPragmatics1:155.
HeathC(1984)Participationinthemedicalconsultation:Thecoordinationofverbaland
nonverbalbehaviourbetweenthedoctorandpatient.SociologyofHealthandIllness6:
311338.
HeathC(2006)Bodywork:Thecollaborativeproductionofclinicalobjects.In:HeritageJand
MaynardDW(eds)CommunicationinMedicalCare:InteractionbetweenPrimaryCare
PhysiciansandPatients.NewYork:CambridgeUniversityPress,pp.185213.
HeritageJandMaynardDW(eds)(2006)CommunicationinMedicalCare:Interactionbetween
PrimaryCarePhysiciansandPatients.NewYork:CambridgeUniversityPress.
HindmarshJ(2010)Peripherality,participationandcommunitiesofpractice:Examiningthe

130

patientindentaltraining.In:LlewellynNandHindmarshJ(eds)Organisation,
InteractionandPractice:StudiesinEthnomethodologyandConversationAnalysis.
Cambridge,UK:CambridgeUniversityPress,pp.218240.
HindmarshJandPilnickA(2002)Thetacitorderofteamwork:Collaborationandembodied
conductinanesthesia.TheSociologicalQuarterly43:139164.
HindmarshJ,ReynoldsPandDunneS(2011)Exhibitingunderstanding:Thebodyin
apprenticeship.JournalofPragmatics43:489503.
HirschauerS(1991)Themanufactureofbodiesinsurgery.SocialStudiesofScience21:279
319.
KoschmannT,LeBaronC,GoodwinC,etal.(2007)Formulatingthetriangleofdoom.Gesture
7:97118.
KoschmannT,LeBaronC,GoodwinC,etal.(2011)Canyouseethecysticarteryyet?Asimple
matteroftrust.JournalofPragmatics43:521541.LatourB(1986)Visualizationand
cognition:Thinkingwitheyesandhands.In:KuklickHand
LongE(eds)KnowledgeandSociety:StudiesintheSociologyofCulturePastandPresent.
Greenwich,CT:JaiPress,pp.140.
Lindwall, O., Johansson, E., Rystedt, H., Ivarsson, J., & Reit, C. (2014). The use of video in dental
education: Clinical reality addressed as practical matters of production, interpretation and
instruction. In M. Broth, E. Laurier & L. Mondada (Eds.), Studies of video practices: Video
at Work (pp. 161-180). New York: Routledge.
MondadaL(2003)Workingwithvideo:Howsurgeonsproducevideorecordsoftheiractions.
VisualStudies18:5873.
MondadaL(2011)Theorganizationofconcurrentcoursesofactioninsurgical
demonstrations.In:GoodwinC,StreeckJandLeBaronC(eds)EmbodiedInteraction:
LanguageandBodyintheMaterialWorld.Cambridge,MA:CambridgeUniversityPress,
pp.207226.
NishizakaA(2011)Theembodiedorganizationofarealtimefetus:Thevisibleandthe
invisibleinprenatalultrasoundexaminations.SocialStudiesofScience41:309336.
PilnickAandHindmarshJ(1999)Whenyouwakeup,itwillallbeover:Communicationin
theanaestheticroom.SymbolicInteraction22:345360.
PilnickA,HindmarshJandGillVT(2009)Beyonddoctorandpatient:Developmentsinthe
studyofhealthcareinteractions.SociologyofHealthandIllness31:790.
PsathasG(1990)Theorganizationoftalk,gaze,andactivityinamedicalinterview.In:
PsathasG(ed.)InteractionalCompetence.Washington,DC:UniversityPressof
America,pp.205230.
RystedtHandSjblomB(2012)Realism,authenticity,andlearninginhealthcaresimulations:
Rulesofrelevanceandirrelevanceasinteractiveachievements.InstructionalScience
40:785798.
RystedtH,IvarssonJ,AsplundS,etal.(2011)Rediscoveringradiology:Newtechnologiesand
remedialactionattheworksite.SocialStudiesofScience41:867891.
SanchezSvenssonM(2007)Monitoringpracticeandalarmtechnologyinanaesthesiology.
HealthInformaticsJournal13:921.
SanchezSvenssonM,LuffPandHeathC(2009)Embeddinginstructioninpractice:
Contingencyandcollaborationduringsurgicaltraining.SociologyofHealthandIllness
31:889906.
SlackR,MarkHartswoodRPandRouncefieldM(2007)Culturesofreading:Onprofessional
visionandthelivedworkofmammography.In:HesterSandFrancisD(eds)Ordersof

131

OrdinaryAction.Aldershot:Ashgate,pp.175193.
StiversT(2007)PrescribingunderPressure:PatientPhysicianConversationsofAntibiotics.
NewYork:OxfordUniversityPress.
StreeckJ,GoodwinCandLeBaronC(2011)EmbodiedInteractionintheMaterialWorld:An
Introduction.Cambridge,MA:CambridgeUniversityPress,pp.126.
tenHaveP(1995)Medicalethnomethodology:Anoverview.HumanStudies18(23):245
261.
ZemelA,KoschmannTandLeBaronC(2011)Pursuingaresponse:Proddingrecognitionand
expertisewithinasurgicalteam.In:GoodwinC,StreeckJandLeBaronC(eds)
EmbodiedInteraction:LanguageandBodyintheMaterialWorld.Cambridge,MA:
CambridgeUniversityPress,pp.227242.

132