“The Fieldworker and the Surgeon”

“The Fieldworker and the Surgeon” From Forgive and Remember and “The Fieldworker as Watcher and Witness” By Charles Bosk

Bosk and His First Book

Background • 18 months of participant observation in two surgical services of a large teaching hospital on the West Coast (his dissertation research for the Ph.D.) • Themes in larger study • Social Control and morality (Durkheim) • Social Support • Dealing with Failure

Hierarchy of a Surgical Service • At the top, the attending surgeon • Everyone else in various stages of training and collectively called the “housestaff” • Residents, by year (history of term, length—up to five years or more) • Medical students, by year • Nurses

Getting in—Attending surgeon deferred to chief resident Cover story: “A dissertation on how surgeons learn to recognize and control error” Sponsorship and performance in roles far more important than cover story Getting In

The Observer’s Role(s) • 1. Extra pair of hands/ “gofer” • 2. Emissary from outside world (bringing newspapers, for example) • 3. Fellow-sufferer… at apprentice stage of Ph.D. program

The Observer’s Role 2 • 4. Sounding board (outlet for dissent) • 5. Referee: tactics to avoid decision—”never totally comfortable with this role” • 6. Historian (housestaff and its rotations)

Moral dilemmas Errors of omission and the historian’s questions… not usually his intention to alter the flow of events Errors of commission: what if the fieldworker knows a patient has been harmed through physician or nursing error?

“Being a patient advocate would have made the kind of field work I wanted to do impossible.” “I was aware that my conduct could either make the way more or less difficult for those who followed me.” (other medical sociologists in other medical settings) Why not intervene?

Relations with authority • Attending surgeons assimilated him to the group by treating him like part of the housestaff • “Success” in that role signaled by two attendings who offered to write him recommendations to medical school

Gift relationship • Charles Lidz: “The right and privilege of being an observer is a gift presented to the researcher by his host and subjects.” • 3 dangers in this gift relationship • 1. Danger of over-rapport • 2. Danger of over-indebtedness • To some extent protected from 1) and 2) by rotation (no one stayed over 3 months)

Danger 3: Over-generalization • Risk of giving too much weight to a particularly vivid experience • . Always made sure to have at least 2 independent examples before generalizing • For example, decision not to include episode involving several unexpected complications and deaths, leading to temporary loss of morale

Why fieldwork 1? • “Fieldwork supplies precisely what other methods of research drop out—the experiencing individual as a member of a community and the set of shared meanings that sustains the individual’s action in an uncertain world.”

Why fieldwork 2? • “Fieldwork, then, provides a mirror for looking at who we are as against who we would like to be. It provides us with the soft data—observations, intuitions, comments—for rethinking some very hard questions about what it means to be a member of the society.”

“The Fieldworker and the Surgeon”