The Fieldworker and the Surgeon

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The Fieldworker and the Surgeon

• From Forgive and Remember and The Fieldworker as
  Watcher and Witness
• By
• Charles Bosk

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Bosk and His First Book
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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

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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, lengthup to
  five years or more)
• Medical students, by year
• Nurses

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Getting In

• Getting inAttending 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

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The Observers 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

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The Observers Role 2

• 4. Sounding board (outlet for dissent)
• 5. Referee tactics to avoid decisionnever
  totally comfortable with this role
• 6. Historian (housestaff and its rotations)

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Moral dilemmas

• Errors of omission and the historians 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?

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Why not intervene?

• 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)

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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

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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)

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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

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Why fieldwork 1?

• Fieldwork supplies precisely what other methods
  of research drop outthe experiencing individual
  as a member of a community and the set of shared
  meanings that sustains the individuals action in
  an uncertain world.

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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 dataobservations,
  intuitions, commentsfor rethinking some very
  hard questions about what it means to be a member
  of the society.