Transcript “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
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

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?
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)
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.”