Sociology news is published by the Medical Sociology Group‚ a study group cf the Eritish Sociological Association Subscription rates for 1987-88



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Homans

(Desk)‚


Jill Russell

(Treasurer)‚

Jon

Gabe


and

Barbara


Lawrence

(Conference

Programme).

The


new

booking forms

were

commended.



wider publicity should

be

given to



the offer of

a limited



number of

free


Conference

places


to

students.

There

was

a

very



high

participation

rate with approximately

25% of


the

Conference

attenders

giving


papers.

Fina11y‚ the Group

would

be

sponsoring a



number

of

one—day

specialist

conferences

in

the


regions.

Treasurer's Regort

-

( J i l l R u s s e l l )



There was

little to report because the

financial

position


would not

be

clear until after



the

Conference.

The

accounts


woüld

be

prepared



in December

and

published in

Medical Sociology News in March.

E800 was made

available for

subsidies

and approximately

twenty


persons

applied.


Additional money had been used to

extend


the

oponing hours

of

the


croche.

Sociology

oi

Health and Illness



-

(Anne Murcott)

The main

item


of

the


report

was

Anne's


announcement

of

her 'ear1y retirement' from the post of



editor

because


of

a visit


to

Australia

in

the


new

year.


Mildred

Blaxter


had been appointed

to the


post

by

the



editorial

board.


Anne

gave

thanks


Co

the


board for their

work

over


the

past


four years.

Fifty


eight

new

papers had

been

submitted



to

the journal since her

last

report‚ of which



27 were

from


the U.K.‚

3

from mainland



Europe,

21

from



Canada

(most)/U.S.A.

and

7

from elsewhere.



Of

these 58,

17

are currently out



for

review:

29

have been rejected;



4 have been accepted

( a f t e r



one

revision):

1 has been

published;

6

returned with an



invitation

to

revise and



resubmit and

1

withdrawn.



Subscription rates

are


to be

increased to:



€36.80

-

institutional



rate

223.75


individual

rate

€20.75


concessionary

rate

Anne


expressed

the hope that

the

number of



subscribers

would increase.

The pub1ishers‚ B1ackwe11s‚ had made

a

number

of

improvements‚ including



Copyright information

for


each paper

and


a

new

type-face was being considered.

The

editor


was questioned

about


the lenqth of

'turn—around time' of

submissions

and it

was agreed

that

the


new

editor


should

give


details

of

this at



the

next


A.G.M.

Fina11y,.there was



some

discussion

of

the


mechanics

of appointing the new

editor

and


the

accountability of

the

board.


The

relationship between

the board

and

the Medical Sociology

Group

was

clarified.

Mildred

Blaxter


qave

an

assurance that



the journal

would


not

be

supported‚ in



any

way‚


by

funds


from

the Health

Promotion Trust.

Medical Sociologx



News

-

(Steve



P l a t t )

There


had

been


an

improved rate

of

subscription this



y e a r

rising to

280.

Approximately 100 subscribers turned



around

each year.

There had been three issues

-

December‚



April

and


August.

The commercial printers



had

made

an

improvement.



The change

of

editorship was



announced and the meetinq expressed its

thanks for

Steve's efficiency and organisation.

There


followed

a

presentation to



Steve

to

mark the gratitude



of

the


Committee.

10.

11.


Information

from


Regional

Groups


It

was

reported that

each group

received


an

annual


subvention of

E50

from


Central funds

(a)


North west

A

parody



of

a

report was presented



indicating that some meetings had

been


held which

were


both interesting and

well-attended.

Meetings were also

scheduled

for

the


Autumn

term.


( b )

London


There had been seminars on

a range


of

topics during the year.

A

planning


meeting for the coming

year


(1988)

would


take place on 7th October at

6

p.m. in



the third floor seminar

room


in

the


Department

of

Community



Medicine‚ 66—72

Gower

street.


(cl

Bristol


:

A

new



group had been established which

had met once so far.

( d )

Scotland


:

The


group

had


held

a

number of one-day



meetings

and

a

weekend



conference.

In

the new



year

it

was

proposed to have

meetings on medical ethnography and

social

factors


and

health.


Proposed Amalgamation wich

the


Social

Researchers in

Health

Groug.


It

was

agreed that all members

of

this


group

should


be

written


to

inviting them

to subscribe to

Medical


Sociology

News

and there

should

be

a



joint

conference

between

the


two

groups


and

a report back

to the

next


A.G.M.

Proposed Change

of

Name

of

Medical Sociology Group.



The options detailed in the last issue of Medical

Sociology News had elicited a nil

response.

After some

discussion

and


clarification

it

was

decided to

invite


subscribers

to write to the Committee if

they felt that

a

name chanqe was



in

order.


Smoking

in

Public



Places

A

letter referring to this



matter

had appeared in the

December

1986 issue

of

Medical Sociology News.



The

Committee

said

it

would



not be

prepared to

'po1ice' a

total ban

on

smoking.


A5

the


protaqonist was not

present no decision was taken.



12.

13.


14.

Status


of

Papers


given

at Conference

It

was

agreed that

all participants giving

papers


should

be

invited



to

give some

indication

of

the



status of

their


papers.

A simple distinction

between

'work


in proqress'

and 'comp1eted research' would

be

suggested.



Elections

(a)


Committee

(four


v a c a n c i e s )

These


were filled without

a

vote



by

Jon


Gabe, David

Silverman‚

Sue

Scott


and Gareth

williams.

( b )

Convenor


-

Elect.


Two nominations

had


been

received


for

this


post

both


for Steve Platt and

he

was



elected

unopposed.

Hilary Homan's

departure to

Zimbabwe

would


mean that

Steve


would

take up the position earlier than

expected.

( c )


Editorial

Board


of

‘sociology

of

Health


and

Il1ness'


The vacancies

were


filled

by

Sara



Arber (Treasurer)‚

Mick


Bloor

and

Janet


Askham.

Ang Other Business

It

was reported Chat the regulations qoverning the



funding of D.H.S.S. units were being

changed to permit

possible censorship

of

research



publications and

granting the D.H.S.S. 'ownership'

of

all


data

collected.

workers in

the field

were

invited to



send

information

to the Committee.

10


Participatory

Democracy

and Medical Sociology

Neil


McKeganey

At

this year's Annual General Meeting



of

the


BSA

Medical


Sociology

group an issue was raised for discussion which

hiqhlighted certain tensions in

the


role

of

the



AGM

in

relation



to both the Medical Sociology Group Committee and the Editorial

Board


of

Sociology

of

Health and



Illness.

Brief1y‚ the issue

surrounded

the changeover in editorship of the journal.

while

the fact of



this changeover

was

announced

by

the


outgoing

editor‚ it

appeared

that


there

was

1itt1e‚ if

any‚ scope for

discussing some

of

the implications



of

this changeover‚

Although the meeting did indeed go on to discuss the

changeover‚ there was at

least one body

of

opinion to



the

effect that the change in editorship was an internal

matter,-

that the editorial

board

had discussed and agreed



o n ‚

and


not

something which could

be

discussed at



the

AGM.


while

such


a

view


may be

in

accord with



the constitutional

position as

currently drawn‚

it

would



seem to stand in

Opposition to

the principle

of

free and open discussion.



Clearly,

it

would



be

quite


inappropriate to

suggest that the

running

of

the journal should



be

the responsibility

of

the


Medical Sociology Group Committee or indeed the

AGM


:

the


running

of

the journal



i s ‚

quite right1y‚ the responsibility

of

the elected and appointed representatives



of

the Editorial

Board.

However‚


I

can see no reason why the operation

of

the


journal

ouqht not to

be

seen


as

something for discussion in

much the same way as the

AGM


discusses

other


aspects of

medical sociology.

There

i s ‚ I think‚



a general point here to

do

with



the role

of

the



AGM.

Speaking


persona11y‚

I

would argue



that‚ if

no where


else,

the


AGM

should


be

the forum

for open discussion.

At

present



I

fear we are in danger

of

creating


an

atmosphere where

to

ask


for points

of

Clarification or



to express

a

dissenting



opinion

is

seen



as tantamount to rocking the boat

of

established opinion and practice



-

that would

be

regrettable.



Sociology in

general and medical sociology

in

particular



is

strengthened

not

weakened


by

the expresion

of

diverse opinions.



11

Medical

Diagnostic Reasoning

as

Cognitive



Sociocu1tura1‚

and linguistic Constructions

Introduction

In

everyday social 1nteractlon‚ the



use of

language


by

speakers contributes to the



way

a situation

is

contextualized



or 'framed."

Hhen

social


interaction is

mot1vated‚

constra1ned‚

or

guided by



institutional

or

bureaucratic



cond1t1ons‚

the


framing of

activities can

be

oriented


to group

derived


prescriptive

norms

that pressure



and/or

channel


people

into


certain physlcal spaces at

particular times in order

to

engage


in speclfiable

speech events



and/or

motor behaviour

accordtng

to

designated



titles

or

positlons and presumed



competencies.

Types


of

context interactz

an

institutional



context‚

for


examp1e‚ auch

as

a governmental



bureaucracy

or

a scientlfic laboratory can



provide

a frame for the



way

a

variety



of activitles

are


progressively

defined


and

redefined.

An

institutional



or

organizational

context allows emergent

processes

of

communication to



occur

that create a

more narrow

sense

ot

context that



is

locally


managed

and


negotiated

over


the

course of

an exchange.

Two

kinds


of

information



become

necessary for

understanding

the


interpretation of

comunicative

contexts

in

medical



settings.

on

the



one hand‚

we

usually take for granted



normative

institutional conditions

of

health care



and

i11ness‚


but

we also


need

information

about

the


general ethnogtaphic

or

organizational



conditions

within which

different types

of

social interaction



emerge

that


are

a

d1rect‚ 1nd1rect‚



or

peripheral



consequence

of

the



work

environment



and

its


patterns

of

social



stratificatlon.

In

the



more

narrou


sense

of

context‚ information 1s



needed

about


the klnds

of

interpersonal



and status relationships

and linguistic and paralinguistic

circumstances

that

are percelved to



be typical of

all speech

events

and/or


specific

to

medical settings.



12

In

the


pages

that


fo11ow‚

I

review some empirical

materials

to illustrate



t h e

way

cogn1t1ve‚ eociocultural



and

linguistic

structure

and

process influence patient-physician



and

physician-physician

communication

and


diagnostic judgments.

The illustrative materials employed will call attention to

the dlstrlbution

of knowledge of

the

participants based



on

thelr tra1n1nq‚



c11n1ca1 experience‚

institutional

authority

or

domlnance within

a c11n1c‚

hospital servlce‚

1aboratory‚

and


professional

background.

A general

issue


15

the extent

to which these conditions

dan be perceived

as ptohibiting

or

enhanclng



comunication.

Additional

relevant factots are

the pat1ent'a and

phys1c1an's

folk theories

of t h e

wor1d‚


of

medical sett1ngs‚



and

their


experiences

wlth


lllness

and

health


care

delivery systems.



The

first


case

presented



below

illustrates the

contrast

that can


exist

between


the

patient


and

physician vis-a-via

their

understanding of



an

illness


and

diaqnostic

reasoning

and


medical

procedures.

The

second case underscores

the


discrepancies

that


can

be

clalmed about the



knowledge

distribution

of

medical expert and novice



when

examining

a

patlent.


The

two cases also illustrate the use

of ethnographic

or

organizational



knowledge

by

the researcher



in

order to


clarify

routine interaction in

a

medical


setting.

Institutional

Contexts

Obtaining access

to

medicnl setting:



can

be

difficult



and

sometimes

imposs1b1e‚ depending

on the


specialty

area‚ clinic

and ward.

In

addition



to

seeking permission

to

tape


record

those

observed‚ a

variety of

bureaucratic



and

Lnterpersonal

obstacles

invariably



emerge

before


and during

the research

experlence.

The

research illustrated



below

was

facllitated

by

many

years


of teaching in

a

university medical



school

and

havtng


direct contact with a

range of


medical school co11eagues‚

13


students‚

Houae

Staff


(interne,

res1dents‚



and training

fe11owa)‚ camm1ttees‚

c11n1cs‚

and

hospital


wards and

laboratories.

I

have been



both

participant and observer

as Hell

as a


research analyst

ellciting

information from

those

observed

directly


and

Erom


participants who

provided


explanations of

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