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

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withdrawn.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