The gift in A&E: re-framing the medical case presentation through Mauss
Case presentations have totemic significance in medical sociology, in which they are analysed as emblematic of medical professional culture. This article makes a case for conceptualising these exchanges in terms of Mauss’ account of gift-giving, which theorises sociality in terms of obligations voluntarily incurred and reciprocated and the performative recognition of hierarchy. This contrasts with two alternatives in existing literature: the case presentation as an instance of pedagogically oriented supervision and legitimate peripheral participation; and as representative of professional discourse more generally. We make our case for re-framing the case presentation in relation to video and audio data generated within a study of an Accident and Emergency department in the UK. We conclude that Mauss’ concept of community allows us to see discursive phenomena that have been overlooked, and to theorise the work of junior doctors in terms of collegiality in a hierarchically organised profession, by contrast to a defective version of the work of their superiors or the manifestation of singular professional discourse.
KeywordsHospital ethnography Case presentation Discourse analysis Ritual Socialisation Institutional order Emergency department
- Atkinson, P. 1994. Rhetoric as skill in a medical setting. In Qualitative studies in health and medicine, ed. M. Bloor and P. Taraborrelli, 110–130. Avebury: Aldershot.Google Scholar
- Atkinson, P. 1995. Medical talk and medical work: The liturgy of the clinic. London: Sage.Google Scholar
- Douglas, M. 2002. Introduction. In The gift: The form and reason for exchange in archaic societies, ed. M. Mauss, 1–9. London: Routledge.Google Scholar
- Erickson, F. 1999. Appropriation of voice and presentation of self as a fellow physician: aspects of a discourse of apprenticeship in medicine. In Talk, work and institutional order: Discourse in medical, mediation and management settings, ed. S. Saranji and C. Roberts, 109–143. Berlin: Mouton de Gruyter.CrossRefGoogle Scholar
- Hunter, K.M. 1991. Doctor’s stories: The narrative structure of medical knowledge. New Jersey: Princeton University Press.Google Scholar
- Karsenti, B. 1994. Marcel Mauss: le fait social total. Paris: Presses Universitaires de France.Google Scholar
- Mauss M. 1924. Essai sur le don: forme et raison de l’échange dans les sociétés archaïques, http://classiques.uqac.ca/classiques/mauss_marcel/socio_et_anthropo/2_essai_sur_le_don/essai_sur_le_don.pdf.
- Pomerantz, A. 2003. Modeling as a teaching strategy in clinical training: when does it work? In Studies in language and social interaction: In honor of Robert Hopper, ed. P. Glenn, C. LeBaron, and J. Mandelbaum, 381–391. Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
- Pomerantz, A., J. Ende, and F. Erickson. 1995. Precepting conversations in a general medicine clinic. In Talk of the clinic: Explorations in the analysis of medical and therapeutic discourse, ed. G.H. Morris and R.J. Chenail, 151–169. Mahwah, NJ: Lawrence Erlbaum.Google Scholar
- Stevenson, F., W. Gibson, C. Pelletier, V. Chrysikou, and S. Park. 2015. Reconsidering ‘ethics’ and ‘quality’ in healthcare research: the case for an iterative ethical paradigm. BMC Health Services Research 16 (21): 21.Google Scholar
- Strong, P.M. 1979/2001. The ceremonial order of the clinic: Parents, doctors and medical bureaucracies. Aldershot: Ashgate.Google Scholar