This research investigates how neuro-rehabilitation staff attend to the issue of patient deservingnesss" in admissions conference talk. Examined are the instances in which staff move from a reporting mode dealing with clinical information to a storytelling mode that conveys personal and moral information for example, that the patient is an "innocent party" in an accident, that the patient has family commitments, or that relatives have struggled bravely in the face of adverse circumstances and deserve help. The distinctive story like segments involved, which are analyzed as "natural rhetorics," appear to be deployed to strengthen the argument for admission by providing a moral under pinning for decisions ostensibly taken on medical grounds. The authors argue that the wider context of resource constraint and rationing, the uncertainty of rehabilitation outcomes, and the dynamics of interdisciplinary teamwork all help to explain the presence of natural rhetorics in admissions discussions.
Get full access to this article
View all access options for this article.
References
1.
Aaron, H. J. , & Schwartz, W. B. (1984). The painful prescription: Rationing health care. Washington, DC: Brookings.
2.
Baruch, G. (1981). Moral tales: Parents' stories of encounters with the health professions. Sociology of Health and Illness, 3, 275-295.
3.
Bershady, H. J. (1973). Ideology and social knowledge. Oxford: Basil Blackwell.
4.
Black, M. (1961). Some questions about Parsons' theories. In M. Black (Ed.), The social theories of Talcott Parsons (pp. 268-288). Englewood Cliffs, NJ: Prentice-Hall.
5.
Bloor, M. , & Horobin, G. W. (1975). Conflict and conflict resolution in doctor/patient interactions. In C. Cox & A. Mead (Eds.), A sociology of medical practice (pp. 271-284). London: Collier-Macmillan.
6.
Bosk, C. (1979). Forgive and remember: Managing medical failure. Chicago: University of Chicago Press.
7.
Calabresi, G. , & Bobbit, P. (1978). Tragic choices. New YorkW. W. Norton.
8.
Crane, D. (1975). The sanctity of social life. New York: Russell Sage.
9.
Davidson, R. C. , & Scribner, B. H. (1967). Patient selection for maintenance dialysis. In R. C. Davidson & B. H. Scribner (Eds.), A physician's syllabus for the treatment of chronic uremia (pp. 2-10). Seattle: University of Washington, Seattle Artificial Kidney Centre.
10.
Davis, K. (1988). Power under the microscope. Dordrecht: Foris.
11.
Dingwall, R. (1977). "Atrocity stories" and professional relationships. Sociology of Work and Occupations, 4, 371-396.
12.
Dingwall, R. , Eekelaar, J., & Murray, T. (1983). The protection of children. Oxford: Blackwell.
13.
Dingwall, R. , & Murray, T. (1983). Categorization in accident departments: "Good" patients, "bad" patients and children. Sociology of Health and Illness, 5, 127-148.
14.
Finlay, W. , Mutran, E. J., Zeitle R. R., & Randall, C. S. (1990). Queues and care: How medical residents organize their work in a busy clinic. Journal of Health and Social Behavior, 31, 292-305.
15.
Fox, R. C. , & Swazey, J. (1978). The courage to fail: A social view of organ transplants and dialysis (2nd ed.). Chicago: University of Chicago Press.
16.
Freidson, E. (1970). Profession of medicine. Chicago: University of Chicago Press.
17.
Glaser, B. , & Strauss, A. (1965). Awareness of dying. Chicago: Aldine.
18.
Goffman, E. (1974). Frame analysis. Boston: Northeastern University Press.
19.
Griffiths, L. , & Hughes, D. (1993). Typification in a neuro-rehabilitation centre: Scheff revisited?Sociological Review, 41, 415-445.
20.
Gritzer, G. , & Arluke, A. (1985). The making of rehabilitation: A political economy of medical specialization, 1890-1980. Berkeley. University of California Press.
21.
Gubrium, J. , & Buckholdt, D. (1982). Describing care: Image and practice in rehabilitation. Cambridge, MA: Oelgeschlager, Gunn and Hain.
22.
Gubrium, J. , & Lynott, R. J. (1985). Family rhetoric as social order. Journal of Family Issues, 6, 129-152.
23.
Haas, J. , & Shaffir, W., (1984). The "fate of idealism" revisited. Urban Life, 13, 63-81.
24.
Hafferty, F. W. (1988). Cadaver stories and the emotional socialization of medical students. Journal of Health and Social Behavior, 29, 344-356.
25.
Hahn, R. A. (1985). A world of internal medicine: Portrait of an internist. In R. A. Hahn & A. D. Gaines (Eds.), Physicians of Western medicine: Anthropological approaches to theory and practice (pp. 51-111). Boston: D. Reidel
26.
Haviland, J. W. (1965). Experiences in establishing a community artificial kidney center. Transactions of the American Clinical and Climatological Association, 77, 125-136.
27.
Hughes, D. (1977). Everyday and medical knowledge in categorising patients. In R. Dingwall, C. Heath, M. Reid, & M. Stacey (Eds.), Health care and health knowledge (pp. 128-140). London: Croom Helm.
28.
Hughes, D. (1980). Lay assessment of clinical seriousness: Practical decision making by non-medical staff in a hospital casualty department. Unpublished doctoral dissertation, University of Wales, University College, Swansea.
29.
Jeffery, R. (1979). Normal rubbish: deviant patients in casualty departments. Sociology of Health and Illness, 1, 90-107.
30.
Katz, P. (1985). How surgeons make decisions. In R. A. Hahn & A. D. Gaines (Eds.), Physicians of Western medicine: Anthropological approaches to theory and practice (pp. 155-175). Boston: D. Reidel.
31.
Kelly, M. , & May, D. (1982). Good and bad patients: a review of the literature and a theoretical critique. Journal of Advanced Nursing, 7, 147-156.
32.
Kilner, J. F. (1990). Who lives? Who dies?New Haven: Yale University Press.
33.
Klein, R. (1989). The politics of the National Health Service (2nd ed.). London: Longman.
34.
Labov, W. , & Waletzky, J. (1967). Narrative analyses: Oral versions of personal experience. In J. Helm (Ed.), Essays on the verbal and visual arts: Proceedings of the 1966 annual spring meeting of the American Ethnological Society (pp. 12-44). Seattle: University of Washington Press.
35.
May, D. , & Kelly, M. (1982). Chancers, pests and poor wee souls: Problems of legitimation in psychiatric nursing. Sociology of Health and Illness, 4, 279-301.
36.
McHugh, P. (1970) A common-sense perception of deviance. In H. P. Dreitzel (Ed.), Recent sociology: No. 2. Patterns of communicative behaviour (pp. 151-180). London: Macmillan.
37.
Miller, G. (1987). Producing family problems: Organisation and uses of the family perspective and rhetoric in family therapy. Symbolic Interaction, 10, 245-265.
38.
Mishler, E. (1984). The discourse of medicine: Dialectics of medical interviews. Norwood, NJ: Ablex.
39.
Myers, L. C. (1982). The socialization of neophyte nurses. Ann Arbor, MI: UMI Research.
40.
Ochs, E. , & Taylor, C. (1992). Family narrative as political activity. Discourse and Society, 3, 301-340.
41.
Parsons, T. (1951). The social system. London: Routledge and Kegan Paul.
42.
Polanyi L. (1989). Telling the American story: A structural and cultural analysis of conversational story-telling. Cambridge, MA: MIT Press.
43.
Rehbein, J. (1980). Sequentielles Erzahlen-Erzahlstrukturen von Immigranten bei Soziolberatangen in England. In K. Ehlich (Ed.), Erzahlen im Alltag. Frankfurt: Sukrkamp.
44.
Ricoeur, P. (1988). Time and narrative. Chicago: University of Chicago Press.
45.
Roth, J. (1972). Some contingencies in the moral evaluation and control of clientele: The case of the hospital emergency service. American Journal of Sociology, 77, 839-856.
46.
Sacks, H. (1978). Some technical considerations of a dirty joke. In J. Schenkhein (Ed.), Studies in the organisation of conversational interaction (pp. 249-270). New York: Academic Press.
47.
Schutz, A. (1971). Concept and theory formation in the social sciences. In M. Natanson (Ed.), Collected papers: Vol 1. The problem of social reality (pp. 48-66). The Hague: Martinus Nijhoff.
48.
Silverman, D. (1987). Communication and medical practice: Social relations in the clinic. London: Sage.
49.
Sprott, W.J.H. (1952). Principia sociologica. British Journal of Sociology, 3, 203-221.
50.
Stimson, G. , & Webb, B. (1975). Going to see the doctor: The consultation process in general practice. London: Routledge and Kegan Paul.
51.
Strong, P. M. (1979). The ceremonial order of the clinic. London: Routledge.
52.
Sudnow, D. (1967). Passing on. Englewood Cliffs, NJ: Prentice-Hall.
53.
Tannen, D. , & Wallat, C. (1987). Interactive frames and knowledge schemas in interaction: Some examples from a medical examination/interview. Social Psychology Quarterly, 50, 205-216.
54.
Turner, B. S. (1986). The vocabulary of complaints: Nursing, professionalism and job context. Australian and New Zealand Journal of Sociology, 22, 368-386.
55.
Wesson, A. (1965). The apparatus of rehabilitation: An organizational analysis. In M. Sussman (Ed.), Sociology and rehabilitation (pp. 148-178). Washington, DC: American Sociological Association.
56.
Zussman, R. (1992). Intensive care: Medical ethics and the medical profession. Chicago: University of Chicago Press.
