So I'm very, very delighted to welcome Professor Catherine Pope here, who's going to give this talk that's really hotly anticipated.
And we are very excited to learn that she is joining our Department of the Department of
Primary Care Health Sciences as of Monday and to do great things in medical sociology.
So no pressure. Thank you. Okay.
So the disclaimers I have are that I'm from South London, so I talk quite fast and sometimes I get animated and I often walk up and down.
I might even walk that way, which can be a bit intimidating for people.
So the main thing is if you really don't understand something or I'm going so fast,
you can put your hand up and stop me and I'll try to slow down and be a bit less South London and forlorn.
And then the other thing is that I am aware this is being recorded and I can get a bit passionate and sweary sometimes,
but mindful that I'm being recorded and mindful of my new fanbase at the back.
I'm going to try very hard to be, you know, just contain that a bit.
So I might have to have you watch me and signal if I suddenly launch into bad language from Australia.
Oh, why do you say it's all going to be fine then?
Okay, so I often start these talks with just a bit about who I am, mainly because I don't know if she's still there,
but there used to be an opera singer called Catherine Pope and also a famous skateboarder called Catherine Pope.
And I just don't want to disappoint you if you thought you were coming to see either of them.
Okay. So I am the Catherine Pope who was involved in writing various things in the BMJ
about qualitative research some time ago and a few little books about that.
And I'll be drawing on some of the knowledge from some of the work that went into those papers tonight.
And can I just see a show of hands here, the students on the qualitative introduction, just so that I know where you are.
Right. Okay. You very cleverly spread yourself around. Okay.
So one of the things that I said I would like to do in this lecture was to talk about what it's really like,
which is why there was that slightly sexy title of the secret diary,
because you're being taught all of the proper stuff by the proper people about how it's meant to be done and what, you know, what you do.
And I'm going to tell you some of the inside stories of what it's been like for me doing the
kinds of qualitative ethnography and case study work that I've done over the last few years.
And I want to be open and honest about that so that you can kind of see it, warts and all.
And I hope that will be useful to you in terms of thinking about how you might use qualitative research.
And I can see that there are some other very experienced qualitative researchers in the
audience who will also no doubt have their own stories to tell about some of these things.
And you never know. We may disagree about some views, which is always good for an evening lecture.
I think, you know, a bit of controversy anyway.
So I want to start with the famous Erving Goffman, because his work inspired a lot of what I have done in terms of reading Goffman ethnography.
And he talked in this lecture that subsequently got written up about ethnography being a way of doing observation
in settings that you subject yourself your own body and your own personality and your own social situation to the
set of contingencies that play upon a set of individuals so that you can physically and ecologically penetrate
their circle of response to their social situation or their work situation or their ethnic situation or whatever.
So you are close to them while they are responding to what life does to them.
So that's the high point of the this is what you should be doing when you're doing ethnographic observation and qualitative observation of a setting,
and then another guru in the field, Martin Hammersley, who's written quite a lot of work around thinking about ethnography as a method, points out.
But actually a lot of us do not live up to Irving's behest.
We do not actually live with the people we study.
We don't reside in the same place, spending time with them most of the day, most of the week, the month in a month out in state.
Many sociological ethnographers. And I would. Health Services.
Ethnography is also focus on what happens in a particular work locale or social institution when it is in operation.
So that in this sense there participant observation is part time.
And I think that's a really important criticism of what a lot of us do and it's
something that we need to think about if we're going to take our work forward.
So one of my fascinations, partly because I drink too much coffee, is I'm very interested in work at night in health care settings.
And I'm fascinated by the fact that so much research goes on during the day, particularly between nine and five.
And obviously there's lots of things that go on between nine and five in a hospital or in a clinic situation.
But there's a lot of fascinating stuff that also goes on at 2:00 in the morning,
and sometimes we don't bother to go and look at those sorts of things.
So I think these things are a reminder that we might need to think a little bit more about how we engage with these methods.
So what I want to do is share with you some observations about the kinds of things you see when you start to look.
So for those of you that are sitting there and are thinking, I don't even know what ethnography is.
Basically it's hanging around,
observing and talking to people and finding out what's going on and it reveals things that you won't get if you simply send people a survey.
Or actually, even if you just ask them things, you won't get as much as you will if you observe and start looking at the situations.
So I'm one of the project sided with an ambulance handover project, and when we set out,
I think we had a very naive view that there was this thing called handover, which was and I'm illustrating now for my friends at the back,
if you imagine I'm an ambulance and ambulance washes,
that's me being an ambulance to the door of the hospital and it hands over a patient and you
take them out of the back of the ambulance and you hand them over to some doctors and nurses,
and then they go into the hospital. And we thought that this was going to be really interesting and we would study it.
And we found out lots of other things about ambulance handovers.
And I'll tell you some more of those insights that we got from doing observation.
But one of the observations was handover before you've even left the compound and the parking space.
So this is an ambulance crew member who's checking the rucksacks the ambulance crews carry and inside the rucksack.
So lots of little sealed bags with little tags on so that, you know, that they haven't been opened because then you know,
that they've got the right amount of whatever it is that you need in there.
And the person that I'm working with is very experienced, seems to know what should be in each of the bags and what the contents are.
And some of them have been signed by a packer, and he talks to me about this, that he trusts these bags have got the right contents.
And then there's another crew member there who says that the things that are required are there.
And the crew member goes to the cupboard and collect some of the things that are missing to replenish the bag.
And it occurred to me that there were lots of different levels of trust in this
very simple operation of picking the rucksack and deciding whether to take it.
And when we started looking at this bit of the handover chain of events,
what we noticed was there were some crews who trusted that the rucksack would be okay if so-and-so said it's,
yeah, I didn't use anything, don't worry, that's fine.
Others would meticulously go through it and check everything because they didn't trust the person that handed the rucksack over to them.
So handover happened before we even got to a patient.
There was this handover of the vehicle and the rucksack and all of the equipment.
So that was an interesting thing that I hadn't even thought about when we started the project.
And the other thing that the handover project showed us was the level of complexity in ambulance handovers, as I just described to you.
We thought handover was this thing that happened over here at the door of the hospital.
The crew say, here's your patient. Please take them away and save their lives.
And actually, what happens is a whole series of complex bits of handover.
And many of those are predicated on bits of technology that do or do not work, which is a thing I've thrown in just for tresch.
So one fascinating thing was there are various digital communication systems on the ambulance.
And when they don't work, everybody reaches in their pocket and pulls out their mobile phone,
which they're not meant to have their personal mobile phone with them at work.
But they do because they know they need to use it for when the digital stuff fails and bits of information may be handed over on the mobile phone.
There's also some fascinating equipment that's meant to give hot traces so that you can do fantastic stuff about
finding out whether someone's having a heart attack and relay that information to the hospital ahead of your arrival.
And very often the battery doesn't work. So actually that doesn't actually work.
So that bit of handover doesn't work. But there's really interesting pathways of landline, mobile, telephone, radio and computer data communication.
And many of these things happen way before we get to the door of the hospital.
So hanging around on the ambulances, you see all of that.
If you go and talk to the managers of the ambulance service or the hospital,
they may only talk about the bit at the door of the hospital because for them, that's the important bit.
But these bits may be important if you're thinking about information decay or some of the issues about team working and communication and patient.
You know how people care compassionately for patients and families.
Another useful thing that I've taken to doing in when I'm doing observation and obviously you have to get ethical permission for this,
particularly if it includes pictures of people, is to understand the context in which interventions are taking place.
So a lot of the work that we do in healthcare is about introducing changes, new practices, quality improvement into health care settings.
And one of the things that fascinated me on a project that failed as an intervention was how crowded the intervention
setting was with numerous different things that staff were expected to engage with us processes of change.
So these are just some of the posters that I noticed when I was in a setting where we were trying to do our intervention.
It was very difficult for the staff to see our intervention in amongst all of the other things that were going on.
So there were things there about changing in how how you were going to do the recycling in amongst things that were about patient safety.
And you go around the hospital that this particular study happened in and all the stairwells had multiple posters up about different things,
studies that were going on, research, changes in policies and various things.
And basically everybody was just walking past everything because there's too much noise and too much trying to grab their attention.
And this was the study that failed,
which was an attempt to use patients health checklists to drive up the quality of communication in the emergency department.
So the idea was Atul Gawande says checklists are a great idea because they help people systematically make sure they do all the right things.
If any of you seen that fantastic film about the the pilot that lands the plane on the Hudson?
He does the engine checklist despite the fact that he knows the engines are failed.
Both engines have failed, but he does the checklist.
And later, apparently, he said that it was because it was part of his process of landing the plane.
And it's just like you do it as a routine and it's so inculcated that you do it.
Even when everything is telling you that the engines aren't working, you still go through the checklist which says all your engines working.
It's like, No, I know that one already, but he did the checklist.
So we had this idea to have this fantastic checklist. And as part of the study, rather than just introduce the checklist idea and then make.
We interview the staff and patients about how it was going.
As a study, I hung around to see what they did.
And one of the things that they did was they piled up stuff on top of the little box with the little checklist thing,
which kind of deters you from handing out to the patient.
And that was what I thought was the low point of that study and is a really good example of why it might have failed.
Because if you keep covering up with blood pressure cuffs, you're never going to hand any out.
But the CQ save is it was even more amazing because everything got tidied away so that
no one could find the box with the stuff in because it was so tidy we couldn't find it.
And I spent a lot of time like a headless chicken running around the emergency department trying to find the box with the checklist in.
The other thing is that I think that is one of the pen boxes there.
If you ever do a study in the emergency department and I'm going to take a guess,
it may apply in other clinical areas if you need people to do things that involve pens.
I suggest you buy ten times as many pens as you think you will need because everybody that comes along doesn't take the checklist,
but they will take the free pen and you're just constantly watching people going on pens.
So one of my plans is to just simply, you know, when I'm rich and famous is I'm just going to keep supplying pens for the NHS because
clearly you can never have enough pens in the paperless world of the NHS anyway.
So that's one of the stories about hidden interventions.
Another study we did was about safety rules in operating theatres where people are meant to have a systemised checklist again for running surgery.
And one of the things that you do when you're operating is that you should make
sure that everybody is aware of who the patient is and what the procedure is,
and some crucial bits of information and some of that is ideally meant to be presented on a whiteboard in the operating theatre.
Seems like a sensible idea, except that when I was standing in the operating theatre, I'm five foot two,
so I am a bit challenged sometimes when it comes to reaching high things in supermarkets.
I noticed that this particular theatre had a white board that was so high up that even the really tall
surgeon couldn't have possibly reached to fill in the bit that said patient's name and some other details.
So they'd got the white board, but they've made it impossible for people to use,
which then helps you understand why certain bits of the checklist may not be being followed.
But again, if I hadn't seen it, I wouldn't have understood that that was what was happening in that environment.
And then another study we did was of NHS 111999 call centres, which are when your phone for an ambulance or you phone NHS one one for urgent care,
your call goes through to a non clinically trained call handler who has a piece of computer software
that's an algorithm and they work through that software to decide what kind of care you need.
And when I first started studying this software,
I was told that they what they wanted was to kind of make it possible for a very low skilled person to use and to eliminate the need for a clinician.
And over the ten years that I've been studying it,
more and more clinicians have been brought in to help make this software run and make this process run,
which is often a fascinating aspect of how we introduce technologies that are meant to substitute.
And it turns out they don't substitute. And one of the things that I managed to notice while I was watching how this co
handling software was used was the way that the clinical staff kind of hover in
the room and they're just kind of listening out or they're sort of looking to see
if there's a call handler over there who's looking a bit agitated or confused.
Sometimes the call handlers put their hands up and want the clinicians to come over.
And this quote here is for one of the clinicians was actually standing beside the call handler and was listening
in and was offering assistance about the call to get it to a disposition that was speak to the doctor.
So it's almost like she's trying to listen for one side of a telephone conversation and
then to chip in little bits of advice to help kind of finesse the processing of that.
Of that call. So these are the kinds of things that you get when you start looking at
organisational settings and groups of people and the sorts of things that they do.
One of the other things that you get when you hang around is what sociologists and anthropologists call atrocity stories.
And these are stories that you sometimes get when you interview people.
But I find that sometimes there's something about a formal interview when you're sat in an office recording an interview
where people feel that they have to tell you the publicly acceptable versions of of what goes on with their profession.
What you get when people are actually engaged in their practice and you're watching them practising,
is they often talk about the terrible things that happened or things they have heard
about as examples of why they are doing behaving in particular sorts of ways.
So one of the anaesthetists on a study that we did of anaesthetic practice talked
about how they in a particular case and anaesthetist gave the anaesthetic without
warning the patient and the patient panicked and this anaesthetist said I felt uneasy
then because the patient sat bow upright and started grabbing hold of her throat.
And I felt because I hadn't warned the patient, I thought the anaesthesiologist was going to do it.
The patient was scared stiff, stiff. And if that was me, I would have quite a phobia about coming into theatres now.
And that alerted us to a whole set of practices, which was seen as completely inconsequential by anaesthetists,
which are we wrote about subsequently as induction routines,
which are little snippets of talk that anaesthetists do with patients as they were inducing anaesthesia.
And I'm sure that some of you in this room may have had anaesthesia, but basically anaesthetists tell you lies as they're anaesthetising you.
They say things like this will feel cold, this will feel like gin and tonic.
You'll feel a bit like you've had a few drinks and they have all these little turns of phrase that they use.
And what they are designed to do is stop you doing what that patient did there.
Because as I understand it, when anaesthetic agents are introduced,
what you feel often is pain in the sense that something is being introduced into your arm and
it feels a sensation that your natural instinct is to get away from that and ideally sit up,
pull away the lines that are introducing the agent that is causing pain and get away.
And if you think about the fact that many people having surgery will be nervous anyway and perhaps a bit agitated before they arrived,
notwithstanding having pretty mates.
So all of this talk is designed to calm people down and allow them to normalise the process, and it's not taught formally.
You learn it by osmosis.
So the apprenticeship system of training, anaesthetists and surgeons allows them to learn that there are things that they need to say.
And then everybody picks up their own little patter that they use for doing anaesthetic induction.
And again, I don't think any of the anaesthetists would have told us about that behaviour because it wasn't important to them,
but we picked it up because of an atrocity story.
And similarly there was another in the Safety Rules project.
The there's a lot of work around the safety rules and the checklists around
the introduction of particular drugs and agents as part of various processes.
And there are particular things that have huge risks associated with them.
And one of them is the use of of of heparin mentioned here.
And this cardiologist said, I have to make sure this is given it gets written on the board, but it must not be written until it is actually given.
He says he likes to hear a 20 minute warning from another team member and then it needs to be given and to have this confirmed at the time.
And then he goes on to tell me a story of a colleague who experienced a fatality of a patient because the heparin was not administered.
So this is a checklist rule following behaviour where somebody in an operating theatre said we're going to give this now an.
It got written on a board, so everybody started behaving as if the drug had been given and it hadn't actually been given and it caused a fatality.
And those stories are hugely important to clinicians because they are the things that inculcate safety practices.
You know, it's like it gets it, drills it into their bones.
So these atrocity stories often come out when you're hanging around and you've got to know people.
They might just say that by way of explanation for something that they're doing.
And again, they may not tell you that in an interview, although there are some some examples of these kinds of stories occurring in interviews.
But they're often really helpful in alerting you to important things that you might not otherwise notice.
So one of the issues in doing this kind of research, which I think you might have covered, so for those of you that are on the quality,
of course, is this idea that in qualitative research, but particularly observation and ethnography, the researcher is the research instrument.
So in survey research you have your questionnaire and you give your questionnaires, people.
But in this kind of research, it's all about the person doing the research.
And there are a number of articles talking about how this is really great and enables you to get fantastic data,
but it also can be disabling or limiting in terms of what you're able to do.
So I've just pulled out some of the examples of that from my own experience.
So I'm not clinically trained. I have worked in ethnographic teams with people who are clinically trained and I've spent 16 years in
Southhampton and I've got to know particularly some of the Southampton clinical settings quite well.
So negotiating access is something that can be easy or difficult depending on some of those characteristics.
So if I say that I want to go and observe the emergency department in Southampton General Hospital, I can get in there.
If I say I want to do that here in Oxford, that might be a bit more tricky.
If one of you says you want to do it and you don't have that magic professor thing at the front of your name.
Maybe you'll find that more or less difficult.
So negotiating access can be problematic depending on who you are, where you're coming from, who your contacts are.
And if you're an insider in the organisation that may facilitate you getting in.
Or it may be that people don't want to let you in because they think you know all of their dirty secrets.
The problem of establishing rapport in a situation and in a setting is one of those things that is written about endlessly in the textbooks,
as if you can just kind of switch it on and switch it off. And what I found over the years is that it's very dependent on the team that you're
studying and the setting that you're in and the kind of work that they're doing.
But also silly things like how you're feeling. If you're feeling nervous or trepidation about what you're going to observe,
then actually you carry that with you and establishing rapport with the group.
Or if you feel intimidated by the group or members of the group, that can be an issue.
And again, that might vary whether you're an insider or an outsider.
There's some lovely stuff about the tacit and taken for granted knowledge in a particular setting.
If you're a clinician, you're you've already got hardwired information about a setting that you think,
you know, that can be great because it can fast track you to seeing really interesting things,
but it can also blink you to seeing things that you need to see because you make assumptions about the behaviours that you're watching.
And in the anaesthetic study that we did, Dawn Goodwin, who was an anaesthetic nurse by background,
did some of the do the bulk of the ethnographic observation, myself and Maggie Moore,
who were medical and staff sociologists,
did the other observation and sometimes we did the observation together and we did
that partly to answer the question Did it matter who was doing the observation?
And one of the gratifying things was that the only real difference between what I wrote in my notes and what.
Dawn as a clinically trained person wrote in her notes while she knew all the fancy names for the things inside the syringes.
And I wrote down things like the big white syringe and then afterwards said, What does the big white syringe have in it?
Because I didn't know what it was, but we actually managed to have notes that were comparable.
But nonetheless, you can also build up knowledge when you're in a setting over time where you start to take things for granted.
A lovely example of the taken for granted this of the researcher was on a surgical
study I did towards the end of my time working in the operating theatres.
One of the surgeons was so used to me hanging around in scrubs that he said, Oh, do you want to scrub in on this?
And there was a brief moment where I thought, I know how to do this operation now.
And I thought, No, actually, I'm a sociologist, probably shouldn't.
But these things are you do need to think through what it is that you may or may not be seeing as you get to know people in a setting.
They may say things to you that are confidential.
Sometimes they helpfully say, This is off the record, and you're like, Okay, it's off the record.
But I'm still hearing it. It's going in my head. I'm going to be thinking about it all the way home.
So you at least you got some signal that maybe you won't write it down in capital letters in your notes,
because they've told you it's off for off the record. Other times people will just have highly confidential conversations in front of
you because you're part of the scenery and they've got used to you being there,
particularly if you're in a surgical setting and you're wearing scrubs and you look like everybody else.
So there are some issues there and doing.
Goodwin led on a paper from the anaesthetic project that talks about situational ethics and how we might deal with some of those issues.
And finally, there's an issue around your responsibility as a researcher,
because the textbooks often make great play of this idea that we're not meant to mess with the field in any way.
We're meant to be there as observers. But we really shouldn't be getting, you know, getting too involved in it.
And if you do clinical studies and you're not a clinician, you're constantly told, you know,
don't touch stuff because you're not clinician and for goodness sake,
don't look like you're doing anything clinical because that's really not allowed.
But then there are issues about what do you do if something comes up that is problematic.
So the classic one is the safeguarding issue. What do you do if you feel that there is a safeguarding issue for somebody in the setting?
So one of my researchers was in a situation observing ambulance crews and went to
a house where she then had concerns about the children that were in that house.
And the plan was that the ambulance crew were going to leave because they felt that there was nothing that they could do.
But this researcher was concerned about the children, so rang social services and waited because she felt that was the appropriate thing to do.
There are those sorts of issues and notwithstanding the injunction not to touch anything clinical.
When I was doing the ambulance study, I became a trip stand on Southampton Common.
It's one of my finest moments standing there in the dark going, I'm a stand.
I'm holding this trip for you because you haven't got enough hands.
And we were on we were in one of those ambulance cars.
So I'd done the drip and was waiting for the ambulance to come and collect the patient, but needed to do lots of other things.
So I stood there and I kind of knew that I was not meant to be holding anything clinical, but what do you do in that situation?
So there are judgement calls that you make. So the textbooks will tell you don't touch and the health and safety people will tell you don't touch.
And then there are some times when you have to think, Well, what should I do?
And my response to that has always been, what would a good citizen do?
So I'm not clinical, so I don't have clinical responsibility in terms of despite having watched the telly, you know,
the television and film things where they put biros through people's windpipes to,
you know, I'm not going to be doing that, but I will hold a drip stand.
And I have held the hand of patients in stressful situations because I'm a person
in the room who can do that while everybody else is saving lives and doing other,
much more important stuff if they need if they say they want somebody to hold the hand or they're feeling frightened,
I would say, would you like me to hold your hand? Would that make it or would you like me to talk to you?
And we could talk about something that might distress. And I feel that that is okay.
But there are textbooks that will tell you that's a real no no.
There's something about this imported research.
So this idea of the researcher as the research instrument and one of the things that we did on the ambulance study was in order to get ethics,
we had to have a load of procedures for what do you do if you're on the ambulance and the patient or the relative says,
we don't want you observing this. So we wrote this thing in the ethics thing where we drew the diagram of the ambulance and we explained
that Cathy will be sat in one of these seats in the back of the cab unless the patient says no,
in which case she will move to the front and sit with the driver.
And now I will tell you this now, and I do realise this is going to be podcast,
so I'm now breaking you no secret that lying there on the ambulance cab there's a door
that's meant to shut with the idea that when the driver is driving the ambulance,
they're not being distracted by anything that's going on in the back.
Nearly every ambulance that I went in had a very carefully constructed piece of something box, a plastic cup,
the stray bit of medical equipment that was used to prop those doors open so
that the cab drivers could talk to the people working on patients in the back,
which meant that the real confidentiality of me sitting in the front was broken.
But I decided to let that go in the interests of research about ambulances.
And there's one of those things about doing research on ambulances that I'd I'd done the thing of talking myself
through what will I do if we go to a road traffic accident and there's children that are being killed or,
you know, and I'd done all of the head talk about what I was doing. And in fact,
I set up a mentoring buddy system with somebody else that was doing ambulance and
emergency department observations that I would have somebody to debrief with.
And I also had a member of the clinical team who said they would take supervisory responsibility for me.
So I'd done all of that and I'd done all this stuff about what do I do if I get blood on me?
What do I do if somebody is violent, what I do if somebody's sick on me, you know,
I done all of that and I'd done the how am I going to take notes going at speed?
And I'd practised in the back of the car I'd got, you know, it's,
it's my partner drive just as fast as you can within the speed limit and I'm just going to see what I can write.
So I was like, Yeah, I can do this. And one of my colleagues said to me,
Do you get carsick at all because you're going to be in a box going at 90 miles an hour and there were no windows and lots of people get carsick.
I thought, I don't know. I don't know if I'm going to get caught.
Thankfully, I didn't. But there were things that I hadn't even thought about as an important researcher going into that setting.
And then that was just the thing about actually ambulance work.
You feel that embodied ness and I think there are many other research settings in healthcare where you feel that.
So there was this lovely occasion when it was a cold and dark night and the road was icy.
It was winter and the ambulance gate at one point and the drive was great,
but it was a bit scary as we were skating on the ice and then we turned off.
We went under a bridge, went across a field, we went along something that on Google Maps was a road,
but it didn't feel like a road as far as I was concerned.
And then we arrived at a couple of houses in the middle of the field and we didn't have any mobile phone reception.
That's a little bit scary and a little bit unnerving, and I'm glad it was me doing it,
you know, an age close to what I am now rather than maybe the 20 year old me starting out.
So I think those sorts of things are just interesting.
And often when you read about the embodied research, it's written about in a way that doesn't maybe bring some of that light to life.
And there's also the stuff about safety where there's often a lot in ethics about how when you're doing qualitative research,
how you're not going to damage anybody else.
But sometimes that attention isn't paid to how you might look after yourself as the researcher and the very first study cited 30 years ago,
it wasn't until I went to work in the US that I had proper occupational health and safety
briefings about what to do with blood contamination and body fluids and all of those.
So I've been merrily going into operating theatres in the UK,
often being introduced as This is Cathy, she's a social worker and I'm like, no, no, no sociologist.
Slightly different and, and sometimes not being introduced to.
Which I feel quite disturbed about now. At the time I was grateful because I was doing it for my PhD.
I was just so grateful to get into the setting. I look back on that now and think This was completely unethical.
And now I make sure that patients, even if they're going to be anaesthetised when I'm in the room,
know that I'm going to be in the room and what I'm doing,
even if I'm not actually collecting data about them, because often I'm watching what the surgeons or the anaesthetists are doing.
And so, again, this is one of those examples of things that you learn in settings about safety.
So one of the things in the interventional radiology settings is wearing light gowns to protect you from radiation.
And there was this lovely conversation with one of the clinicians who said, you know, you mustn't drop these LED gowns on the floor.
They're really expensive and you need to look hard and you mustn't drop them on the floor.
They have to go on the special hangers and they're really heavy.
So when the radiation is not being used, everybody takes their gowns off and everybody puts them on the back of the chair or on the table,
and sometimes they slide off onto the floor. So you notice what's going on with the safety equipment.
And that was that was interesting. This, by the way, is a picture of me that Glenn Roberts owns and frightens me with every night.
Again, that's me doing the treatment centre project that we did when we went to visit a treatment centre that was being built.
So that's why I'm in a hard hat for that one. I don't always dress like that when I'm doing ethnographic work.
And then another example from that same study, one of the clinicians talked to me about the they have these headband,
a little clip on dosimeters that tell you how much radiation you've been exposed to.
And they're designed to fit on glasses, except that they can often only fit on the bridge of the glasses,
which means you can't actually see because they kind of obscure your vision.
So some people put them on their headbands or they put them on a bit of their cap,
and she wears contact lenses with clear protective glasses over the to the top.
And she's describing all of that. And then as we're talking, she goes, Oh, and I've lost it again.
And she has to go and find another one. And there is a bit me thinking, I wonder if she hadn't been talking to me whether she would even have known.
And these things are meant to record the dosage that you receive over a month or something.
So you learn things about the safety wear, both as the embodied researcher having to wear it and by talking to the people in the setting.
And I thought I'd be honest about an unnerving situation.
I have had lots of unnerving situations,
including deciding that I would get into a fast red sports car with a surgeon after having watched operating this,
because I thought I might get really good data and I did get really good data, but I was very scared and I would say that's a step too far.
Never get in a sports car with a surgeon because they just don't seem to know what the speed limits are.
Or maybe that's changed. But this was a more recent situation,
and one of the studies that I did and this was anaesthetists are lovely people and I think they do amazing things,
but there are bits of downtime in operations.
One of the jokes says that that's when the anaesthetist has a snooze and this particular anaesthetist was looking at his
mobile phone in the bit in the operation where he didn't need to be paying quite so much attention to what was going on.
And they were talking about holidays and things like that and reading tweets out and things like that.
And then he started looking me up on Twitter and he went through as many Kathryn Pope's as he could find on Twitter and
was reading out their bios and guessing whether it was me and I was trying to do my I'm a professional researcher.
I'm not going to rise to this. I'm not going to I'm not going to challenge it.
I'm simply going to observe it. I'm going to write some notes about it.
And I'm feeling a little bit nervous and I'm thinking, Oh, what did I tweet about last night and what,
you know, have I put anything on Twitter that I would feel embarrassed about in this situation?
I do have a rule about not tweeting when I'm drunk, but nonetheless, I'm probably sweary on Twitter as I can be in lecture theatres.
So I was starting to feel a little bit nervous about this because it felt like my life was being in.
Although that's a public space, it wasn't a space that I had chose necessarily to share with that surgical team,
and they didn't know about my political activism and my role in the trade union.
They didn't know any of that, and I didn't feel they needed to know about that. But it was all on Twitter.
And later, as I was reading the notes, it made me think that I.
Actually, that was I kind of understood what that pushback was because I was in their space and this was partly this person saying,
You're in my space watching me. I'm feeling a bit uncomfortable.
I can do that. Back to you. And it made me think differently about the data and about my role.
So sometimes I think we have these unnerving situations or things happening for our work and we feel a bit uncomfortable.
And I think we need to get curious about that and question what's going on,
because I think you can do some further learning from those kinds of situations.
And there's a load of stuff about status passage in the anthropological literature and in the sociological literature,
which is basically just this idea that we move through different kinds of status as, as as we're in a work situation or during the life course.
And I just want to reflect on my own status passages because I think when I started doing observational research,
I was 21 and I've never been in a clinical environment.
I'd done a sociology degree and I'd worked in Sainsbury's and supermarkets and those kinds of things and I've never been in a clinical
situation and I think I was really naive and I was fresh faced and I was female and petite and I was studying urological surgeons,
which at the time I think there was one female urological surgeon.
I hope that's changed now. I haven't looked it up recently. But I think that I was very naive.
And the if I did that study again, now I know because of all the other studies I've done,
I would have some cumulative wisdom about the settings and about the people and about the interactions.
And I think just acknowledging that might be helpful.
There's a load of stuff in the literature about this thing called Going Native,
which is the idea that you overall identify with the people that you're studying to the
point where you can't actually see what's going on because you just feel like them.
And I think there are ways that you can counter that by making really good field notes and being reflective about what you're saying.
But an example of that is that I don't think I feel the same way going into surgical environments as I did when I was 20, 21.
When I first went into a surgical environment, I wrote notes about the smell, the temperature and the bizarreness of.
I wrote pages about how weird it was that I got to see the insides of people's bodies when they never got to see the insides of their bodies.
And how weird it was that every surgeon opens people's abdomens and goes, Oh, I wasn't expecting that.
And I wrote stuff about that because I was fascinated by it and horrified by it and discomforted by it.
And now I walk in and I'm like, Oh, what's that kit that they've got there?
And what? You know? And I might read about the surgical procedure or seen it before, and I think that's changed how I do things and see things.
So I need to reflect on that. And if I'm working in a team with more and less experienced people,
we need to use that to counter the going negative and over identifying with the field.
And then I think also linked to that, I think I was a mascot in the first studies that I did.
I think there was something particularly amongst the urological surgeons who were mainly men,
as I said, which was we've got this young woman following us around.
It's quite fun because that doesn't normally happen in our working life and we can kind of go, Oh,
I've got the young woman following me today, and I was, and that gives you access to things, but it also closes that, you know.
So I think I was told things that maybe they thought I wouldn't understand and maybe
I'm sure there were things that I just didn't clue in to and didn't understand.
And now if I go in, I've got the baggage of being a professor, being, you know, I'm 53, so I'm older.
You know, there's all sorts of things about who I am now and what people expect.
Well, I wonder how that is also influencing what's going on.
And I just hold that up as being aware of those passages because, again, I think when we when the textbooks when I write about these methods, we.
And not to think about those things. But it does matter that I'm white and older and from South London and not clinical.
Those things do matter and short because that means I see and hear particular things and I feel particular things and that matters.
And I thought. Just to end on a bit of controversy, I don't know how many of you saw that, because I started with Erving Goffman.
His daughter Alice wrote a fascinating book based on a very long term ethnography of what she calls fugitive life in an American city,
basically living in a very deprived area and watching the gang and crime activity of a small group of people in an urban deprived setting.
I still think this is a fantastic ethnography.
I enjoyed reading it and I think I would recommend it to any of you that haven't read it.
But there was a huge furore about this book.
There have been some, I think, important criticisms of its focus on criminality as its key theme and set of messages
and the portrayal of black Americans as being involved in criminal criminal activity.
There are what Lubet calls uncertain vignettes in that there are some episodes in this ethnography where Alice
Goffman describes things which make it appear that she probably participated in things that were criminal activities.
And there's some debate about what her role was and whether she should or could be prosecuted.
So there's a bunch of ethical issues and dilemmas.
And I think that part of the reason for the furore around this particular study is
because some of these things are present in a lot of the ethnographic work that we do,
but on a lower level. So I think that some of the things that I've described to you, they're not up there with committing a felony.
But the fact that I've mentioned that and anaesthetist was playing with their mobile phone while they were doing an operation,
for example, should I should I be telling you that it's a piece of my data?
I've anonymized it. There are issues there,
and then there are issues about how how these things get reported and how we protect people and how we allow people to see what it is that we've done.
And as a final in having started with those injunctions from from Erving Goffman and Martin Hammersley Mitchell Junior,
who has also written some stunning, stunning ethnography,
which I recommend to you, says we can improve our methods by engaging in practices that reassure our readers that they can trust,
that they know how they have been convinced. It is a lack of transparency that results in a sense that the wool is being pulled over a reader's eyes.
Our goal should be to institutionalise methods that make it normative for us to be as upfront as possible about how we have achieved our facts.
So part of what I've wanted to do tonight is be open about some of the stuff that maybe sometimes gets hidden behind
the formal reporting of ethnography and the kinds of observational research that we do in health care settings.
Because I think that will get us to this place and we will start to have ethnography so that we can really
engage with and that we can then use to make a difference to health care and health care practices.
So there is a slide with references on if you want them.
Some of the references were embedded. There may be some people here are desperate for the references, so you can ask me for them.
And then I have to acknowledge various things about the studies being funded by great and wonderful organisations that give you money,
but then make you say that everything you say has to be attributed to you, not to them.
So that's what that slide is. And I particularly want to the bottom of that slide acknowledge that most of this
research that I've talked about has been done in teams with amazing people,
and all the best bits of it is obviously their work, not mine. And that's me and I can take questions.
Thank you.