Anthropology & Medicine

ISSN: 1364-8470 (Print) 1469-2910 (Online) Journal homepage: http://www.tandfonline.com/loi/canm20

Negotiated interactive observation: Doing

fieldwork in hospital settings
Gitte Wind
To cite this article: Gitte Wind (2008) Negotiated interactive observation: Doing fieldwork in
hospital settings, Anthropology & Medicine, 15:2, 79-89, DOI: 10.1080/13648470802127098
To link to this article: http://dx.doi.org/10.1080/13648470802127098

Published online: 01 Jul 2008.

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Date: 02 November 2016, At: 09:51

Anthropology & Medicine

Vol. 15, No. 2, August 2008, 7989

RESEARCH ARTICLE
Negotiated interactive observation: Doing fieldwork in
hospital settings
Gitte Wind*
VIA University College, The School of Nursing in Aarhus, Denmark
(Received 2 February 2008; final version received 27 May 2008)
In this paper I discuss the possibilities and limitations of the ethnographer
participating in the different on-going activities and events in highly specialised
healthcare systems. The concept of participant observation is based on a number
of assumptions, particularly that the ethnographer will become one of them to
be able to follow the steps belonging to the accepted ethnographic research
practice of doing fieldwork. The character of fieldwork in highly specialised
healthcare systems does not fit well with this assumption. I suggest that we need
to rethink the concept of participant observation and I propose negotiated
interactive observation as a more appropriate way to describe ethnographic
fieldwork in a setting such as the hospital or the clinic.
Keywords: fieldwork; participant observation; negotiated interactive observation

Introduction
In this paper I discuss the possibilities and limitations of ethnographers participating
in activities and events in highly specialised healthcare systems. I suggest that we need to
re-define the concept of participant observation and I propose negotiated interactive
observation as a more appropriate way to describe ethnographic fieldwork in hospital
settings. Fieldwork and participant observation are the hallmark of ethnographic
research as Shweder puts it, they are the basis of a true ethnography (1996). As a
medical anthropologist I have as is expected by the standards of my profession worked
my way through various courses on ethnographic methods, and read several books and
articles on ethnographic and qualitative research methods, many of which are written by
non-ethnographers. I have taught courses on ethnographic methods to various health
professionals and I have carried out fieldwork in hospitals in The Netherlands and in
Denmark. In all of that, I have been unable to find much literature on what it actually can
mean to do participant observation in a hospital setting.
Ever since Malinowski (1922) set the gold standard for doing ethnography the
common understanding of participant observation in ethnographic research has been:
living in a community for a substantial period of time, participating in the daily lives of
people. Participant observation performs the dual purpose of placing the researcher both
inside that is participation and outside that is observation of the social world of
their host community. The ethnographer is expected to be simultaneously insider and
outsider (Spradley 1980). Participant observation thus rests on the assumption that it is
possible to participate in the lives of the people you are studying, that it is possible for
*Email: giwi@viauc.dk
ISSN 13648470 print/ISSN 14692910 online
2008 Taylor & Francis
DOI: 10.1080/13648470802127098
http://www.informaworld.com

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G. Wind

a while to become one of them and immerse yourself in daily on-going activities. At the
same time, the researcher is expected to maintain enough analytical and intellectual
distance to allow him- or herself to undertake observations, and analyse and interpret
what is going on. The main purpose of participant observation is to gain access to the
insiders point of view, learning what it is like being part of the host community, learning
what it is like to be differentially situated and living with different constraints and
preferences. This is only ever a partial view, or as Clifford puts it a partial truth (1986, 7),
a balancing act of concurrently maintaining both intimacy and distance.
The notion that participant observation is about getting as near to the field as possible
by participating in the lives of the people studied has been modified over time. Within
anthropology, it is recognised that the degree of participation will differ according to the
field, the specific situation and on-going activities, and the personal characteristics
of the ethnographer, from no participation at all to total participation (going native).
Spradley speaks of nonparticipation, passive participation, moderate participation,
active participation and complete participation (1980, 5862). Feminist anthropology
has taught us that we have to be acutely aware of the personal background of the fieldworker, and the differences gender, age, looks and former experience may make when the
field-worker tries to find a suitable place and role in the field (Moore 1988). But this
insight seldom finds its way to the descriptions of ethnographic method in articles on
ethnographic research projects, including hospital ethnography. It appears to be sufficient
to write participant observation without further discussion of what that may mean within
a specific research project. I will give a couple of recent examples. Van Dongen writes in an
article entitled Walking Stories: Narratives of Mental Patients as Magic in Anthropology
and Medicine (2003):
During the 1990s I did my fieldwork in a psychiatric hospital in The Netherlands. My focus
was on people who were diagnosed with schizophrenia and psychosis. I worked in the units
for emergency and short term treatment as well as in units for long term stay. I was especially
interested in the patients narratives about their lives, their experiences of affliction and the
way they had to deal with it. Besides the protocols of participant observation and in-depth
interviewing, I systematically recorded more than 50 conversations of therapists and
psychiatric nurses with their patients that were verbally transcribed and analysed. (213)

In an article entitled In the Presence of Biomedicine: Ayurveda, Medical Integration

and Health Seeking in Mysore, South India in Anthropology and Medicine (2006), Nisula
writes that:
The empirical data are derived from interviews with various healers and patients, survey
material, and participation in consultations and diagnostic assessments in clinics and
hospitals. Altogether 25 Ayurvedic practitioners and 30 patients were interviewed. Participant
observation was carried out in two hospitals and nine clinics offering Ayurvedic services.
Also two colleges offering Ayurvedic training were visited. Finally, a questionnaire was
administrated to a total of 233 respondents who were surveyed in the University of Mysore
and on trains and buses between Mysore and Bangalore. (208)

Within the health sciences there is a tendency to use what is described as ethnographic
(inspired) methods employing the concept of participant observation. The main discussion
about methods, if any, centres around the possible bias caused by the presence and the
subjectivity of the researcher, not because of who she is but just by being there (see, for
instance, Costello 2001; Wikstrom and Larsson 2003; Landstrom, Rudebeck and
Mattsson 2006) and the concept of non-participant observation, without much discussion
of what that means (see, for instance, Gabbay and le May 2004; Eagle and de Vries 2005;
Austin, Luker and Martin 2006). There are also a number of studies where the

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researcher(s) prefer(s) the use of tape recording without being present (see, for instance,
Steihag, Ahlsen and Malterud 2001) or videotaping (see for instance Latvala, VuokilaOikkonen and Janhonen 2000) as it is seen to reduce the personal influence of the
researcher on the results.
I am therefore curious as to how other anthropologists have made their way round
the hospital or the clinic. What did participation mean, and what were the possibilities and
the problems encountered during the fieldwork? My curiosity is based on an
uncomfortable feeling, a sense of uneasiness that I havent been able to do proper
fieldwork and proper participant observation because I didnt really manage to become
an active part of the on-going activities and events in the hospital settings.

Hospital ethnography and the ethnographer

I will describe my personal background and the hospital ethnography I have been engaged
in to show how my questions have arisen. I am educated as a nurse, went to nursing school
in Denmark 20 years ago and had two years of experience working as a nurse in Norway,
Denmark and the Sudan. In the Sudan I worked for nine months in an unsuccessful
primary healthcare project, which mainly failed because no one in the project, myself
included, had much knowledge about the Sudan, the local situation or theoretical tools
to be able to understand what was going on. As a result of that experience I decided that
the right thing for me to do was to go to university and study anthropology, return to
Africa afterwards and be more successful in another primary healthcare programme.
So I went to The Netherlands, studied for six years, had two children and obtained a
masters degree in medical anthropology. I never did manage to get back to Africa.
I then moved to Denmark and started working as a lecturer at a university college
teaching nursing students courses in sociology, anthropology and qualitative research
methods. I taught post-graduate education in medical anthropology at the Open
University in Aarhus, Denmark, where the students were nurses and some other
healthcare professionals: doctors, physiotherapists and occupational therapists.
In The Netherlands I did fieldwork in a haematology ward studying the patientnurse
relationship (Wind 2001). In Denmark I did fieldwork in two locations: a rheumatology
ward including an out-patient clinic in a public hospital and a privately owned rheumatism
clinic. This last research project explored the handling of chronic disease among people
with rheumatoid arthritis and their nursing staff. I examined how people with rheumatoid
arthritis and their nursing staff think, talk, perceive and act in relation to living and
working with chronic disease. At the rheumatology ward, patients from all over Jutland
(a province of Denmark) are diagnosed, treated, monitored and nursed. Patients newly
diagnosed with rheumatoid arthritis are invited to join a so-called Rheumatism-school
where they receive lessons from different health workers and have the possibility to
exchange illness stories. At the Rheumatism clinic people with different kinds of muscularskeletal diseases are rehabilitated, nursed and treated. In the clinic the majority of the
patients stay for four weeks. They follow individual training programmes consisting of
occupational therapy and physiotherapy, and may join a Rheumatism-school which offers
lessons in understanding disease, pain, drugs and occupational therapy.
The two fieldwork settings offered me the opportunity to meet people at different times
in their life with a chronic disease and with different experiential encounters with the
healthcare system. It enabled me to study the handling of chronic disease in both a
treatment practice with focus on the medical treatment and care of people with rheumatoid

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G. Wind

arthritis and in a rehabilitating practice with focus on how to improve the handling of
living with a chronic disease. Some people were in the middle of the diagnostic process,
and did not yet know if what they had was rheumatoid arthritis or not, others had lived
with the disease 30 or more years and knew both the rheumatology ward and the
rheumatism clinic by heart.
I wanted to have a double focus, understanding the handling of chronic disease from
both the view of people with rheumatoid arthritis and from their nursing staff, because
in general the nursing staff sees themselves as the health staff concerned with helping
patients learning to live with their chronic disease. I also wanted to understand what was
going on between them. So I divided my time in the field between following patients and
following nursing staff. When following patients I dressed in my own clothes, trying as
far as possible to place myself where they were. Following the nursing staff, that is, nurses
and nursing assistants, I wore a white coat over my own clothes. In the hospital, and in
many others across the globe, a white coat gave me access to most spaces within the
hospital. Apart from when patients or nursing staff sat drinking coffee and chatting
I cannot say that what I did came close to participation. I argue that this lack of the
possibility to participate more fully in an immersive capacity is intrinsic to most if not all
hospital ethnography.
In the best of ethnographic worlds the ethnographer locates a place from where she can
participate in the lives of the people studied; she finds a credible role that gives her the best
opportunity for building trust and rapport so that she can join in different situations and
activities. The question is what kinds of roles are available in a hospital setting and what
kinds of activities are going on? In the rheumatology ward and the rehabilitation clinic
there are as is common for most hospital settings in Denmark and in many Western
hospitals three usual roles1: you can be a patient, a health worker or a relative/visitor.2
For patients, time is mainly filled with three kinds of activities. For the patients in the
rheumatology ward, including the out-patient clinic, the main activity is waiting. In
the rheumatism clinic waiting takes up much less time, because the training activities fill up
most of their day. In both places clinical interactions between patients and health workers
take place, including undergoing painful medical procedures and engaging in sometimes
emotionally disturbing conversations about what decisions to make concerning the
handling, caring and treatment of the disease. In the rheumatology ward, especially in late
afternoon and in the evening, social interactions with fellow patients and with relatives
take place, though some patients sleep at home and some patients keep to themselves.
In the rheumatism clinic the patients spend a substantial amount of time together, chatting
and often exchanging illness and life stories. They seldom receive visits from relatives,
although many go home for the weekend.
The health workers day consists mainly of clinical interactions with patients including
medical and nursing procedures, administrative work, meetings and coffee breaks.
Visitors are limited to the hospital visiting hours. During these times they are mostly
with the patient, taking part in conversations with them and the health staff about the
patients situation.
None of these roles offer any real possibility for participation by the ethnographer.
In my fieldwork, being the patient was not an option. I know of only a few cases where
anthropologists undertook the role of patient in a hospital (Caudill et al. 1952; Rosenhan
1973; van der Geest and Sarkodie 1998). As van der Geest and Finkler (2004) state, ethical
considerations, personal unease and practical problems discourage researchers from
embarking on such an endeavour. Even though it was not possible to participate as

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a patient, it was possible to interact with patients, especially in the waiting time, chatting
and listening to their illness and life stories.
Undertaking the role of visitor gives you very restricted access to most of the activities
and places in the hospital and therefore does not seem like a useful approach. Participating
as a health worker is not an option for most ethnographers. Even though I once was
a nurse, the responsibilities of healthcare work make it incompatible with combining
nursing, doctoring or allied health work with ethnographic fieldwork. It was of course
possible to interact with the health staff and to join coffee breaks, and my professional
background enhanced my opportunities for inclusion in insider discussions.
A further possibility is to take on the role of student, although that was not possible
for me due to my age (46) and background as a lecturer at the college where a number
of the nurses had trained.
The only feasible role for me in these settings was that of researcher. As van Maanen
(1982) writes, the work routines of the fieldworker are rather unnatural or unusual in most
settings hanging around, asking weird and sometimes even dumb questions, drinking
coffee, taking notes, chatting. These activities do not look like work and they definitely
do not look like academic research.3 In a hospital setting these activities are seen at best
as trivial, and at worst as time wasting or even interfering with the real work of the
health workers. This is particularly so in a highly specialised hospital where many of the
work activities involve technical medical procedures, complicated and often emotionally
disturbing conversations between the health staff and patients, and difficult decision
making for both. The work of the ethnographer often appears trivial, or as if the
ethnographer is watching, monitoring or policing staff inappropriately. The following
excerpts from my field notes illustrate these challenges:
I was sitting in the nurses office in the outpatient clinic where three nurses were busy caring
of patients with an appointment at the outpatient clinic and talking on the telephone with
patients calling from home asking questions about their illness and the treatment. I was busy
trying to find out what was going on and how, when one of the rheumatologists rushed in.
Apparently distracted by my seeming inactivity, which the doctor saw as just sitting there,
she said to me in a quite annoyed tone: When are you going to do something? Without
waiting for an answer she quickly talked to one of the nurses and then rushed out the door.

It was not the first time that the doctor perceived me as doing nothing. She had seen me
sitting in the nurses office at the out-patient clinic earlier that day and she had seen me
hanging around at the rheumatology ward in the weeks beforehand. The evident clash
between her having to rush, to actually run to be able to fulfil her job responsibilities, and
me just sitting there doing nothing made my presence the more trivial and her work even
more stressful.
I had successfully and very quickly negotiated my way into the rheumatism clinic and
the rheumatology ward. Although I was made very welcome by the head nurses, my
position was a daily on-going negotiation, which sometimes went well and at other times
did not. At the rheumatism clinic I unsuccessfully tried to persuade the nurses and the
nursing assistants to let me join them when they went into the room of one of the patients
to help the patient get (un)dressed or to talk with the patient about her stay in the clinic.
They gave explanations like not today she [the patient] does not feel well, or not today
I have to get to know the patient better first, or rather not today Im so busy. During
the fieldwork it became clear why the nurses and nursing assistants resisted me following
them to the patients rooms. The rheumatism clinic is not a training place, which means
that they do not train student nurses or nursing assistants trainees. They also work alone

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with individual patients because of the regulations of the clinic; the clinic does not receive
patients in need of care from more than one person. Furthermore the rooms of the patients
have a far more private character in the rheumatism clinic than in the rheumatology ward.
The patients stay for four weeks, most of them in rooms of their own and the room is
considered by both staff and patients as the private domain of the patient. This means
that it is unthinkable for both staff and patients to enter a room without explicit
permission to do so. The nursing staff makes agreements with each individual patient as
to when they are welcome, whereas the patient rooms in the hospital are considered
semi-public and definitely not the patients private space. Thus at the rheumatism clinic my
presence was not considered disturbing in its triviality, but disturbing in its potential to
unsettle a delicate relationship between patient and health staff and to cast judgement over
the care given.
My opportunity to participate in the lives of the patients at the clinic was further
restricted during periods of cold weather. Whenever the weather was warm the patients
would sit outside in the lovely garden of the clinic in between and after their training
activities, but when it was cold they would go inside, either separately to their own rooms
or to the sitting room for smokers. As a non-smoker I could only manage to be in the
sitting room for very short periods of time before my eyes were running, I was coughing,
and I felt terrible. I soon had to realise that the sitting room for smokers was not going
to form a substantial field site for me.

Negotiated interactive observation

Of course the question of the degree of participation is not only relevant for doing
fieldwork in a hospital or a clinic, it has everything to do with the changing nature of
what anthropology and ethnographic methods are about. As Shweder remarks,
Ethnography was about something called a culture but what is it about today?
(1996, 19). With the breaking up of the culture concept (Abu-Lughod 1991; Barth 1995;
Hastrup and Olwig 1997), with the on-going process of anthropologists increasingly doing
research at home (Peirano 1998), with the knowledge that most people do not form
neatly demarcated and closed social groups that can be entered and studied as cultural
islands (Gupta and Ferguson 1992; Hastrup 2003a), the need to re-conceptualise
fieldwork and participant observation is becoming increasingly important. This is
especially so when the ethnographer is studying a social category and not a social group
(Amit 2000). The question is all the more pertinent when you think of the success
participant observation and ethnographic methods have had as a research method outside
anthropology.
With the concept of participant observation as it currently stands, the focus is on
participation and observation from the perspective of the ethnographer. In that way the
concept of participant observation accentuates the ethnographers authority over the field
and its people by emphasising our agency over the fieldwork. The ethnographer is there to
participate and make observations but the ethnographer also becomes an object for the
Others interpretation and social engagement, including their friendliness, cheerfulness,
aggression, irritation and indifference (Hastrup 2003b). The Others will study you as well
and, as van Maanen (1982) argues, the success of one study depends on the success of the
other. Irrespective of the degree of participation, the ethnographer is an important
audience for the informants. At least some if not all of an ethnographers informants will
watchfully scrutinise all her actions, attitudes, comments and questions.

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This was exactly what happened to me. The doctors were more than puzzled with
what I was doing; some of the nursing staff were thrilled to have me there (at last
research was being done in their field!), but others were quite anxious, afraid that I was
there to judge whether or not they did their work correctly. Some, especially the nursing
assistants, just could not understand why I was interested in their work at all. Some of
the patients enjoyed talking with me about their lives with a chronic disease, while others
resisted.
Participation in something means than you become part of what is going on, involving
yourself in a common goal, a plot, in an emerging narrative, helping to further the activity
in a hoped for direction. Activities taking place within a hospital or clinical setting often
do not, however, form a singular narrative. The field is ambiguous; it is a differentiated
social space as Hastrup mentions (2003b). Behaving as if the ethnographer is bound by the
same ties, by the same mutually binding relations as the patients and the health staff, is to
misconstrue the role of the ethnographer.
Interacting means that something is going on between people but not necessarily
that there is agreement on what is going on or that they engage in the same narrative.
It does not require that they are bound by the same kinds of strings. And it means that the
interactive observation goes both ways. They will try to make sense of what you are
doing (and not doing) and saying (or not saying). There will be a constant negotiation of
when and how the observation and interaction will and will not take place.
Writing this paper I have come to realise that my feeling of not being able to participate
in a supposedly proper way, which could fulfil the criteria of doing true participant
observation, stems from the fact that I do have an intimate, thorough and embodied
knowledge of the work of nurses. I know what it means to be working in a setting
where the working conditions are characterised by what the Norwegian educational
theorist Dale (1998) describes as forced action. As a nurse or as a medical doctor you very
often cannot wait an hour or until the next day, next week or next month; you are forced
to take action, and have to decide right there and now which action to take. Often these
are actions that will have both immediate and possible long-term consequences for the
patients and which you, as the nurse or doctor, will have to live with. Ethnographic
fieldwork seldom has this urgency in decision making. We can wait, reflect, think, discuss
and be critical. And we can pack our bags and leave. We do not in any way participate
in the forced actions of the health staff and we do not have to live with the consequences,
as do the patients and the health staff.
But my uncomfortable feeling of not being able to really participate also has to do
with the old philosophical problem of our ability to know the Other. How can we ever
know anything outside our own experience? I do not live with a chronic illness that
evolves progressively but following no definite pattern with the pain, the loss of
mobility, the crippled joints, the need to take medication every day, the side-effects, the
fatigue and the reactions from relatives and society in general. Shweder discusses the
problem of solipsism in doing ethnography, arguing that if ethnography is possible then
solipsism is wrong. While acknowledging that it is probably true that the only head you
can ever get into is your own head, Shweder suggests that the real problem with solipsism
is the premise that the only way to understand the mental life of something that has a
mental life is by getting inside its head, by experience it or observing it directly (1996, 25,
italics in original). Van der Geest discusses the problem of inter-subjectivity in
ethnographic research into illness and suffering, arguing that the best we can do is
sharing of relevant experience and remaining constantly reflective; but we should never

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forget that we are not committed in the same way as the people whose experience and
world we are trying to grasp (2007, 11). Attempting to know the Other is different when
you do not only want to know the mental life of somebody else but also their embodied
ways of living and experiencing. As Stiker warns us we should always be aware that
disability is not only a social problem there is always a hard core consisting of an
impairment of functions, of organs, of bodily or mental structures (1999, 357). This
means that we cannot stop our interpretation when we have figured out how it is to be a
differently situated human being to have different preferences and live with different
social constraints we also have to understand how it is to live with and through different
embodiment. Its the feminist anthropological question of: does it take one to know one?
According to one of the women I interviewed this is not entirely the case though it
definitely helps. Based on her 30 years of experience living with chronic illness, her answer
is that many people do have troubles understanding what its like. She finds that it is
easier to share her experience of living with chronic illness with people who themselves
have experienced that life is not always following a neat and straight path, people who
have had setbacks in one way or the other.
We could of course call fieldwork in hospital settings non-participation (Spradley
1980). That could be the end of the discussion and leave us with observation as the sole
research technique. However, non-participatory observation misses some very important
aspects of fieldwork. First is the issue of negotiated interaction, which is always going on
between people as described earlier; second is the difference between just being in the field
observing what is going on and the doing of fieldwork, which is so much more than
just being there. As Wolcott argues, fieldwork is more about intent and a mental state than
it is about presence at a specific location (2005). It is about being open and sensitive
towards the quality of the lives of people, their experience, feelings, sociality and moral
(Hastrup 2003b).
Doing fieldwork at home in Denmark and in a clinical setting I have had to
convince other anthropologists, including myself, that it is possible to engage in
ethnographic research, maintaining the balance between intimacy and distance. One
instance at the out-patient clinic stands out as the ultimate proof to me that I was not
present as a health professional but as an ethnographer trying to grasp what was going on.
This situation is the only instance where I was placed in the role of medical student
by one of the health professionals.
I am following one of the senior doctors at the out-patient clinic to see what happens when
patients have an appointment. The doctor and I are sitting in one of the small consultation
rooms when one of the younger doctors knocks on the door and asks for help with a patient
he has to give an injection to in the joint of the ankle. The senior doctor rushes out with the
younger one but returns within a few minutes, wearing a mask and a protective hood over his
hair. He tells me to follow him. In one of the other consultation rooms a man in his fifties is
lying on the examination couch. He has a bare left foot, his trouser leg is pulled up to the knee
and the ankle is swollen and red. I am handed a mask and a protective hood by the assisting
nurse and put it on. The senior doctor explains that the man has arthritis urica, that he is
having a very painful attack and therefore needs an injection in the ankle. The nurse passes
the syringe to the senior doctor who searches for a suitable spot on the ankle. The man is
wailing quietly and the senior doctor is comforting him by telling that he knows it hurts and
that the injection will help. I am following the course of events closely when suddenly I start
feeling all the blood leaving my head. I feel sick, the feeling of cold sweats come over me, and
I must pull myself together quickly in order not to faint or vomit. I tell myself to stand

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straight, breathe steadily and take care that no one notices my state. Luckily the hood and the
mask are covering most of my face.

This episode tells me that I am not present as a health professional. As a nurse, a simple
injection in a joint would not make me feel ill. The openness and the sensitivity that I bring
into the field as an ethnographer means that I am not merely an observer; I am there to
witness what is going on and the only way to do that is by interaction, by being receptive
to the experiences of the people studied and the on-going activities and events.
Within nursing the question of how to know the other has long been answered with
the concept of empathy, as a nurse you have to be empathic towards your patients in order
to be able to share their thoughts and care for them. Morse and Mitcham have suggested,
however, that empathy only is half the way of knowing the Other; empathy means the
self-conscious effort to share and accurately comprehend the presumed consciousness of
another (Wispe, cited in Morse and Mitcham 1997, 650). But nurses also experience what
Morse and Mitcham have coined compathy, which they define as the acquisition of the
distress and/or physiological symptoms (including pain) of others by an apparently
healthy individual following contact with the physical distress of another (ibid., 650).
Compathy is thus the sharing of a physiological state. What I experienced during the
injection of the ankle might be explained as a compathetic response to the obvious pain
and distress of the man whereby his suffering became accessible and imaginable. But in
general the suffering is not that obvious in the lives of people with rheumatoid arthritis. As
one of the nurses noticed, there is not a lot of blood and sirens going on in neither the lives
of people with rheumatism nor their treatment. Whereas experiences of compathy are
beneficial to the work of anthropologists, according to Morse and Mitcham (ibid.) it is
counterproductive in the work of nurses. Because nurses both have to inflict pain (e.g.,
giving injections, motivating patients to get out of bed even though it hurts) and to be able
to take immediate action, they have to (learn to) suppress their compathic responses in
order to be effective in their work. I was able to do that 20 years ago working as a nurse;
fortunately Im not able to do that anymore.4
Anthropological knowledge production is situated, it rests on fieldwork and on social
relationships in the field, relationships between the people studied, and between the
ethnographer and the people studied (Hastrup 2003a). We need to be explicit about how
we negotiate our way in the field. The concept of negotiated interactive observation forces
us to reflect upon and openly discuss how we do this. How and with whom did we (not)
interact and form relationships? The result of the on-going negotiation and how we
interpret it influences which stories are told and whose voices are heard or muted. As Amit
says it is the circumstance which define[d] the method rather than the method defining the
circumstance (2000, 11). The so-called reflexive turn in anthropology has resulted in
a growing awareness of these questions. I argue that a new concept could help in clarifying
the essentials of ethnographic fieldwork and writing.
The concept of negotiated interactive observation captures what happens when you are
doing fieldwork without at the same time assuming that you become one of them. The
concept of participant observation has become a cliche we often use without much
reflection. A new concept could open our eyes and minds to what it means to do fieldwork
and to grasp the critical dialogical relations we create with the people we study, regardless
of whether we do fieldwork in the mud or on the street (Kapferer 2006) or amongst the
blood and the stainless steel of the hospital.

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Notes
1. There is a fourth possible role in some healthcare settings, though not in Denmark, the role of
volunteer. In the ward in the hospital in The Netherlands where I did fieldwork, middle-aged
women undertook volunteer work consisting of taking care of the flowers of the patients and
helping with the distributing of food and drink.
2. The character of and the relative limited number of possible roles in the hospital makes it
difficult to engage in what Otto calls cultural role-plays (see Otto 1997).
3. In the health sciences in general and in medicine especially, qualitative research studies have
a low ranking (when ranked) on the highly influential evidence scales (see Sackett et al. 2000;
Robson 2002).
4. I had the same experience with the smells and odours of the hospital and the clinic. Working as
a nurse I didnt notice the sometimes bad smells and odours, but now as an anthropologist I was
very aware of the different smells. I still though am able to eat with pleasure and at the same
time talk about and listen to stories about bodily fluids, wounds, blood etc.

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