Early conversations with participants revealed that the way concerns were expressed (outside the consultation; invited by the professional; opportunistically in a lapse or interval in the spoken activity; as an extension of an answer to another question; deferred to a consultation at another time) was shaped by the clinic environment. Through observations, interviews with patients and health care professionals, and review of the consultation recordings, I became increasingly attuned to the need to pay attention to the physical layout of the clinic, and health professionals' and patients' use of clinic space, in order to locate and understand the opportunities for patients to express their concerns.
Spatial dimensions in the clinic
In interviews, and as recorded in my fieldnotes from conversations with the multidisciplinary team, professionals constantly referred to 'environment' when talking about how they co-ordinated care for patients, how they communicated with them and how they involved them in decisions. That this was such a discussion point is testimony to the challenges the environment presented. Communication took place everywhere, and despite the challenges and apparent chaos, the ways space was used enabled different forms of expression of patients' concerns, involving different members of the multidisciplinary health care team. For patients, the clinic's geography furnished their experiences of illness and of their care. Through it they gleaned information and insights into the nature of their cancer and the treatment options available, and, in voicing their concerns in interviews with myself, and explaining whether or not they would express these to the doctor, they made reference to this geography. In both clinics, the three main arenas in which consultations took place were the consulting room, the 'quiet room' and the area comprising the corridor and waiting room (Figure 9.1).
The consulting room housed formal presentation of diagnoses and medical treatment options. The corridor and waiting room created opportunities for chance meetings and picking up on patients' concerns that remained unvoiced, or partially expressed, in the consulting room. The quiet room provided uninterrupted space for reflection and consolidation of the prior, more formal surgeon consultation.