The corridor and waiting area
The corridor and waiting area provided most opportunity for the nurse, speech and language therapist and dietician to make contact with patients. The dietician commented that the layout made a significant difference to her communication:
In [a previous clinic] I was right at the end of a corridor, and I wouldn't necessarily see all the patients coming through ... Whereas you're right in the heart of this clinic, you see a lot of people you know just to say hello to, find out how they're getting on ... And you can feel free to go in with any of the consultants.
(Dietician, Interview, Clinic A)
Conversations in the corridor, immediately before and after the surgeon's consultation, provided opportunities for patients to rehearse a concern, clarify their understanding, ask a question, or revisit a decision. Here, communication was more open and fluid. The fieldnotes, consultation recordings, and interviews showed how conversations in the corridor were generally brief and spontaneous, and served a variety of purposes: a patient's rehearsal of a concern before mentioning it to a surgeon; a professional's opportunity to catch up with a patient's progress; clarification of a treatment issue the surgeon had raised in the main consultation. I observed that, for patients on return visits to the clinic, it was as possible for them to approach professionals spending time in the corridor as it was for those professionals to approach them: passing one another, or being visible, in the corridor, allowed conversations to take place. This lent these consultations symmetry and informality, marking them out from those in the main consulting room. The following extract, from an impromptu conversation in the corridor between a patient who has had a laryngectomy and the speech and language therapist, prior to the patient's consultation with the surgeon, is a case in point. Sitting in the waiting room, the patient saw the speech and language therapist, and sought her out. They both moved to the other side of the corridor, where an unused space and the wall they leaned against provided some privacy, and the patient began to outline his current concerns, as a means of preparing for his consultation with the surgeon. The extract opens with the speech and language therapist reinvoking a topic, 'swallowing', mentioned first by the patient, and the speech and language therapist's apology for interrupting suggests a symmetry about each other's respective contributions to the interaction. The patient responds to this invitation by specifying his concern, 'little bit harder to swallow', and reflecting on possible reasons for this. He continues to list a number of topics he wishes to raise with the surgeon in the main consulting room, to which the speech and language therapist responds with minimal acknowledgements and agreements that endorse what the patient is saying:
- 1 SLT: .hhh Yes (.) sorry (.) I interrupted you (.) your swallowing
- 2 Pt: Yeah (0.3) (it's just) about the last two weeks [it's been a=
- 3 SLT: [mhmm
- 4 Pt: =little bit 'arder tuh swallow
- 5 (0.4)
- 6 Pt: .hh an ahh don't know if it's my oesophagus is getting a little bit swollen
- 7 (.) or my saliva is a bit thicker or what I don't kno[w I'll ask th- =
- 8 SLT: [Right
- 9 Pt: =professor t'day
- 10 SLT: Ye:s ye:s
- 11 (.)
- 12 Pt: A couple of other little things to ask him as well
- 13 SLT: Ri[ght
- 14 Pt: [Er:m (.) basically do I 'ave to 'ave anymore tests to make sure that it's
- 15 gone
- 16 SLT: Right
- 17 Pt: Er: yuh know for example a scan o[r ] whatever I don't kno[w
- 18 SLT: [yeh] [yeh (.)°yeh°
- 19 Pt: An' also the after effects of the radiotherapy's still there
- 20 SLT: ?Yeah[:
- 21 Pt: [an I've stopped me drink...
- (Consultation, B-103-306)
In this sequence, the patient expresses, among other concerns, a desire to know whether the cancer has gone or not 'do I have to have anymore tests to make sure that it's gone' (lines 14-15). Working through this list with the speech and language therapist in the corridor provides a form of rehearsal and a means of legitimising concerns the patient wishes to express to the surgeon.
Another example, taken from my fieldnotes, illustrates how the corridor provided an opportunity for patients to revisit concerns not fully addressed in the main consulting room.
In the main consulting room, the patient asked the surgeon a question about the frequency of the radiotherapy treatment that was being proposed. 'We work two weeks on you see' the patient added, by way of explanation. This second explanatory part was not picked up on by the doctor, who answered the question in terms of the radiotherapy schedule in general, but not in a way that addressed the patient's concern (how would the radiotherapy fit around his work - would it affect it?). The patient didn't pursue his reason for asking. Later I heard the patient put the same question to the speech and language therapist, outside the consulting room door. The speech and language therapist heard both the question and the concern underpinning it, and relayed the whole back to the surgeon, to have it answered for the patient.
(Fieldnotes, Clinic B)
In the waiting area, the visibility of people's illness, in close proximity, signified cancer, and forewarned of treatment. This might be considered expedient: noticing others' conditions gave patients a way of gauging their own progress. The waiting room also provided a measure of how busy the clinic was that day. Patients tailored what they said to the surgeon accordingly, saving questions for another time:
I find if you go early in the day ... you're in and out pretty quickly and everything's okay ... if you're later he tends to be running late by then, and also he looks very tired ... so ... I really wouldn't want to start asking questions to him then - sometimes I've gone in and he looks exhausted.
(Interview, Patient with facial cancer, C-310)
Patients developed an awareness that different treatments signified different degrees of severity. From sitting in the waiting room, they compared themselves with others to measure their own progress; often, to reassure themselves about their own state. For example, patients expressed their relief (on hearing they did not need surgery) in terms that presented themselves as better off than others around them:
I'm only glad I hadn't to ... talk like a dalek. I know it's awful for these people that do but I would never have spoken again.
(Interview, Patient with throat cancer, C-357)
Patients also related how they drew on others' experiences, sitting in the waiting room, to prepare themselves for what lay ahead:
There was a young chap just before [my partner] ... He was our little rock if you like. We could see all his stages - that's the next one, then that's the next one ... It was follow my leader sort of thing.
(Interview, Partner of a man with laryngeal cancer, D-349)