Strategic use of space in the clinic

The co-existence of different 'spaces' allowed patients to express different aspects of their concerns. Through their concerted use - for example talking about a patient's concern about treatment in the corridor, and then addressing this concern more formally in the consulting room - professionals could create a variety of forms of communication. By meeting the boundary, or providing overlap between, a consultation in one space in the clinic with another, patients' concerns found fuller expression.

It was possible for professionals to orchestrate meetings with patients and other members of the multidisciplinary team: by 'floating around' in the corridor, or by being 'seen' in the consulting room. For the specialist nurse, dietician, and speech and language therapist, this reliance on movement meant not only that the clinic's geography played a significant part in their ability to make contact with their patients; but also that they were able, through movement, to overcome some of the challenges presented by the physical layout (such as the boundaries between more public and private spaces) for all professionals' and patients' communication with each other. (See also Rushing's (1964) study of occupational therapists' work in a psychiatric hospital, and Allen's (2001) observations of nurses' movements in hospital as 'institutional glue'.)

The bounded nature of the surgeon's consultation in the main consulting room meant that problems that might come later tended not to be raised at all. Certain treatment topics, if not mentioned in the main consulting room were later raised in passing, as if already spoken about. For example, loss of sensation from nerve damage during surgery, effects on teeth, problems in everyday stoma management: these patients generally discovered for themselves. This led some patients to speculate, in interviews, as to whether, had they known these long-term effects, they would choose those forms of treatment. Autobiographical accounts provide similar reports of casual references to side-effects: a first mention of dental treatment (Diamond, 1998: 83), or hair loss (Piff, 1985: 23).

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