This book is centred around ethnomethodological analyses of talk that took place during case meetings in a hospital stroke rehabilitation ward. A setting par excellence where decisions are indeed made about people. The aim of the research, following standard ethnomethodological concerns, was to explicate the taken‐for‐granted conventions that govern such decision‐making processes. In other words to make explicit the (normally implicit and unexamined) rules and underlying expectations of the decision makers themselves. Such concerns mean that the book had little in common with conventional management textbooks on decision making; it resonated much more with research centring on the micro‐processes of social interactions, exemplified in the health field by texts such as Medical Talk and Medical Work (Atkinson, 1995).
In order to locate itself precisely within a sub‐stream of the ethnomethodological tradition, the book opens with a headlong plunge into detailed and fairly technical debates about controversies within ethnomethodology. These (sometimes for me at least) rather abstruse debates continued throughout the book, cropping up regularly even in later sections that were ostensibly primarily considering empirical material. Unfortunately, this tended to obscure some of the analytical points. Needless to say, such discussions are more likely to be of interest to specialist sociologists than to general readers. People who want to start to explore ethnomethodology and its application to organizational research would be better off looking at more introductory work such as Hassard (1990) or Richards (2001), perhaps returning to this book once their appetite for ethnomethodology has been whetted.
Following the scene setting we finally get to a discussion of the empirical material, the bulk of which consisted of meticulous examinations of two quite lengthy verbatim transcriptions of the proceedings of case meetings – given in full as appendices. This material was minutely dissected in order to examine what taken‐for‐granted meanings the participants shared with one another, meanings that enable the meetings to proceed in ways that were more or less straightforwardly intelligible to those involved. To indicate the flavour of the kind of issues explored, this is an excerpt discussing the significance of the lack of talk about the fact that one particular patient suffered from diabetes:
Although this [the diabetes] might legitimately be construed as a problem … for the purposes of her rehabilitation … it is discarded. This means that her career [journey as a patient] as a‐typical‐course‐of‐treatment‐leading‐to‐a‐standard‐outcome … can continue. What is of interest here is not that this career can be spelt out in its specific features, but that these features do not require such spelling out. It would be singularly inappropriate for any member of staff to say “if there is no medical problem with her blood sugar we can continue to treat her as we would any such patient, which means doing the following things … A legitimate question that might be asked is why such spelling out would be required of someone who is supposed to be a competent practitioner of rehabilitative treatment. Such competence does not just mean knowing what needs to be done, but also requires an awareness of what does and does not need to be said to other competent practitioners” (p. 102).
The whole work seemed primarily orientated towards describing the conventions operating in this environment rather than seeking to examine what seems to me a more interesting issue – what generates the conventions. I suspect an assertion that actions are governed by conventions will cause little controversy and that explicating them in the way attempted might leave many readers asking the question, “so what?”. For example, the claim that to appear competent in a particular setting “requires an awareness of what does and does not need to be said” seems to me to be veering towards a rather trivial and uncontroversial point. Wider social questions at a supra‐individual level, such as why actors might feel constrained to appear to be competent, are potentially more interesting and yet were outside the concerns of the research.
In summary then, this book is doubtless not without merit to specialists committed to ethnomethodology and I suspect that non‐specialists, especially those in the fields related to rehabilitation, are likely to find a number of unconventional and thought‐provoking questions raised. However, bear in mind that it is much more concerned with the debates in ethnomethodology than it is with casting light on the standard topics currently preoccupying research in health care decision making.
