The discursive construction of competence and responsibility in medical collegial talk

Abstract

The paper explores the construction of clinical competence in the spoken discourse of physicians. The analysis is derived from transcribed recordings of physicians' talk in the specialty of Haematology in an American teaching hospital. It is argued that current discussions of 'competence' among medical sociologists and anthropologists are not adequately based in the direct observation and recording of physicians' professional, collegial interactions. It is argued that physicians' constructions of case narratives and presentations inscribes the evaluations of the responsibility and competence of other physicians, through the representation of their agency and character in the course of accounts of cases. The paper thus addresses the naturally occurring use of 'evidence' in a clinical setting, and is an invitation to more naturalistic studies of 'evidence-based medicine'.

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