Ethnographers study how people make sense of the worlds they live and work in by spending time with them, observing everyday practices and paying close attention to relationships and context. But what happens when the ethnographer is also a doctor studying a hospital environment that is already deeply familiar to them?
In a new article in Qualitative Research in Medicine & Healthcare , David Wenzel, a physician and doctoral researcher at the University of Leicester, examines how his clinical identity shaped ethnographic fieldwork in acute hospital settings. The fieldwork formed part of a wider study of end-of-life care for patients using non-invasive advanced respiratory support.
Wenzel found that his position in the clinical environment changed according to how other people understood his role. When he introduced himself as a doctor undertaking research, staff often trusted him quickly and spoke in compressed, technical language. In contrast, when he presented primarily as a PhD student, staff were more likely to explain their reasoning, hesitation, emotions, and the relational work involved in caring for patients.
Small changes could have striking effects. “Wearing a student lanyard, for example, made me far less visible to medical staff than I was accustomed to being as a doctor,” shares Wenzel. “This change disrupted my usual place in the flow of clinical information and made me more attentive to forms of work I had previously overlooked, particularly the emotional and relational work undertaken by nursing staff.”
The study also reflects on situations in which Wenzel's responsibilities as a doctor came into tension with his role as an observer. “In some circumstances I intervened to prevent a clear clinical error; in others I withheld a medical opinion because I was not part of the treating team,” says Wenzel. “Both intervention and restraint changed the relationships around me, showing that professional authority can remain influential even when it is not actively exercised.”
Wenzel did not, however, propose a single ideal position for clinician-researchers. “Moving between insider and outsider positions can reveal how authority structures work; who is expected to speak, who is expected to explain, and whose uncertainty is visible,” he adds. “Reflexivity, the deliberate examination of the researcher's own position and influence, therefore becomes more than a statement of potential bias; it becomes part of the analysis.”
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Contact the author:
David Wenzel
School of Medical Sciences, Public Health and Epidemiology, University of Leicester, Leicester, UK
dw343@leicester.ac.uk
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Qualitative Research in Medicine & Healthcare
Observational study
People
Dual perspectives: Navigating the roles of physician and ethnographer in sensitive spaces
The author declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.