Ethnomethodology is a sociological discipline which focuses on the ways in which people make sense of their world, display this understanding to others, and produce the mutually shared social order in which they live. It is distinct from traditional sociology, and does not seek to compete with it, or provide remedies for any of its practices. Furthermore, ethnomethodology is concerned with the"how" (the methods) by which that social order is produced, and shared (1,2).
It seeks to describe the practices (the methods) these individuals use in their actual descriptions of those settings. Ethnomethology may ask, how do people perceive understand and explain the world in which they live? Specifically, with patient care, it may ask, are these perceptions and beliefs about the world changed when we become ill?
Ethnomethodology is particularly concerned with cultural differences in explanations offered, especially the influence of social norms on the communication process. This cultural context is particularly significant when a patient tries to understand or the doctor tries to explain a condition, for example, a disease or newly diagnosed cancer.
The approach, literally, 'the study of a people's (folk) methods' was developed by Harold Garfinkel in the 1960s, based on his analysis of traditional sociological theory, traditional sociological concerns, and the phenomenologies of Aron Gurwitsch, Alfred Schutz, and Edmund Husserl. Ethnomethodology has had a significant impact on social scientific inquiry. For instance, ethnomethodology has always focused on the ways in which words are dependent for their meaning on the context in which they are used. This has led to insights into the question of the objectivity of the social sciences, and the difficulty in establishing a description of human behavior (1,2).
Ethnomethodology is a qualitative method, involving participant observation, usually involving the researcher becoming very closely involved with the group under study. So, for example, a researcher who was interested in the way in which social interactions between staff and patients may influence patient care may adopt an approach in which they, as part of the health care team, observe these social interactions from within the group under study.
It is a method that focuses on an area often overlooked in health care== the cultural influences on medical care delivery and how patient perceive and understand their interactions with their doctor, their disease, the exam room, and possibly, with a 3rd actor in the exam room, the computer.
Often to apply this method one must be an actor in the setting, for example, a researcher observing the doctor-patient interactions with a newly implemented EMR. If the doctor and patient are aware of this analysis then the cultural nuances may be lost or biased. Also, it can be hard to be only an observer and not instill your own biases culturally or otherwise.
Examples in informatics
Soc Sci Med. 2006 May;62(9). 2267-78.
“Doctor-patient interaction in a randomised controlled trial of decision-support tools.” This study used ethnomethology to explore doctor-patient encounters in an experimental trial of a complex intervention. It studied the different roles of doctors and patients when using a decision support system-roles defined as authoritative or neutralistic doctors, and passive or active patients.
Inform Prim Care. 2005;13(1).13-22.
“Communicating about medications during primary care outpatient visits== the role of electronic medical records.”
This study assessed the role (by using ethnomethology) of electronic medical records (EMR) in facilitating the content and process of patient-provider exchanges about medications during outpatient primary care visits. EMR facilitated content and process of communication regarding medications during outpatient encounters, especially among patients taking multiple medications and patients who used physical descriptions to identify their medications. EMR use stimulated medication exchanges, leading to further expansion about the topic. However, less than one-fifth of exchanges ended with clear conclusions by both parties regarding prescribed medication regimens.
- Bowers L. Int J Nurs Stud. 1992 Feb;29(1)==59-67.
Amit Shah, MD as001