constituting vision: social interaction and professional practice in optometry (w. gibson)
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Constituting Vision
A study of social interaction and professional practice in optometry
Will Gibson - [email protected]
Optometry
• Study of the operations of the eye• Only interested in visual experience as far as it
aids the assessment of visual acuity/eye health
• ESRC study to look at communication in optometry and the roles of technology in the process of visual assessment
Conversation Analysis
• Social structures and practices are made and displayed through interaction
• Through their talk and actions people display their understandings/analysis of social context
• Aim of our study is to unpack the tacit understanding of optometric work as seen within the actions in consultations
The Distance Vision Test
• Usually a test that comes at the start of the sequence of tests (after history taking)
• Patient read out lines of letters from a sheet at a distance from them
Optometrists have three ways of starting a test. They choose which formulation on the basis of:
• The optometrist’s level of experience• The level of knowledge they have about the
patient, gleaned by the history taking or by prior knowledge
(1) The textbook way: “Please read the smallest line that you can see on the chart” (Elliott 1997: 32)
Pauses as indications of • The apparent reciprocity of gesture is similar to other medical contexts
• Centrally though, the feature of this formulation is that it means the patient has to self-select an appropriate line that they can read – This is the NORMAL/TEXTBOOK way to start the test
• Ambiguity of what ‘reading’ means
(2) Starting at the top of the chart
• Least common method of starting the test
• Used mostly by more experienced optometrists
(3) Selecting a line to start on
Identifying visual problems through reading and talk
• Reading lines as a proxy for visual experience• Monitoring the way reading occurs to spot
visual problems
• Each line of letters as a turn construction unit• Acknowledgement tokens after each turn
(yeah, good, ok)• Change of acknowledgement token attending
to repair• Changes in reading structure treated as
instances of visual problems
• Reading of earlier letters helps optometrists to establish the normal way of reading letters
• Optometric methodology involves spotting reading differences to identify visual difficulties
• From here optometrists start the ‘test closure sequence’
The test closure sequence
• Sequence begins because of apparent difficulty of reading previous lines
• Administrative activity stops• Close attendance to the patients bodily
postures • Sequences designed to imply possible failure
(saving face for both optometrist and client)
Often the sequence comes very early on in the test process
• Closure of sequence involves production of the test score
• Test does not specify the nature of how something is/is not seen – simply that it can’t be read
• For the score to be correct it is important:– To establish what counts as a normal report on vision– To push someone to try to read something
• Managing the ‘saving of face’ of both optometrist and patient
• The close analysis of conversational structures helps to demonstrate the tacit methodologies of optometry
• There are no manuals or instructions that specify these features of the distance vision test
• The results from the study will be used to inform the design of training courses on communication for optometrists
Concluding Remarks