Role in the clinics

Those experienced in undertaking clinical ethnographies in “elite” field sites highlight that the clinic is a busy place where “time is always at a premium” and a space which can be “an intimidating and confusing” for participant observers (Franklin and Roberts, 2006: 84). In this respect, I often felt aware of not having a legitimate defined role and not wanting to be obstructive, in a setting in which everyone was busy performing tasks. Initially I felt tense and awkward about my role in ‘observing’

clinicians, who were only used to being externally observed by regulators and new members of staff, and tried hard to position my presence as akin to the latter.

However, as time progressed, I found myself more familiar with and engaging in the

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etiquettes of the clinics and felt that my presence had been accepted by participants, which helped to legitimise and define my role as a researcher (for both participants and myself).

At Creative Fertility, I was much more of an observer than participant. The formal structure and organisation of clinic meant that there were clearly demarcated roles for staff, and so it was difficult to ‘participate’ and immerse myself in the clinic.

However, attending the clinic on a regular basis to undertake general observations was more difficult, unless I had a pre-arranged reason to be there (i.e. observations of specific events and interviews). At The Fertility Centre, I was more of a participant (and observer), as I became more integrated in the clinic’s culture. However, this did not always translate into observations of matching related activities. Furthermore, at the beginning of fieldwork, my attendance at the clinic was patchy, infrequent and dependent on my gatekeeper. At The Fertility Centre, donor allocation was often undertaken informally, by clinicians in isolation or during informal meetings, making it difficult to pre-arrange observation of these sessions. Trying to observe donor allocation in the clinic was difficult, time-consuming, and often an unsuccessful process.

It wasn’t uncommon for my gatekeeper to contact me the night before arranged matching sessions to cancel my going in, or for the sessions to be cancelled on the day itself, because the clinic was “too busy” to have these sessions. For several weeks at a time my gatekeeper didn’t respond to my e-mails or phone calls and I was unable to attend the clinic. Other times, my gatekeeper would telephone me to inform me that she was “in the “mood to do some matching”, giving me less than an hour’s notice to reach the clinic. In all, my gatekeeper cancelled my going into the clinic or my observations of donor allocation for 4-5 months of fieldwork. When I told the Clinic’s

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Director that I was not observing as many matches as I had hoped, she began scheduling matching sessions into the clinic’s diary. However, these were frequently cancelled. Although I arranged to work-shadow the nurse undertaking donor allocation at The Fertility Centre, this did not result in significantly more observations of this practice, as the nurse continued to allocate donors to recipients outside of observations.

For the last 3 months of fieldwork, I decided to ask the nurse about the matches that she had made in retrospect, at the end of every week (as advised by my supervisor).

After spending over a year in the field at The Fertility Centre I felt like I had ‘failed’

in finding out how donor allocation was undertaken and that despite my best efforts at systematic observation ‘it was all happening elsewhere’ (Hammersley and Atkinson, 2007). However, near the end of fieldwork I realised The Fertility Centre had its own model of matching, and it was this informal model of matching’ that I had documented over a long period of note taking. Furthermore, I realised that to a large extent ‘matching sessions’ at The Fertility Centre appeared to have taken place for the purposes of this study. When I stopped asking to observe these sessions no subsequent matching sessions were scheduled in the clinics’ diary (which I had access to).

Halfway through fieldwork, the director of clinic asked me to undertake a ‘data-inputting’ role, as the clinic had installed a new database during fieldwork and needed to transfer patient information from the existing patient files onto the new system. I agreed to input information about donors and recipients who had been matched at the clinic, and it was agreed that I could anonymise and use the information I inputted for my own research. My role as ‘data-inputter’ legitimised and normalised my presence in the clinic and allowed me to undertake general observations.

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My integration into The Fertility Centre, at different levels over time, was also evident in the activities that I undertook at the clinic. I was commonly asked to buy milk, make coffees, to escort patients between appointments, to retrieve patient files and later to answer ringing telephones and to update patients with non-clinical information. I was told I no longer needed to sign the ‘visitor book’ and was invited to the staff Christmas party. Having this defined role meant that I could access the clinic more frequently, independently and easily. Whilst my access to observing clinicians’

practices of matching still depended on my gatekeeper (Noreen) having a regular presence in the clinic meant that Noreen often approached me spontaneously to observe her undertaking matching activities.