The routine of data collection

The cyclical pattern of the DRS (Spradley, 1980) permitted return to the exploration of the wider context of the practice setting with continuation of fieldwork, conduct further observation, to interview, write, decode, translate and decode and analyse (Fig. 4.2).

Fig. 4. 2 The cyclical experience of the DRS. (Adapted from Spradley, 1980).

Fieldwork Immersion Data collection Writing and describing Translating and decoding Analysis of the data Saturation Exiting fieldwork Participant Observation of clinic activities Interviews and recording

DRS sequencing helped me to systematically explore the cultural perspective in a way that is workable and that allowed me to re-enter a particular aspect of data collection (Spradley, 1980). Analysing data was therefore ongoing and concurrent with data collection whilst in the field setting and involved the search for commonalities in the patterns of clinical activity and exceptions in the relationships of these recurrent activities and interactions between practitioner and clients.

Each entry into the field allowed opportunity for specific questions to be asked and, to make further observations from which the data was complied then analysed. Working through these stages and from the field notes, assisted to discern and to confirm the patterns that emerged within the setting and the authenticity of the participant observation. The format of documenting field notes followed the principles suggested by Spradley (1980).

Field observations were initially recorded in notepad form and then written more fully as notes and arranged chronologically. Notes were made to capture the lived experience of the clinic, the people and the practitioner (Field & Morse, 1985). Transcribing these notes become imperative to ensure there was consistency in observations by using guidelines according to the convention of the DRS that helped identify patterns of interaction. To identify specific patterns of interaction observed from the clinic setting the notes were numerically coded and identified by date, time of day, chronologically arranged and a review conducted on these at the end of the day.

The clinic was open from 1000 to 1700 hours each day and during this time usually on a Tuesday, Thursday and Saturday I made notes of those interactions observed each day in the clinic. In the clinic under observation, two practitioners were usually present. One practitioner conducted client assessments while the other dispensed herbs. Prior to conducting an assessment the practitioner informed the client that I was there to observe the procedure and the client’s consent was obtained. Field notes were then made of activities in the assessment room and in the waiting room. I did not participate in any of the clinics work practices and attempted to remain unobtrusive at all times (Agar, 1986; Hammersley & Atkinson, 1995; Marcus, 1986).

If a client did not wish me to sit in on the assessment I would go to the main herbal room to observe any interactions that took place there. Usually this consisted

of people who came in to purchase herbs over the counter. The herbalist would sell herbs and give informal advice on the various herbs. An example is when a client came in to ask for pain relief. The herbalist would ask ‘what kind of pain?’ or ‘what is your particular problem?’ and ‘why have you come to visit the clinic?’. The practitioner would then provide herbs made in capsule form. Herbs were dispensed after clients had been through the assessment consultation with the practitioner. When it was not possible to directly observe a clinic interaction, as for example, if a client refused permission, I reviewed the clinical assessments made by the practitioner at the end of consultation. appointment with the client. At least seven to ten clients visited the clinic each day for a consultation. Some were repeat consultations to follow up with their treatments and the number of follow up visits made ranged from four to six over fortnightly or weekly intervals depending on the specific problem.

Following client consultations, I approached the practitioners when time permitted or at the end of the working day clinic to discuss specific features of the assessment technique and selection of treatment. The practitioners referred to the notes they had made, which were written in Mandrin. They would then go through the diagnosis with me and explain how they had made their observations. Physical observation of the client included inspecting the tongue, taking the pulses on both wrists before any notes were made on the client’s general condition. To differentiate between the entries of field notes and to separate direct quotes provided by the practitioner on their observations, commas and brackets were used in the field notes (Kirk & Miller 1986). For example differential diagnosis related to the theory of Yin and Yang was explained by the practitioner as:

- “Yin and Yang”,

- [when we study] [the basic] [theory]

- “The symptoms” [belong] [are caused] by

- [“hyperactivity”]

- “Exhibit signs “When [we find] [the symptoms”]

- “Yang deficiency” [deficiency of ] [Yang”]

The process of recording the terms used such as ‘yin and yang’, ‘hyperactivity’, ‘yang deficiency’, ‘hyperactivity of yin’ ‘when we find’ and the meaning attached to these by the practitioner helped to identify the semantic relationships in domains in the diagnostic assessment. This is discussed further in Chapter Six. Memos made during the fieldwork were used to record thoughts and interpretations against the more detailed and explicit field notes. Memo’s also assisted with the follow up discussions with the practitioner for any detail I had not understood about a particular practice or treatment of TCM. An example of the notes I took is given below.

I observed Practitioner (1) commence a first assessment on a client at 11.30am. He took a sheet of paper which he placed in front of him on the desk and proceeded to ask the client questions related to their illness. He asks the client “do you prefer to drink hot or cold fluid”? As he listened to the client he made notes on the paper [the client history sheet that he had placed in front of him]. These notes were written in Mandarin. He then proceeded to make his assessment based on the method of Sizhen (Figure 4.7).

Why does he ask about whether they feel they [prefer to drink hot] or [cold fluid]” Why [does he then ask them] if they have [dizziness] and/or [insomnia]? What connection is he trying to make? What conclusion has he made from this information in his assessment? [Memo from the Hanyu clinic], how has he deduced what the person is suffering from after he has analysed these symptoms related to the condition. I would need to discuss these connections with the practitioner after the consultation ended.

In reference to my memo I verified my understanding of the assessment with the practitioner. For example, the practitioner informed me that if a person is experiencing inner cold they prefer warm fluids to drink. When the person experiences inner heat they prefer cold fluids. This applies to both acute onset illness and ongoing chronic conditions that the client may present with. Another example is when a person says they feel dizzy or suffer insomnia, which may be linked to a heart or liver ailment. Journal notes made of clinic encounters recorded of TCM practice in China helped me to reflect and to re-interpret TCM activities in the practice (Geertz, 1988; Strauss & Corbin, 1998).

Interpretations made from these journal notes and the bracketing assisted in the discovery of patterns that formed a composite picture of the life observed within the clinic (Hammersley & Atkinson, 1995; Spradley, 1980). These patterns provided interpretation from which I was able to “… make sense of the cultural practice that is part of the cultural plot” [of the TCM practice] (Lentricchia, 1990, p. 335). A basic understanding of how TCM was managed gradually emerged from the exposure to the clinical setting.