“Difficult to assess in this manner”

An “ineffective” showing sequence in post-surgery video consultation

Abstract

There is a growing interest in telecare, particularly in the kind of “invisible work” involved in teleconsultations (Oudshoorn, 2011). One dimension of this work is the “sensory work” in support of clinical examination at a distance (Lupton & Maslen, 2017). More research is needed to understand how such sensory work is done in and as multimodal interaction (Mondada, 2019). Recent work has shown the extent to which such sensory work could be re-mediated, despite challenges due to the technology, in particular the asymmetry of sensory access (Seuren et al., 2020; Stommel, Van Goor, & Stommel, 2020). In earlier research, we found that showings occurred less frequently in post-surgery consultations conducted through video rather than face-to-face (Stommel et al., 2020). Moreover, in spite of the apparent relevance of visual access, it seemed as if showings were even being evaded. In this article, we use a conversation analytical perspective to examine one case of emergent showing sequences in a video-mediated post-surgery consultation, in order to track its sequential organisation, which develops towards an eventually inadequate showing. The case comes from a set of post-surgery consultations with patients who had undergone tumour resection (abdominal surgery) two weeks earlier. We first present a case from an in-person consultation, in which a showing sequence is inserted smoothly and closed with mutual assessments. Next, we focus on the VMC-showing, which is also inserted in the context of a patient question concerning the surgery scars. We analyse the context leading up to the showing, the showing itself and the abandonment of the showing sequence. We found that, first, the showing is not initiated at the earliest sequential opportunity, but is requested with an orientation to potential barriers. Second, screen-based evidential boundaries emerge, as the surgeon has no visual access to what is shown, in response to which the surgeon employs remedial action. Third, the surgeon moves out of the showing to an instructed touch-sequence – in other words, displays of visual appreciation are neither produced nor pursued. Upon the surgeon’s closing formulation that it was “difficult to assess in this manner”, the contextual factor of visibility is eventually explicitly claimed to be “ineffective” for medical assessment. These findings might explain the scarcity of showing sequences in our data. More generally, they raise questions about (the limits of) sensory work in video consultations.