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Breaking the ceremonial order: patients' and doctors' accounts of removal from a general practitioner's list

By Tim Stokes, Mary Dixon-Woods and Simon Williams


This is the authors' final draft of a paper published as Sociology of Health and Illness, 2006, 28(5), pp.611-636.The removal of patients from general practitioners’ (GPs) lists in the UK offers important sociological insights into what happens when the doctor-patient relationship ‘goes wrong’. An interactionist analysis shows how removers (doctors) and removed (patients) strategically invoke ‘rules of conduct’ to account for difficulties in the doctor-patient relationship and for GPs’ decisions to end their relationships with patients. In this paper we extend this analysis through recourse to Bourdieu’s theory of practice, by juxtaposing ‘paired’ accounts of the same removal event by both remover and removed. Our analysis demonstrates the unthinking or non-reflective nature of people’s understanding of the rules governing social interactions, but also demonstrates how apparent rule violations make the rules explicit and expose patterns of power distribution. We argue that removal of patients amounts to a strategic exercise of symbolic power by GPs, and that this is experienced as an overtly violent symbolic act by patients. A theoretical reconciliation of interactionist theories of the doctor-patient relationship with Bourdieu’s theory of practice is both possible and profitable, providing a micro-macro link in which issues of capital and power within the health (care) field are brought to the fore

Publisher: Blackwell Publishing
Year: 2006
OAI identifier:

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  1. (1994). A narrative perspective on mediation. In doi
  2. (2004). A sociological perspective on public participation in health care.
  3. (1997). Accounts, Interviews and Observations. In doi
  4. (1994). Being heard: the report of a review committee on NHS complaints procedures. London: Department of Health.
  5. (2003). Breaking up is never easy: general practitioners’ accounts of removing patients from their lists. doi
  6. (1998). Case Studies. In doi
  7. (1987). Communication and Medical Practice: Social Relations in the Clinic. doi
  8. (1997). Culture and Power: Sociology of Pierre Bourdieu. Chicago: doi
  9. (1984). Distinction: a social critique of the judgement of taste. doi
  10. (1980). Doctors and dirty work - the case of alcoholism, doi
  11. (2002). Ending the doctor-patient relationship: an investigation of the removal of patients from general practitioners' lists [PhD thesis].
  12. (1992). Erving Goffman and Modern Sociology. doi
  13. (1996). From fear to fraternity: doctors' construction of accounts of complaints, doi
  14. (1975). Going to See the Doctor: The Consultation Process in General Practice. London: Routledge and Kegan Paul. doi
  15. (2001). House of Commons Select Committee on Public Administration (2002). Fifth Report For Session
  16. (1989). Ideas About Illness. doi
  17. (1997). Illness and narrative. doi
  18. (1995). Interpretation, structuration and rules. In
  19. (2002). Investigations completed December 2001-March 2002, Chapter 2.
  20. (2004). London: The Stationary Office Limited.
  21. (1998). Maintaining professional identity: doctors' responses to complaints. doi
  22. (1988). Minor courtesies and macro structures. In
  23. (1981). Moral tales: parents' stories of encounters with the health professions. doi
  24. (1979). Negotiations, Varieties, Contexts, Processes and Social Order. San Francisco: doi
  25. (1979). Normal rubbish: deviant patients in casualty departments, doi
  26. (1967). On Face-Work. In
  27. (2003). Patients' accounts of being removed from their general practitioners' list: qualitative study. doi
  28. (1995). Patients' influence on doctors' behavior: a case study of patient strategies in somatization, doi
  29. (2004). Primary care and general practice
  30. (1977). Roles, Role Formats and Medical Encounters: A Cross-Cultural Analysis of Staff-Client Relationships in Children's Clinics, doi
  31. (1970). Rules of Conduct and the Study of Deviant Behavior: Some Notes on the Social Relationship. In
  32. (1988). Shadowland: general practitioners and the treatment of opiate-abusing patients, doi
  33. (1968). Stigma: notes on the management of spoiled identity. doi
  34. (1990). Strategic Uses of Narrative in the Presentation of Self and Illness: doi
  35. (2002). Supporting the implementation of Patient Advice and Liaison Services: A resource pack.
  36. (1990). Surveillance and concealment: a comparison of techniques of client resistance in therapeutic communities and health visiting.
  37. (2003). Symbolic power and organizational culture. doi
  38. (1979). The Ceremonial Order of the Clinic: parents, doctors and medical bureaucracies London: Routledge and Kegan Paul. doi
  39. (1984). The Constitution of Society. Cambridge: doi
  40. (1990). The Logic of Practice Cambridge:
  41. (1980). The View from Goffman. doi
  42. (1995). Theorizing class, health and lifestyles: Can Bourdieu help us?. doi
  43. (1994). Two sides to every story’: complainants' and doctors' perspectives in disputes about medical care in a general practice setting. doi
  44. (2003). Violence against doctors: a medical(ised) problem? The case of National Health Service general practitioners. doi

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