Breaking the Ceremonial Order: Patients' and Doctors' Accounts of Removal from a General Practitioner's List

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 the analysis is extended through recourse to Bourdieu's theory of practice, by juxtaposing 'paired' accounts of the same removal event by both remover and removed. The 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. The authors 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.

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