Boundaries and breakdowns: applying Agar's concept of ethnography to observations in a pediatric clinic

This paper discusses a methodology for observing and describing interactions between clinicians and patients in an inner-city pediatric clinic serving families of diverse ethnicity. The framework is derived from Michael Agar's concept of ethnography as an interpretive, problem-resolving method. In Agar's model, the participant-observer moves cognitively and analytically from focusing on breakdown (awareness of a problem in understanding) to resolution (applying knowledge structures or schemas to bounded phenomena or strips) and ultimately to coherence. This framework applies not only to describing what the ethnographer does, but also stages in the clinician's efforts to communicate. Awareness of repeated breakdowns allows the ethnographer to document fundamental differences in expectations and premises that affect communication between clinician and patient. Two major types of breakdowns are discussed: those occurring between clinic staff and families, and those occurring between staff and ethnographer. Terminological and analytical modifications of Agar's method are recommended to reflect more accurately the ethnographer's degree of involvement in the communication breakdown (active resolution versus passive resolution). The paper concludes that Agar's model provides a useful structure for developing a systematic ethnographic language that can readily be demonstrated and communicated to clinicians.