Territories of knowledge, professional identities and patients' participation in specialized visits with a team of practitioners

Objective: In specialized healthcare visits with a team of practitioners, the examination phase is a collaborative work where multiple professional competences are indexed and activated, contributing to a complex ecology of knowledge. The doctors' need to consult their colleagues might take over and collide with patients' understanding and willingness to participate. We describe the practices through which practitioners accomplish teamwork and how these impact on patients' participation. Methods: Using conversation analysis we investigate 30 video-recorded visits where patients with an injured upper limb meet a team of practitioners in an Italian centre for prosthesis construction and application. Results: Analysis shows the collaborative practices and division of labour through which practitioners activate their territories of knowledge in the service of the joint activity of evaluating the patient limbs' conditions. Whereas professionals orient to their different competences, patients keep their body available for inspection, monitor the ongoing activity, draw assumptions about their own conditions and tentatively claim their epistemic rights. Conclusions: Doctors' orientation to teamwork involves the enactment of tacit communicative practices and the use of technical language, which might prevent or mislead patients' participation. Practice implications: Doctors should employ communicative practices to ensure patients' understanding and participation in the unfolding examination activities.