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The Ethnographic
Radiographer
Ruth M. Strudwick
The Ethnographic Radiographer
Ruth M. Strudwick
The Ethnographic
Radiographer
Ruth M. Strudwick
School of Health & Sports Sciences
University of Suffolk
Ipswich, UK
ISBN 978-981-16-7251-4 ISBN 978-981-16-7252-1 (eBook)

https://doi.org/10.1007/978-981-16-7252-1
© The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd. 2021
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or
the editors give a warranty, expressed or implied, with respect to the material contained herein or for any
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Cover illustration: Pattern © Harvey Loake
This Palgrave Macmillan imprint is published by the registered company Springer Nature Singapore
Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721,
Singapore
Firstly, thank you to my husband Mike for his constant support.
Thank you to my two doctoral supervisors: Dr. Stuart Mackay
and Dr. Steve Hicks.
Thank you to all my colleagues and particularly to Nancy for reading this
book and providing encouragement.
Finally, I would like to dedicate this book to my Dad, Anthony (Tony)
Cooper, who always believed in me, and died before he could see this book
in print.
Contents
1 Introduction to Ethnography and the Ethnographic

Researcher 1
2 Ethnographic Methods 13
3 Working as a Diagnostic Radiographer: Relationships with

Colleagues 25
4 Working as a Diagnostic Radiographer: Structure and

Environment 43
5 Working as a Diagnostic Radiographer: The Role of the

Diagnostic Radiographer 57
6 Radiography Education 73
7 Interprofessional Learning and Working 83
8 Relationships with Service Users and Values-Based Practice 95
vii
viii Contents
9 Summary, Conclusions and Recommendations125
Index133
1
Introduction to Ethnography
and the Ethnographic Researcher
Abstract This is an introductory chapter about ethnography as a meth-

odology and the ethnographic researcher. The chapter provides a back-
ground and rationale for this book and introduces the author with some
autobiographical material.
There will also be an introduction to the author’s doctoral study which
was an ethnographic study of the culture in a diagnostic imaging depart-
ment looking at the professional culture and the ways in which diagnos-
tic radiographers work and interact. The author used participant
observation and interviews with a purposive sample of the staff working
in the department to provide an overview of the culture within the diag-
nostic imaging department and the professional culture of diagnostic
radiography.
A brief overview will be given of the main themes from the doctoral
study and will be outlined and explained to set the scene for the following
chapters within this book.
Keywords Ethnography • Methodology • Methods • Professional

culture • Diagnostic radiographers
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021 1
R. M. Strudwick, The Ethnographic Radiographer,
https://doi.org/10.1007/978-981-16-7252-1_1
2 R. M. Strudwick
Introduction
Ethnography has become for me a way of living and seeing the world.
Since the research methodology was introduced to me back in 2006
when I started my doctoral journey, I have seen the benefits of ethno-
graphic research and it has taken a grip on me. In reading this book you
should be convinced of the benefits of ethnography as a research method-
ology and its application to radiography. I love the simplicity of the
methodology but the structured way in which the research can work suits
my personality and the way in which I like to undertake research. The
ethnographic researcher is able to spend time with the participants of the
study and get to know them, learn about different groups of people and
study the ways in which groups of people live, behave, work and interact
with one another. For me, this is fascinating, getting to know people,
how they think and behave and asking questions opens a whole new world.
Ethnographic research employs the full range of research methods
available to any researcher using an obvious, common sense approach.
Observation is a key method of data collection, along with asking ques-
tions in both informal and formal settings using interviews and focus
groups. The ethnographic researcher also studies the artefacts and ‘props’
used within the group. This is very similar to the ways in which we all
make sense of our world, using all the senses. For me, the simplicity is
key. Yet, the ethnographic researcher can also utilise a systematic and
rigorous approach to research which also appeals to my structured and
logical brain. It is a great way to learn about different groups of people.
My introduction to ethnography as a methodology came by way of
being introduced to the film Paris is Burning (1990), an American docu-
mentary which was filmed in the mid-1980s. The film uses ethnographic
methods to study the ‘Ball Culture’ of New York city and the African-
American, Latino, Gay and Transgender communities involved in it. The
film director Jennie Livingston spent time with the group to learn about
ball culture and voguing. She also researched African-American history,
literature and culture, as well as reading up on queer culture and the
nature of subcultures. As well as spending time with the group, Livingston
undertook audio interviews with several of the ‘ball people’. The main
1 Introduction to Ethnography and the Ethnographic Researcher 3
scenes in the film were shot at the ‘Paris is Burning’ ball in 1986. The film
shows the culture of the group being studied through film clips of their
lives and their preparation for attending balls and through interviews
with the key members of the group.
This ‘opened my eyes’ to ethnographic research where the researcher
spends time with the participants, becoming and being part of the group
or culture being studied. The way in which the participant’s stories were
captured and illustrated allowed me, as the viewer, to gain an understand-
ing of their world and what it was like to be part of the group. Providing
such an insight into different groups of people was the hook for me.
Ethnography has its roots in both British social anthropology, where
researchers travelled the world to study foreign cultures and in American
Sociology (from the Chicago school) which used observation to explore
groups on the margins of urban industrial society. The task of these two
distinct groups was the same, to provide cultural descriptions of the
groups they had studied (Brewer 2000). Since then, ethnography has
developed and moved into other spheres such as education, health care
and social work. It has become a recognised form of qualitative research.
In many respects ethnography is really the most basic form of social
research; it bears a close resemblance to the routine ways in which we
make sense of the world around us in everyday life (Hammersley and
Atkinson 1995). Ethnography is as relevant now in contemporary
research as it was in historical anthropology.
Ethnography involves the study of a particular social group or culture
in their naturally occurring setting (Hobbs and May 1993; McGarry
2007). This means that the researcher moves ‘into the field’ and needs to
have access to the group. The researcher needs to become part of the cul-
ture being studied to gain understanding and insight and in order to
document their findings. In ethnography the researcher needs to have
direct and sustained contact with the group of people being studied
within their cultural setting, that is, where they are situated or where they
meet as a group. This involves watching what happens, listening to what
is said and asking questions (O’Reilly 2005). It also involves collecting
data to ‘throw light on’ the issues that are the focus of the research
(Hammersley and Atkinson 1995). The group should be studied in its
4 R. M. Strudwick
natural state and setting and be as undisturbed by the researcher as pos-

sible, so that ‘normal’ behaviour is observed.
An ethnographic study takes time, and the researcher should spend a
period of time with the group in order to reduce the impact of their pres-
ence on the situation being studied. People can sustain an act or maintain
their best image only so long, then ‘normal’ behaviour is resumed
(Wolcott 1999). The researcher’s presence may alter behaviour for a short
period of time, but this will only continue for a while as ‘real’ behaviour
re-emerges. The researcher may become so much part of the group that
the group members forget why they are there, more of this later when we
discuss ethical issues.
The heart of ethnography is the ‘lived order’ or the way in which mem-
bers of a group construct, enact, do and inhabit their daily world (Allen
2004). Ethnography utilises three main research methods: observation,
interviews or focus groups and the study of written documents or arte-
facts (Hammersley and Atkinson 1995; Brewer 2000). Ethnography is
iterative-inductive research, and is an ongoing simultaneous process of
theory building, testing and re-building (O’Reilly 2005). Ethnography is
usually fluid and flexible; a reflexive process with a broad topic and some
guiding questions (O’Reilly 2005).
utobiographical Information About

A
the Author
In 2011 I completed my doctoral thesis titled ‘An ethnographic study of
the culture in a Diagnostic Imaging Department’ (Strudwick 2011). I
was interested in studying the culture of my own profession, and I con-
sidered ethnography to be the obvious methodological choice. I am a
diagnostic radiographer with over 20 years’ experience. I worked as a
radiographer in practice in the UK National Health Service (NHS) for
eight years, then I moved into education, and I am currently an associate
professor at a university in the East of England. I have had close involve-
ment with many diagnostic radiographers working in placement hospi-
tals associated with the university. The hospital where my doctoral
research was carried out is one of those placement hospitals. I continue to

hold a ‘bank’ contract as a diagnostic radiographer and work shifts at my
local hospital, in this way I am still integrated into the culture of my
profession.
My perspective as a researcher is therefore not one of a detached, objec-
tive researchers. I am familiar with the working practices and professional
culture of diagnostic radiographers and how they work. I am also familiar
with how diagnostic imaging departments function on a day-to-day
basis. As an educator and an active member of the professional body in
the UK, the Society and College of Radiographers (SCoR), I am aware of
the current issues and challenges within the radiography profession, both
in practice and in education.
I am conscious of the way in which I write, as a diagnostic radiogra-
pher. I have been taught to write in a factual way, using the ‘evidence
base’, presenting information in an objective manner so that my work
can be open to scrutiny. There was little room for emotional involvement
or the inclusion of the self, and so the production of an ethnographic text
became a challenge to me, and one with which I continue to struggle.
There is, of course, a continuing battle that qualitative research and, in
particular, ethnographic research such as mine will be seen as un-scientific
and therefore insignificant in a field such as radiography. Over the past
few years qualitative research has become more readily accepted, although
ethnographic research it could be argued lacks rigor and as such may not
be accepted.
The purpose of this book is to persuade you otherwise, so that you will
see the relevance of ethnography as a methodology within healthcare and
radiography.
So, why ‘the ethnographic radiographer’? I felt that this title depicted
who I am and what I am known for within the radiography profession. I
have published several of the themes from my doctoral research as journal
papers and books chapters (Strudwick et al. 2011, 2012, 2013; Strudwick
2014, 2015, 2016, 2018, 2020). Therefore, my research is well-known
within the profession, and I am known to be an ethnographic researcher.
At the time when I started my doctoral journey in 2006 and at the
time when I was collecting my data (2008–9) and undertaking my litera-
ture review for my thesis, there were very few research studies about the
6 R. M. Strudwick
culture in radiography. The studies that had been written were focussed
on one particular aspect of radiography and the culture associated with it.
For example, Karasti et al. (1998) looked at the effect of teleradiology on
culture using ethnography in Finland, Larrson et al. (2008) investigated
knowledge in image production using observation in Sweden and Brooks
(1989) reviewed patient care in radiotherapy using interviews and obser-
vation. It became apparent that there was a gap in the literature at that
time, with very few ethnographic studies looking generally at the culture
in an imaging department and focussing specifically on diagnostic radiog-
raphers. Ethnography did not appear to be a widely used methodology in
radiography research. Since that time others have undertaken and pub-
lished ethnographic studies in radiography (Hayre et al. 2018; O’Regan
et al. 2019; Holmstrom 2019). The purpose of my doctoral thesis was to
write in detail about the work and workplace culture of the diagnostic
radiographer in order that those outside of radiography could gain an
insight into the profession and so that those within the profession of
radiography could critically evaluate their own profession and develop
their own practice.
I want to convince you that exploring who we are as a profession and
what the nuances are of our professional culture are key to understanding
why we behave in particular ways and how the diagnostic radiographer
fits into the healthcare system. The implications of studying and under-
standing radiography from this perspective mean seeing the profession in
a different light. Many of the studies carried out previously in radiogra-
phy are scientific and quantitative in nature and do not take account of
people’s ideas, feelings and values.
In understanding ourselves we can only improve. We can work better
with others, collaborate and work with others in the interprofessional
team, and we can improve the care that we provide to our service users.
These aspects are explored further in Chap. 7 – Interprofessional Learning
and Working, and Chap. 8 – Relationships with Service Users and Values-
Based Practice.
The Ethnographic Researcher

The ethnographic researcher is someone who is naturally curious about
the world around them. As an ethnographer this has pervaded my think-
ing. I often find myself asking why things are done in the way that they
are, why people behave in a certain way in different situations, I am
always asking why? The ethnographic researcher is curious about the
underlying culture of the setting, the situation or the group of people,
always wanting to ‘dig deeper’. They want to know what the expected
behaviours are and why these behaviours are expected, what the norms,
values and beliefs are in the group and how these apply to the setting, the
situation or the group of people. How people learn to become part of a
group or culture is also of interest. Group socialisation and learning ‘how’
to behave, speak and what is and is not acceptable are fascinating.
In every ethnography, regardless of topic, subject matter or discipline
the ethnographer themselves emerge as part of the research. The ethnog-
rapher is inseparable from the ethnography (Vine et al. 2018). This is
because the ethnographic researcher is positioned within the group being
studied and they are reflexive about their role within the research. This
goes against all that we learn about research, that we need to be objective
and not influence the outcomes of our research. This is not possible as an
ethnographic researcher, as the research not only reveals information
about the group being studied, but it also reveals who we are as a
researcher. Even if we as researchers chose not to disclose ourselves, the
written product of an ethnographic study reveals ourselves and our
integrity.
ackground and Rationale for the Book

B
and How to Read/Use It
The purpose of this book is to introduce the reader to ethnography as a
methodology and how an ethnographic researcher sees the world in
which they live. I am writing from the perspective of a diagnostic radiog-
raphy educator, and this book follows my journey of discovery, firstly of
8 R. M. Strudwick
qualitative and ethnographic research and secondly to how this pervades

the way in which one sees the world. Since the completion of my doctor-
ate in 2011 I have noticed that my ethnographic curiosity is part of my
work and the way in which I view the world.
Ethnographic research involves participant observation and as such we
can all be ethnographic researchers in whatever group or location we find
ourselves in.
Qualitative research in radiography is relatively new and as such
radiographers are not always aware of qualitative methodologies and
methods which can be used in research. In reading this book you the
reader will become more aware of ethnography as a research methodol-
ogy, how it can be used in healthcare research and more specifically radio-
graphic research.
It is not necessary to read this book in order. Each chapter can be read
separately, as each chapter deals with a specific topic.
Chapter 2 outlines the methods used in ethnographic research, the
advantages and challenges of these research methods.
Chapter 3 discusses the role of the diagnostic radiographer in more
detail, using the findings from my doctoral research to explore the rela-
tionships that diagnostic radiographers have with others.
Chapter 4 looks at the structure and environment in which diagnostic
radiographers work using findings from my doctoral research.
Chapter 5 specifically focusses on the unique role of the diagnostic
radiographer.
Chapter 6 outlines the world of radiography education utilising an
auto-ethnographic approach.
Chapter 7 is about interprofessional learning and working and pro-
vides an overview of the way in which diagnostic radiographers work and
interact with other health and social care professionals.
Chapter 8 focusses on the relationship that diagnostic radiographers
have with service users and values-based-practice.
Chapter 9 provides a summary and conclusion to this book and makes
recommendations for future practice.
The ethnographic researcher is constantly undertaking participant
observation in whichever roles they are in, and it is my own experiences
of the different situations I have been in, along with the research findings
of others that will formulate these chapters.
Introduction to and Overview of My

Doctoral Research
My doctoral study explored the workplace and professional culture in a
Diagnostic Imaging Department. The primary focus was on the diagnos-
tic radiographers, looking at how they worked and interacted with one
another, with other professional groups and with their service users. The
study was carried out in one department in the East of England. I under-
took participant observation for four months, and I took on the role of
observer as participant during that time (Gold 1958). After the four
months of observation, I interviewed a purposive sample of ten partici-
pants using semi-structured interviews. These interviews were used to
explore some of the issues uncovered by the interviews in more depth.
Thematic analysis was used to analyse the data from both the observa-
tions and interviews (Fetterman 1989).
The aims of the study were: to describe the workplace culture in the
Diagnostic Imaging Department, to highlight the current issues that face
diagnostic radiographers, to explore how one learns to become a diagnos-
tic radiographer and become professionally socialised and to observe and
describe how diagnostic radiographers communicate and interact within
the workplace.
Four overarching concepts emerged from the data. These were: rela-
tionships with patients, relationships with colleagues, structure and envi-
ronment and characterising the role of the diagnostic radiographer. The
four overarching concepts and the individual themes are shown in
Table 1.1, with the overarching concepts shown in bold text. When
reviewing the data four more meaningful themes emerged, and these
were referred to as key themes.
These four key themes were more prominent in the data and following
discussion with my supervisor, who acted as a member checker, it was felt
that these were familiar anecdotally through experience and deserved
10 R. M. Strudwick
Table 1.1 The overarching concepts and themes

Relationships with patients Relationships with colleagues
Involvement with patients Use of dark humour
Task-focussed interactions Team working and communication between
Time pressures and waiting diagnostic radiographers
times Interprofessional relationships
Avoiding confrontation Diagnostic radiographer and radiologist
Categorising patients relationships
Discussion and storytelling
Role modelling
Structure and environment Characterising the role of the diagnostic
radiographer
Blame culture Visible product
Structure, organisation, Diagnostic radiographers’ views about research,
routine—the way things continuing professional development and
are done evidence-based practice
Workflow Extended role and barriers
Behaviour in different areas Dealing with radiation
more in-depth analysis. These four key themes appeared more frequently
throughout the study, from both the observations and the interviews.
The four key themes demonstrated new knowledge about the culture
within the department and were not found to be discussed in depth in
previous literature. The four key themes were: involvement with patients,
use of dark humour, blame culture and visible product. The four key
themes are shown in italics in Table 1.1.
Throughout this book data from my doctoral research findings, my
other research along with the research findings of others both in the field
of radiography and within ethnographic research will be used to give
rigour to the arguments presented in the text.
References
Allen D (2004) Ethnomethodological insights into insider-outsider relation-
ships in nursing ethnographies of healthcare settings. Nursing Inquiry 2004,
11(1), p14–24.
Brewer J D (2000) Ethnography. Open University Press, Buckingham.
Brooks C (1989) Idealism and realism in patient care during radiotherapy treat-
ment. Radiography Today. Vol 55, Issue 627, August 1989, p16–21.
Fetterman D J (1989) Ethnography – Step by Step. Sage, California.
Gold R L (1958) Roles in Sociological fieldwork. Social forces, Vol. 36,
pp217–223.
Hammersley M and Atkinson P (1995) Ethnographic Principles in Practice. (2nd
Edition) Routledge, London.
Hayre C M, Blackman S, Calton K and Eyden A (2018) Attitudes and percep-
tions of radiographers applying lead (Pb) protection in general radiography:
An ethnographic study. Radiography (February 2018), Vol 24, Issue 1,
p e13-e18.
Hobbs D & May T (Eds.) (1993) Interpreting the field – Accounts of ethnogra-
phy. Oxford University Press, Oxford.
Holmstrom A (2019) Radiography Students’ Learning of Plain X-Ray
Examinations in Simulation Laboratory Exercises: An Ethnographic
Research. Journal of Medical Imaging and Radiation Sciences, Vol 50, Issue
4, December 2019, p557–564.
Karasti H, Reponden J, Tervonen O and Kuutti K (1998) The teleradiology
system and changes in work practices. Computer Methods and Programs in
Biomedicine, 57 (1998), 69–78.
Larrson W, Lundberg N and Hillergard K (2008) Use your good judgement –
Radiographers’ knowledge in image production work. Radiography (2008),
https://doi.org/10.1016/j.radi.2008.09.003.
McGarry J (2007) Nursing relationships in ethnographic research: what of rap-
port. Nurse Researcher 2007, 14, 3, p7–14.
O’Regan, Robinson L, Newton-Hughes A and Strudwick R (2019) A review of
visual ethnography: Radiography viewed through a different lens.
Radiography, Vol25, Supplement 1, October 2019, p s9-s13.
O’Reilly K (2005) Ethnographic Methods. Routledge, London.
Paris is Burning (1990) Directed by Jennie Livingston, Academy Entertainment
Off White Productions.
Strudwick R M (2011) An Ethnographic Study of the Culture in a Diagnostic
Imaging Department. DProf Thesis, Unpublished, University of Salford.
Strudwick R, Mackay S & Hicks S (2011) Is There a Blame Culture in Diagnostic
Radiography? Synergy. December 2011, p4–7.
Strudwick R, Mackay S & Hicks S (2012) Cracking up? The use of dark humour
in the radiography department. Synergy. February 2012, p4–7.
12 R. M. Strudwick
Strudwick R, Mackay S & Hicks S (2013) It’s good to share – The importance
of discussion and story-telling in diagnostic radiography. Imaging and
Therapy Practice. March 2013, p27–31.
Strudwick R M (2014) The Radiographic Image: A Cultural Artefact?
Radiography, Vol 20. Issue 2, May 2014, p143–147.
Strudwick R (2015) Creating a Professional Culture. Imaging & Therapy
Practice, September 2015 p23–29.
Strudwick R (2016) Labelling patients. Radiography, Vol 22. Issue 1, February
2016, p50–55.
Strudwick R (2018) Blame Culture in the National Health Service (NHS), UK
in Thomas W, Hujala A, Laulainen S & McMurray R (2018) The Management
of Wicked Problems in Health and Social Care. Routledge, London.
Strudwick R (2020) Ethnographic investigations of a diagnostic imaging depart-
ment in Hackett P M W & Hayre C M (2020) Handbook of Ethnography
in Healthcare Research. Routledge, London.
Vine T, Clark J, Richards S and Weir D (2018) Ethnographic Research and
Analysis: Anxiety, Identity and Self. Palgrave Macmillan, London.
Wolcott H F (1999) Ethnography – A Way of Seeing. Altamira Press, Oxford.
2
Ethnographic Methods
Abstract This chapter provides an outline of the research methods used

within an ethnographic study and how these methods are used with
examples from the author’s ethnographic work. Each of the research
methods will be explained along with reflectivity and the inductive nature
of ethnographic research. This chapter finishes with a discussion about
ethnographic data analysis.
Keywords Ethnography • Research methods • Participant observation

• Interviews • Focus groups • Documents • Reflexivity
Introduction
As outlined in Chap. 1, the main research methods used in ethnographic
research are observation, focus groups or interviews and the examination
of documents and artefacts. Ethnography employs several research meth-
ods, which link findings together and allow for what Richardson and St.
Pierre (2005) call crystallisation. Richardson and St. Pierre (2005) argue
against the more quantitative term ‘triangulation’ saying that this term
https://doi.org/10.1007/978-981-16-7252-1_2
14 R. M. Strudwick
suggests that there is one objective truth that we are trying to plot by
using different research methods. They propose that in undertaking qual-
itative research we need to acknowledge that there are many dimensions
in which to approach the world (just like a crystal has many facets and
dimensions) and that what we see depends on our viewpoint and per-
spective. As researchers we are trying to understand a little more about
the different facets of the crystal as there is infinite variety. In utilising
different research methods, we gain a greater understanding of the world
and different people’s viewpoints. This chapter will explore the use of
these research methods in ethnographic research using examples from the
literature and my research.
Ethnographic research is by its very nature iterative and inductive, that
is, it evolves over time. An inductive approach, also known as inductive
reasoning, starts with the data collection, which in the case of ethnogra-
phy as a period of observation and it develops from there. Patterns are
recognised and the study evolves from the data that have been collected.
Explanations emerge as the study continues and the researcher is free to
change the direction of the study as the research process continues. The
benefits of an inductive approach are that it allows for flexibility depend-
ing on the findings. The researcher can therefore respond to what has
been discovered. Theories, concepts and themes are generated through-
out the study. Hammersley and Atkinson (1995) therefore steer away
from prescribing exactly how to conduct an ethnographic study, as each
study varies in approach depending on the setting and the group being
studied. This can be seen clearly in ethnographic research as the researcher
can generate topics for discussion and develop the questions to ask in
follow-up interviews or focus groups from the information gathered dur-
ing the observation. In the case of my doctoral study, the interview ques-
tions came from the behaviours that I observed and wanted to explore
further with the participants to understand them more fully.
Reflexivity is also key to ethnographic research. Reflexivity refers to the
ways in which the researcher influences the study and requires the
researcher to examine their own beliefs, judgements, behaviours and
practices during the study and how they may have had an influence on
the research process. Reflexivity is an important part of any qualitative
study as there are many ways in which the researcher can influence or
affect their study. This includes the choice and design of research meth-
ods, and the data collection tools, the ways in which the data are col-
lected, the data analysis process and the ways in which data and findings
are presented. Reflexivity is ‘a concern with how the selves and identifies
of the researcher and researched affect the research process’ (Brewer 2000,
p126). The researcher needs to be ‘up front’ about who they are so that
the reader understands the decisions that they have made during the
research process. This subjectivity should be obvious, acknowledged and
not hidden. In making this explicit the legitimacy of the data and its
representation can be believed.
The researcher is the research instrument and as such the study will be
influenced by their decisions throughout the data collection, for example
what to observe, where to observe, who to observe and how long to
observe. Trustworthiness of qualitative research is measured in a different
way from quantitative research, instead of reliability and validity, the fol-
lowing measures are recognised: credibility, dependability, authenticity,
transferability and conformability (Guba and Lincoln 1994). Ensuring
trustworthiness comes from, introducing the researcher, their back-
ground and from triangulation—the use of more than one method of
data collection (Casey and Murphy 2009), thorough data collection and
fieldwork—prolonged engagement with the participants (Lincoln and
Guba 1985), having a thorough audit trail (Ryan-Nicholls and Will
2009), member checking—verifying the themes with the participants
and being reflexive.
Access to the Field

Before the study commences the researcher needs to gain access to the
field and the group being studied. This may be straightforward and sim-
ply a question of turning up and watching the group in action, or it may
be more complex and require negotiated access to the group via a gate-
keeper. Access to the field may also require ethical approval from the
organisation where the group is located, for example a place of work. In
the case of my doctoral study, I needed the department manager to agree
16 R. M. Strudwick
to ‘host’ my study and become the gatekeeper in terms of access; NHS

ethical approval was also needed.
In most cases the researcher needs to be open about their research,
covert research is not permissible within the NHS and many organisa-
tions, although it may be permissible in other settings.
Ethics
The main principles when conducting research are that participants
should not be harmed because of participating, participants should give
informed consent to take part in the study and that their confidentiality
and anonymity should be preserved.
Participants should give consent to being observed and can withdraw
their consent at any time throughout the study; this needs to be managed
by the researcher. It is difficult to gain consent from everyone who inter-
acts with the group being studied, particularly in a work setting as others
who are not participants may venture into the setting. In my study this
included patients and staff members from other departments. I was
bound by my own professional code of conduct in this situation and as
my focus was on the diagnostic radiographers this was accepted by the
local NHS research ethics committee.
There is also a dilemma about when and if you need to intervene and
this would be if something occurs that you could not simply ‘watch’.
Johnson (1997 and 2004) discusses why intervention is a difficult con-
cept for researchers in the clinical environment. He calls the lack of inter-
vention by a researcher the ‘wildebeest perspective’ (Johnson 1997),
referring to nature documentaries where the person filming does not
intervene when the predator stalks and eats the vulnerable new-born and
ageing wildebeests as it is argued that intervention would disturb or
intervene with nature. Johnson (1997) goes on to state that it is useful to
consider where interventions or their avoidance can be planned for or
predicted in research, but this does not reflect the turmoil of the real and
messy world of clinical research. Johnson (2004) suggests the develop-
ment of a personal ‘bottom line’ of care below which the researcher feels
they must intervene. For me this was if I felt that anyone could be
physically harmed unnecessarily because of an interaction. It is important

to report practice that is less than satisfactory in research, because
although this may be controversial, without reporting such incidents
future practice cannot improve and the profession can move forward.
Confidentiality and anonymity of the participants need to be pre-
served; this can be done through the use of pseudonyms or numbering
the participants. As well as this there needs to be an awareness of expres-
sions of speech when using quotations from interviews or focus groups as
these may inadvertently identify the participant.
Participants should be given the opportunity for support should any
element of the study cause them distress. Ethics committees will need
assurance that this is in place either via an occupational health depart-
ment in a work setting or through an independent counselling service.
Observation
Ethnographic research starts with a period of observation where the
researcher spends time observing the group being studied and getting to
know them and how the group works. The length of the period of obser-
vation is really governed by the situation, the setting and the researcher’s
judgement. The observation normally ends when data saturation is
reached, and this will be at the discretion of the researcher.
If the group is based in a particular location, for example a place of
work, a floor plan or map of the location can be beneficial to the reader
to provide information about space and place as well as the context and
location of events.
The researcher will need to decide how much to participate in the
group being studied and what their role will be. Gold (1958) created a
typology of participant observer roles which is still relevant today:
Gold’s (1958) Typology of the Participant Observer Roles
• The complete participant—takes an insider role, is fully part of the set-

ting and often observes covertly.
• The participant as observer—the researcher gains access to a setting by
virtue of having a natural and non-research reason for being part of the
18 R. M. Strudwick
setting. As observers, they are part of the group being studied. This
approach may be common in health care settings where members of
the health care team are interested in observing operations in order to
understand and improve care processes.
• The observer as participant—in this role, the researcher or observer has
only minimal involvement in the social setting being studied. There is
some connection to the setting, but the observer is not naturally and
normally part of the social setting.
• The complete observer—the researcher does not take part in the social
setting at all. An example of complete observation might be watching
children play from behind a two-way mirror.
I took on the role of ‘observer as participant’ in my study, although I

am a diagnostic radiographer, my purpose for being present was to
observe the group and not to take part.
Observation involves sound, movement, touch and smell. The observer
needs to be a senate field researcher (Edvardsson and Street 2007), and in
the case of my study observing how the human body is central to any
healthcare environment.
I carried out my observation over a four-month period, one day per
week, varying shifts and days of the week, and observing in different areas
of the imaging department. The importance of finding out where things
happen is crucial and I soon found out that there was one central viewing
area where everything was co-ordinated from, so I spent more time there.
The researcher needs to find a place to be and think about the impres-
sions they create; this includes behaviour, what they wear and where they
stand or sit. The researcher should cause as little disruption as possible
(Bonner and Tolhurst 2002). Coffey (1999) encourages carving out a
space to be, a location that allows for observation but does not intrude on
events. For me this meant standing in a corner in the viewing area or
behind the lead glass screen in an X-ray room where I was out of the way
and did not interrupt the workflow but could still see what was going on.
I wore a diagnostic radiographer’s uniform at the request of the imaging
department manager and the local NHS research ethics committee. This
did help me to integrate into the department. Although it did feel odd to
be wearing the uniform but not performing the role, I was dressed as a
radiographer, but I was not ‘being’ a radiographer, Cudmore and

Sondermeyer (2007) describe this as being there but not being there. In
order to become immersed in the culture of the imaging department I
spent the whole shift with the staff, taking breaks and eating lunch with
them in the staff room.
In studies using observation the ‘Halo effect’ is often described (Asch
1946); this is when participants being observed want to be seen in a
favourable light. Other writers describe the ‘Hawthorne effect’ (Bowling
2004), where participants alter their behaviour because of being observed.
It is felt, however, that the behaviour of staff changes over a period of
time as the researcher is accepted into the group. I noticed that there was
a change in behaviour towards me, the reservations soon disappeared,
and I was accepted into the team. This reinforced my understanding and
indeed findings from the literature that over a period of time normal
behaviour resumes and the participants behave as they would when the
researcher is not present. It is not possible to be completely overt as you
do not want to keep reminding the participants that you are there and
why you are there. It is difficult to balance the need to be open and hon-
est with the need to fit in and become unobtrusive.
In order to really observe what is happening, it is important to look at
the setting with a sense of strangeness and try to fight familiarity.
Fetterman (1989) terms this the etic perspective, seeing the environment
as an outsider would. The emic perspective is the insider viewpoint and if
you are studying a familiar environment, the emic perspective may mean
that data are overlooked as they are seen as familiar and important infor-
mation could be missed. To guard against this in my study I decided
every day to look around the department as a newcomer would and note
something down that I had not recorded before in my notes.
During observation, the researcher takes field notes, these are qualita-
tive notes, jottings, diagrams, pictures and thoughts that are noted down
during the fieldwork. Initially, field notes were places where researchers
could record their own private thoughts and ideas regarding their obser-
vations and interviews (Phillippi and Lauderdale 2018). Field notes can
be considered as data to be analysed and interpreted and they provide the
context (Creswell 2007), along with thick and rich descriptions of the
research setting (Phillippi and Lauderdale 2018). Thick description is a
20 R. M. Strudwick
way of writing that includes not only the description of what is observed
(usually human behaviour) but also the context in which the behaviour
occurs. The term ‘thick description’ was made famous by anthropologist
Clifford Geertz who wrote in this style as a way of capturing his brand of
ethnography in the 1970s (Geertz 1973). Since then, ‘thick description’
has gradually taken hold in qualitative research, particularly those under-
taking observational studies. Thick description includes voices, feelings,
actions and meanings (Ponterotto 2006).
Field notes enable the researcher to document the behaviours, activi-
ties and events that occur. Spradley (1980, p78) provides a helpful list of
things to consider when writing field notes:
• Space: the physical place/places

• Actor: the people involved
• Activity: a set of related acts that people do
• Object: the physical things that are present
• Act: single actions that people do
• Event: a set of related activities that people carry out
• Time: the sequencing that takes place over time
• Goal: the things people are trying to accomplish
• Feeling: the emotions felt and expressed
There is more information about fieldnotes in my book chapter

(Strudwick 2020).
Interviews and Focus Groups

Interviews and/or focus groups are used in ethnographic study either
during or after the period of observation to explore in detail some of the
issues raised during the observation. In qualitative research the researcher
is not really concerned with objectivity and representativeness of the data.
Therefore, many interviews with a set structure of questions are not
required. Rather, the interviews used in qualitative research are influ-
enced by interpretivism and it is the quality of the information given that
is of interest. Qualitative interviews with either one person or a group of
people during a focus group are an opportunity to explore the subjective

meanings, feelings and beliefs which are of interest to the researcher.
Sampling for interviews or focus groups tends to be purposive (Bowling
2004). A purposive sample allows the researcher to select participants
from different groups who could be considered to be ‘information rich’.
For example, in my study I selected ten key informants for the interviews
covering different grades, job roles, background, experience and points of
view. I selected participants who I felt would be able to interact in an
interview setting and provide information. I had noted these individuals
during the observation and selected them purposively.
A semi-structured approach is normally used so that there is some
structure of questions to follow but open-ended questions are used to
allow the participants to answer in the way that they choose. The ques-
tions are exploratory and based on themes from the observation. A flexi-
ble approach is used so that the participant can wander off the point and
this may provide useful additional information for the researcher which
they would not have found out. Building a rapport with the participants
is useful in gaining information and allowing them to become more
relaxed in the interview or focus group setting so that they feel able to
share their ideas, thoughts and feelings about the subject matter.
The choice of individual interview or focus groups will depend on the
study and the group being studied. It may be appropriate to find out
individual’s responses, or you may wish to find out what the group thinks
and see if there is any consensus. Participants will relate to the researcher
in different ways in groups and individual settings. In a focus group the
group may well take the lead with the researcher observing the discussion
and these unexpected discussions may provide rich information.
Therefore, the choice of data collection method will largely depend on
the research question and the group being studied.
A decision needs to be made about how the interview or focus group
data will be recorded, video, audio or notes. Notes are time consuming
and difficult to take as well as conducting the interviews, so these can be
taken alongside an audio or video recording. Videos can be used if you
wish to observe non-verbal cues but can be more off-putting for both the
participants and researcher as they are so visible, and the camera also
needs to be controlled by either the researcher or an independent person.
22 R. M. Strudwick
Audio recordings work well if they record the sound from all of those
speaking, an audio recording device is a lot less obtrusive.
Recordings are usually transcribed verbatim, and a decision needs to
be made about the recording of non-words, for example, um, er.
Transcription is time consuming but if carried out by the researcher can
be the start of the data analysis process. You may decide to pay someone
to undertake the transcription for you, this is undeniably quicker but will
cost. This may be something to consider for a funded project, but it does
mean that you do not get to know the data in as much detail.
Reviewing Documents and Artefacts

There may be both documents and artefacts used in the group that are
relevant to the culture of the group. Documents could include literature,
diaries, letters, notes, minutes of meetings, protocols and procedures. In
some settings documents would form a key aspect of the culture, for
example if you were studying a work setting the rules, technical manuals
for equipment, policies, protocols and procedures would be important
documents. Prior (2003) suggests that documents can be full of concepts,
assumptions and ideas. Documents can also provide information about
hierarchy and power relationships within the group. Artefacts could
include visual images, equipment used by the group, visual media such as
leaflets and posters, the built environment, dress code or uniform worn
by the group.
The examination of documents and artefacts will again depend on the
group being studied. This could be classed as another research method, or
it could be integrated into both the observational data and the inter-
views/focus groups.
Data Analysis
The way in which data are collected will have an influence on how it is
analysed. Due to the iterative inductive nature of ethnographic research,
data analysis occurs both during and after the data collection. Data
analysis is the process of making sense of the data. Thematic analysis is

the most common process and the preferred method in ethnographic
research where data are coded and themed.
Summary
In summary, the main research methods used in ethnography are obser-
vation with field notes, interviews or focus groups and the analysis of
documents and artefacts. Thematic analysis is the preferred data analysis
method, themes and theories about the group being studied emerge from
the data and can be used to provide an overview of the culture of
the group.
References
Asch S E (1946) Forming impressions of personality. Journal of Abnormal and
Social Psychology. 41, 258–290.
Bonner A and Tolhurst G (2002) Insider-outsider perspectives of participant
observation. Nurse Researcher 9, 4, p7–19.
Bowling A (2nd Ed) (2004) Research methods in health – investigating health
and health services. Open University Press, Maidenhead.
Brewer J D (2000) Ethnography. Open University Press, Buckingham.
Casey, D., & Murphy, K. (2009). Issues in using methodological triangulation
in research. Nurse Researcher, 16(4), 40–55. https://doi.org/10.7748/
nr2009.07.16.4.40.c7160
Coffey A (1999) The Ethnographic Self. Sage, London.
Creswell J W (2007) Qualitative Inquiry and Research Design – Choosing
among five approaches. (2nd Ed.) Sage, London.
Cudmore H, and Sondermeyer J (2007) Through the looking glass: being a
critical ethnographer in a familiar nursing context. Nurse Researcher 2007,
14:3, pp25–35.
Edvardsson D and Street A (2007) Sense or no-sense: The nurse as embodied
ethnographer”. International Journal of Nursing Practice 2007; 13; 24–32.
Fetterman D J (1989) Ethnography – Step by Step. Sage, California.
Geertz (1973) The Interpretation of Cultures. Basic Books, New York.
24 R. M. Strudwick
Gold R L (1958) Roles in Sociological fieldwork. Social forces, Vol. 36,

pp217–223.
Hammersley M and Atkinson P (1995) Ethnographic Principles in Practice. (2nd
Edition) Routledge, London.
Guba, E., & Lincoln, Y. (1994). Competing paradigms in qualitative research.
In Denzin N & Lincoln Y (Eds.), Handbook of qualitative research
(pp. 105–117). Thousand Oaks, CA: Sage.
Johnson M (1997) Observations on the neglected concept of intervention in
nursing research. Journal of Advanced Nursing, 1997, 25 p23–29.
Johnson M (2004) Real world ethics and nursing research. Nursing Times
Research. 2004: 9: 251–261.
Lincoln, Y.S., & Guba, E.G. (1985). Naturalistic inquiry. Newbury
Park, CA: Sage
Phillippi J and Lauderdale J (2018) A Guide to Field Notes for Qualitative
Research: Context and Conversation. Qualitative Health Research, 28
(3): p381–388.
Ponterotto, J.G. (2006) Brief note on the origins, evolution and meaning of the
qualitative research concept ‘thick description’, The Qualitative Report
11(3), 538–54.
Prior L (2003) Using Documents in Social Research. Sage, London.
Richardson L and St. Pierre E. A. (2005) Writing – A Method of Enquiry. In
Denzin N. K. and Lincoln Y. S. (2005) The Sage Handbook of Qualitative
Research. (3rd Ed.) Sage, Thousand Oaks.
Ryan-Nicholls, K.D., & Will, C.I. (2009). Rigour in qualitative research:
Mechanisms for control. Nurse Researcher, 16(3), 70–85.
Spradley J P (1980) Participant observation. Holt, Rinehart and
Winston, London.
Strudwick R (2020) Fieldnotes in Ethnographic Research in Hackett P M W &
Hayre C M (2020) Handbook of Ethnography in Healthcare Research.
Routledge, London.
3
Working as a Diagnostic Radiographer:
Relationships with Colleagues
Abstract This chapter will outline in more detail the findings from the
author’s doctoral study about the culture of the imaging department and
how this has an impact on the way in which diagnostic radiographers
work and interact with others. This chapter will focus specifically on the
relationships that diagnostic radiographers have with their direct col-
leagues, that is, with other diagnostic radiographers, radiologists and
other members of staff working in the imaging department. The relation-
ships that radiographers have with their patients and service users are
briefly touched on in this chapter, but this is covered in more depth in
Chap. 8.
Keywords Professional culture • Diagnostic radiographers •

Relationships • Colleagues • Dark humour • Teamwork •
Communication • Story telling • Role model
https://doi.org/10.1007/978-981-16-7252-1_3
26 R. M. Strudwick
Introduction
Within any hospital, the diagnostic radiographers spend most of their
time working with other diagnostic radiographers within the imaging
department. They also work with other professionals both in the imaging
department and in other areas of the hospital such as the emergency
department, operating theatre and on the ward. This chapter focusses on
the relationships that radiographers have with their colleagues in the
imaging department. Relationships with other professional groups are
covered in Chap. 7, except for radiologists, who work in the imaging
department and are therefore discussed in this chapter.
The relationships that diagnostic radiographers have with their patients
are mentioned on a few occasions in this chapter, but this is covered fully
in Chap. 8.
There were five themes from my study that emerged about the rela-
tionships between staff within the imaging department:
• Use of dark humour

• Team working and communication
• Relationships with radiologists
• Discussion and story telling
• Role modelling
Each of these themes is explored in detail in this chapter.
Use of Dark Humour

Like many professionals working in public services, diagnostic radiogra-
phers use dark humour in their conversations about their service users.
Dark humour is used as a way to express emotion and to deal with situa-
tions within the workplace. It was evident that dark humour was an
acceptable part of the culture in the imaging department.
Dark, black or gallows humour is a genre of humour in which laughter
comes from cynicism. Often about peoples’ misfortunes or death. Taboo
3 Working as a Diagnostic Radiographer: Relationships… 27
subjects such as death and dying are brought into the open and dealt with
in an unusually humorous way, which can be amusing and also uncom-
fortable. The catalysts for such behaviour include murder, suicide, death,
depression, terminal illness, violence, disease and disability; all of which
are experienced by health care professionals including diagnostic
radiographers.
There is very little in the literature about the use of dark humour in
diagnostic radiography. It is mentioned by Decker and Iphofen (2005) in
their paper about the use of oral history to describe the development of
the diagnostic radiography profession; they observe that dark humour is
used as a coping mechanism. Wolf (1988) in her ethnographic study of
an acute hospital ward observed nurses using humour in their interac-
tions with one another, particularly during stressful situations or follow-
ing an emergency. Dean and Major (2008) suggest that humour helps
with teamwork, emotion management and maintaining human connec-
tions. From their ethnographic work in critical and palliative care they
note that humour enabled co-operation, relieved tension, developed
emotional flexibility and ‘humanised’ experiences.
This use of humour was evident in the imaging department and
afforded staff the opportunity to ‘let off steam’ and bring into the open
how they are feeling. The first example I observed followed a particularly
stressful situation when a patient had suffered a cardiac arrest in the
department.
The radiographers joke about a patient having a cardiac arrest in the imaging
department. They laugh about what the patient looked like, what colour his
face was and also how stressed everyone was. (Observation in staff room)
This incident had been challenging for all those involved, and the
patient had died. Humour was used to diffuse the situation and relieve
stress. There was another occasion I observed in the computed tomogra-
phy (CT) viewing area.
The staff make derogatory comments and joke about the size of an obese patient
who was so large that he only just fit through the CT scanner. (Observation, CT)
28 R. M. Strudwick
This occurred when the radiographers had been having some difficul-
ties scanning the patient, and the humour was used to diffuse the situa-
tion and let out their frustrations.
In the main viewing area of the department, I recorded this observation:
Discussion in the viewing area about a few patients with unusual conditions
who had visited the department over the past week. The radiographers joked
about these patients and jokes were made about them regarding what they
looked like, how they behaved and also about their images. (Observation,
viewing area)
Sometimes the comments turned from humour into derogatory

remarks. I wondered where the line should be drawn, and why humour
was used in this way, one of the radiographers in her interview made this
suggestion.
It’s never nice to see patients in pain and I think to an extent we laugh about it
to keep it light. (Interview with radiographer)
This radiographer tried to justify laughing about patients and implying

that it was acceptable in order to lighten the atmosphere and make things
less serious. Other radiographers saw the use of dark humour as a coping
strategy and a way to deal with the challenging situations that a radiogra-
pher might experience.
I think it’s a coping strategy you know … I guess you turn it into humour to
keep you going, it’s just a coping mechanism… well you can’t cry, you can’t well
you can’t show any emotion so the only way you can show it is by joking about
it and turning it into something light-hearted. (Interview with radiographer)
This is a standard and expected response. This radiographer was also

reflecting on their own use of dark humour and taking up a subject posi-
tion which says, ‘I am not a bad person’ and ‘I can justify my behaviour’.
From this quote we can also see that that this radiographer felt that they
were not able to cry or show any emotion, even if the incident was upset-
ting. For this radiographer, the next best thing was to show emotion
through humour and use laughter to release the tension. Another radiog-
rapher expressed this in her interview.
I think it helps you to cope, to make a joke, otherwise you can get quite depressed
I suppose. Oh yes, definitely, it is about how we cope. It is you know how you
get through it and otherwise you know you’d just get so depressed and so stressed
you well you wouldn’t cope. You have to not take it into heart too much … but
it’s good that you can you know well even if something starts off as a joke it
brings it to the fore and you can you can then discuss it you know … there’s no
point in trying to hide things up and pretend it didn’t happen. If you take it on
board, it’s not healthy no no. (Interview with radiographer)
This radiographer felt that the use of humour gave staff a way of dis-
cussing something that had occurred in a non-threatening way.
The department manager discussed how uncomfortable he felt as a
radiographer in challenging situations and how he believed colleagues felt
about discussing life and death matters.
You’re actually dealing with things that are well if they happen to you would be
the stuff of your worst nightmares but because you’re in a front line hospital,
you’ve got people coming well if you’ve just had a severe road traffic accident or
have got the worst forms of cancer, the things that you absolutely dread and it’s
not actually you know even as I’m sitting here talking to you about it on that
level well it almost feels uncomfortable but you’d normally cope with it by say-
ing or by treating it a little bit more lightly. (Interview with Manager)
And so, he concludes that radiographers like to treat things a little

more lightly, using humour, in order to cope with what they might have
just dealt with.
It’s almost like a ‘you’ve got to laugh, or you’ll cry’ kind of reaction. (Interview
with Manager)
Another radiographer was keen to emphasise that the alternative to

using humour to sound off was not good.
30 R. M. Strudwick
I think it’s the way that that we deal with it because I think if we took every-
thing to heart, I think that seriousness um we would never cope… We do see
some very horrible, pretty horrendous things and you know then you can see
some of the radiographers are shaken up over it and the only way to probably
deal with it is make a joke about something you know and they’ve sort of used
it to see the smiles return to everyone’s faces. (Interview with radiographer)
This radiographer felt that it was important to keep going and to keep
smiling, which raises the issue of emotional involvement. Radiographers
expressed that they should not be upset in front of patients and that they
need to maintain a professional demeanour. This is learnt behaviour
which Goleman (2004) calls ‘display rules’, and it is how we present our-
selves in different situations. Diagnostic radiographers are there to pro-
vide a service and therefore it was felt that emotional displays should
occur after the event, in private.
The department manager also suggested that dark humour and joking
could be used to gauge if a colleague was okay and that they were not too
upset after a difficult situation.
there was a patient who was very ill and had a brain tumour, I can’t really
remember any of the sort of light-hearted remarks that were made …but it was
just a way of dealing with it and almost well these sort of things happen or
something like that. I can’t remember exactly the throwaway line that she used
to say, yeah I’m okay about it. I mean what you’re actually communicating is …
I know that it was horrible, and I’ve been through it and I’m actually okay and
don’t worry too much. You’re actually giving that kind of message to somebody
yep that I’ve coped with it and you can unload. An awful lot of that kind of
emotional stress that people experience is dealt with in that almost subliminal
sort of humorous way … that was horrible you know and are you okay? I heard
you had a really really difficult experience, it’s oh I’m sorry to hear that hap-
pened or something like that. And they will come back with a flippant remark
which is actually saying I’m okay you know, and I’ve dealt with it and if they
promote the conversation then you know they want to talk about it. Then you
are banging around for a few minutes and then you’re gonna throw off a couple
of jokes and that’s the end of it so it’s a coping strategy that often I think is actu-
ally a very effective one. (Interview with Manager)
Goleman (2004, p135) suggests that ‘being able to pick up on emo-

tional clues is particularly important in situations where people have rea-
son to conceal their true feelings’ (p135), so in behaving as the manager
describes we are giving our colleagues a non-threatening way of talking
about what they have been through and using humour as a means to do
this. Dean and Gregory (2005) found that higher levels of stress elicited
greater use of humour.
It is important to include the context in which dark humour was used.
Most of the time in my study, dark humour was used as a coping mecha-
nism and was not used in front of patients. It was confined to the staff
only areas of the department and occurred ‘backstage’ (Goffman 1959).
Radiographers need to be aware when certain behaviours are appropriate
and acceptable, and dark humour is definitely ‘backstage’ behaviour
which occurs away from the patients.
Teamworking and Communication

Teamwork is an important aspect of being a diagnostic radiographer.
Radiographers become ‘part of the team’ very early on in their training
and become professionally socialised into the culture. They learn ‘how we
do things here’. This can also be termed as becoming part of a commu-
nity of practice or professional network. Newcomers to the team learn by
close contact, imitation and role modelling and the understanding of
concepts. This allows others in the professional group to recognise the
newcomer as competent.
Within my study there were two distinctive areas of teamworking
described by the radiographers; the friendly atmosphere between col-
leagues and the ways in which they worked together.
Friendly atmosphere:
Everyone seems to work together really really well. I think everyone communi-
cates really well here, there’s lots of respect between the radiographers. (Interview
with radiographer)
32 R. M. Strudwick
This radiographer felt that good communication demonstrated mutual

respect.
I think we’ve a good comradeship and teamwork going. (Interview with

radiographer)
One of the student radiographers agreed and stated.
Everyone seems happy and willing to work together as a team and everyone
knows what we’re here to do. (Interview with student)
The student also mentions the common goal, to work together for the
patients.
Whilst I was observing I noted this teamwork. I noted how the radiog-
raphers worked together on many occasions in my observational field
notes and also how there was a friendly atmosphere in the team, they
worked together to get the job done. This has also been apparent during
the COVID-19 pandemic. Diagnostic radiographers taking part in a
recent study have mentioned on several occasions how the diagnostic
radiographers in their departments have worked together as a team and
looked out for one another. So, there is this friendship between colleagues
and camaraderie, but there are also the ways in which the radiographers
work together practically.
Working together: the diagnostic radiographers that I observed would
take on different roles in the team in order that the examination would
run smoothly. I noted this in CT.
There is a small team of radiographers in CT, and they all play their part. The
radiographers take it in turn to do the scans, one radiographer prepares the
patient and the other prepares the equipment. If the patient needs a cannula
inserted, then the radiographers work together to do this. (Observation, CT)
The radiographers had developed their own system of doing things, so

that everyone had a part to play. Everyone took it in turns, and they knew
whose turn it was next and what needed to be done in each of the roles.
This was also evident in other parts of the department, for example in the
inpatient room.
When dealing with in-patients the radiographers work together. The radiogra-
phers help one another to sit patients up, position the image receptor and the
X-ray tube. (Observation, main department)
It was clear that when working together, the radiographers were able to
adapt to the situation, taking on different roles as and when needed. For
example, one radiographer would look after the patient whilst the other
manoeuvred the X-ray equipment, or one would explain the procedure
whilst the other would sort out the image receptor. The radiographers
were also able to take on and adapt to different roles in the team, depend-
ing on who they were working with. Effective team players can work in
this way without thinking, it becomes second nature.
This teamworking appeared as if it was choreographed, each radiogra-
pher played a different role, working with each other and as an effective
team to ensure that every imaging examination went smoothly.
Radiographers who worked together frequently, particularly those in
smaller teams like CT, magnetic resonance imaging (MRI) and fluoros-
copy, were able to read one another’s body language and it seemed as if
they could communicate without speaking to one another, using non-
verbal cues such as facial expressions. This is highly adapted teamwork-
ing. When interviewed one of the radiographers said that when you have
been working together for so long, you often do not need to use words!
Staff members observe one another and the patient to work out how the exami-
nation is going and what is going to happen next. A lot of the shared language
is unspoken, non-verbal communication, facial expressions and body language.
The use of language is different with patients and colleagues. (Observation,
fluoroscopy)
Facial expressions are used to communicate. A patient with an unpleasant

odour was in the room and the radiographer communicated this to her col-
leagues without speaking. (Observation, accident and emergency X-ray room)
34 R. M. Strudwick
This shared communication between professionals is highlighted in

other studies (Wolf 1988; Street 1992; Annandale et al. 1999). Wolf
(1988) also suggests that team members who have worked together for a
period of time will know when someone in the team has an emergency by
the way in which they speak and their tone of voice; this is learnt from
experience and working together.
Within a professional team shared language is also common. I observed
the radiographers using technical language in front of the patient so that
they could communicate with one another without the patient necessar-
ily understanding what was being said. For example, the radiographers
would discuss how they were going to position the patient between them-
selves to gain agreement and then they would revert to language the
patient understood to convey this to the patient. The shared language
used within a professional group includes technical language or abbrevia-
tions which may not be understood by those outside the group. It is
important that radiographers and students are aware of this professional
jargon and are able to adapt their use of language when talking to non-
radiographers and patients to ensure they are understood.
iagnostic Radiographer Relationships

D
with Radiologists
Radiologists are specialist medical doctors who are trained in radiology.
They are trained to interpret medical images, provide a diagnosis and
carry out specialist imaging procedures. They are based within the imag-
ing department. There is therefore a historical relationship between the
two professions: radiologists and diagnostic radiographers. In the past
there was a definite delineation between the role of the radiologist and
the radiographer, but with a national shortage of radiologists and radiog-
rapher role development; this boundary has become somewhat blurred.
There is some history of subordination and medical dominance from
radiologists over radiographers (Lewis et al. 2008). However, this is
changing due to technological advances and the advent of advanced prac-
tice. Radiographers are taking on extended and advanced roles which
include reporting on images and performing examinations, all of which

were within the domain of the radiologist.
It was evident within the department when I observed that there was a
reluctance from some radiologists to relinquish some of their roles. In
CT, the duty radiologist checked and vetted all inpatient CT requests
and reviewed all CT images before the patient left the department. I
know that in other hospitals these roles had been taken on by radiogra-
phers. It was evident that the level of decision-making and autonomy
experienced by radiographers was dependent on the radiologists and their
interests. In some cases, it could be seen that the radiographers were
reluctant to make decisions without consulting with radiologists. I had
an interesting discussion with two radiographers about this.
I discussed with two radiographers the extended role of the radiographer and the
role of the radiologist in facilitating this. They said that there was a ‘ceiling’ to
the roles that the radiologists would permit radiographers to take on in the
department. The radiologists were keen to ‘hold on’ to the things they were inter-
ested in and certain perceptions about what was acceptable for a radiographer
to do. (Observation)
This feeling was shared by another radiographer in her interview.
Our radiologists are a bit reluctant to relinquish some things, some things have
come about because it’s easier for them you know it’s not because of the role
extension and that, so it’s what suits and there’s a tension between the radiolo-
gists and the radiographer extending their role and that’s different in different
hospitals. (Interview with radiographer)
It was not always clear where this boundary was, and it did appear to
be blurred and depended largely on the individuals involved. For exam-
ple, in areas of the imaging department where the radiologists had a keen
interest such as CT and MRI, there was little scope for radiographer role
extension, but in other areas of the department such as fluoroscopy there
were four advanced practitioners carrying out examinations and report-
ing on images. Although my data collection occurred in 2008, this is still
36 R. M. Strudwick
reported in imaging departments at the present time, there is still some

jostling for roles and responsibilities.
Despite this, there was evident teamwork between the radiographers
and radiologists. Each profession was able to play their part and provide
expertise. Once again, the teamwork appeared to be choreographed, but
in this situation, the radiologist would always take the lead. It was
observed that there were both formal interactions about work and
patients, and informal social conversations between radiographers and
radiologists. Where the two groups worked together, good teamwork was
evident.
Discussion and Story Telling

In every area of the imaging department during my observation I noted
that the radiographers discussed their work with one another whilst they
were working. The radiographers discussed their patients, the imaging
requests, patients’ previous images, their colleagues, the rota and there
were general discussions about how to do things. This discussion took
place in the viewing areas of the department where the radiographers
congregated. This was a normal part of the workplace culture in the
department. Discussions about work often occurred to gain positive reas-
surance from colleagues.
The radiographers discuss their images, and ask the opinion of their colleagues—
are my images acceptable? Would you repeat this image? How do I need to
reposition the patient to correct this image? (Observation, viewing area)
The radiographers discuss their patient and their images in the viewing area.
One radiographer has a patient who cannot turn their leg for an image of their
knee and so asks another radiographer for help in positioning the patient and
then they look at the resultant image together and decide if it shows the fracture
clearly enough. (Observation, viewing area)
This is an example of a supportive environment which is described by

Southon (2006). The radiographers also discussed interesting or unusual
cases with colleagues, frequently to ask for advice, but also to share
experiences.
One of the radiographers checks the clinical history on a request card with a
colleague. This was a particularly quiet time in the department and so all the
radiographers wanted to find out what the pathology was on the request card;
this resulted in a Google search and a discussion about the unusual condition
the patient had. The radiographers then went on to discuss some of the unusual
pathologies that they had come across and some of the interesting cases they had
recently seen. This discussion took place in the viewing area. (Observation,
viewing area)
Diagnostic radiographers need to ensure that the images they produce

of their patients are diagnostically acceptable and answer the clinical
question asked by the referred. Therefore, it is commonplace for radiog-
raphers to check this with one another. The conversations would go
something like this:
Questions: what do you think? Is that okay? Do I need to do it again?

Responses:
I think that’s okay, let’s have a look at your request card? Yes,
that’s fine.
Or
I would have another go at that and see if you can get a bet-
ter image.
This was observed many times during the course of a day.
The radiographers also discussed patients that they considered to be

more challenging with colleagues before they started an examination to
obtain advice and to decide upon a course of action. Radiographers used
the expertise of others to give them support. Hafslund et al. (2008) when
writing about evidence-based radiography suggest that radiographic
practice relies on tradition and subjective experience. On a day-to-day
basis the radiographers tap into that experience by asking their colleagues
for their opinions and discussing their work as they are doing it. This
provides support and facilitates the sharing of expertise.
38 R. M. Strudwick
This has been seen in other studies, Hunter et al. (2008) on the neona-
tal ward, Street (1992) and Wolf (1988) in general wards. Wolf (1988)
also found on her ward that nurses would usually go to a colleague first
before consulting with written policies. The radiographers in the depart-
ment where I observed also did this.
Storytelling about work was also commonplace during quiet periods
or during breaks. This usually occurred in the staff room, out of the ear-
shot of patients. The staff room was a good place to observe the culture
‘behind the scenes’, and storytelling was part of this ‘backstage’ culture.
Whilst sitting in the staff room during their break the radiographers tell stories
about the patients they have seen this morning, and during out of hours shifts.
Each radiographer takes it in turn to discuss how their morning has gone and
to share something that has happened. This ranged from complaining about a
rude patient, to talking about a nurse who had not been very helpful. The sto-
ries told within the staff room tended to be derogatory or complaining about
others, there were rarely any positive stories told. (Observation, staff room)
A lack of understanding of the role of the diagnostic radiographer

emerged on several occasions during this story telling and resulted in
frustration all round. There were also discussions about bodily fluids
when we were eating lunch.
There was a discussion about nasty experiences and about bodily fluids. One of
the radiographers started to talk about a pus-filled abscess whilst one of the
other radiographers was eating some custard! It was pointed out that the custard
and pus were very similar in colour… this did not appear to faze the radiogra-
pher eating the custard and in fact she proceeded to talk about a patient who
had vomited that morning. None of the radiographers were bothered that they
were discussing pus and vomit whilst eating! (Observation, staff room)
Storytelling also involved humour which was discussed earlier in this

chapter. Storytelling sessions often became competitive, particularly in
respect of which radiographer could tell the most gruesome story. Allen
(2004) suggests that having a repertoire of stories and the ability to know
when it is a good occasion to tell them are important requirements for
fitting into the group and becoming a legitimate member. My fieldnotes
Another random document with
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CHAPTER XIX
ARE WE CITIZENS?
“The establishment of a Constitution, in time of profound peace, by

the voluntary consent of a whole people, is a prodigy.” (Fed. No. 85).
Those were the words of Hamilton, in a final appeal to the people of
America, as they were about to assemble in their “conventions.”
As he thought it a prodigy that their voluntary consent should be
secured to that constitution of government contained in the First
Article, he frankly added that he looked forward “with trembling
anxiety” to their own determination as to whether or not they would
give that necessary consent to the enumerated grants in that First
Article. We know how the patriotic efforts of himself and Madison and
his other colleagues were later rewarded by the giving of that
consent. We know where those average Americans of that day gave
that consent, where they made that constitution of their national
government which is that First Article. “It is true, they assembled in
their several states—and where else should they have assembled?
No political dreamer was ever wild enough to think of breaking down
the lines which separate the states, and of compounding the
American people into one common mass. Of consequence, when
they act, they act in their states. But the measures they adopt do not,
on that account, cease to be the measures of the people
themselves, or become the measures of the state governments.”
In the many other Supreme Court decisions, telling the tale of the
completion of the “prodigy” and all stating the same legal fact, is
there a more apt and accurate expression of the knowledge of the
American people, who were better acquainted “with the science of
government than any other people in the world,” that the
“conventions” in the respective states, assembled to constitute their
American government by grants like those in the First Article and the
Eighteenth Amendment, are the Americans themselves and that the
state governments never are the American people themselves and
never represent those people for national purposes. It was natural
that such apt and accurate expression of that concept should have
been voiced by Marshall in the Supreme Court. He had been one of
those people, fighting on the battle-field with them to wrest from all
governments in the world any ability to constitute government by
making grants like those in the First Article or the Eighteenth
Amendment. He had been one of those people in one of those
“conventions,” in their respective states, where they made the only
Article of that kind which ever entered their and our national
American Constitution. Later it became his privilege and duty (and
our great good fortune) to explain who alone could make and did
make that First Article and who alone can ever validly make Articles
like it or the Eighteenth Amendment, namely, the American people
themselves, assembled in convention in their respective states.
When, therefore, we read the Fifth Article, made by him and his
fellow Americans in those “conventions,” we recognize at once and
we will never forget or ignore their mention of themselves, in the very
word by which he and they then described themselves,
“conventions” in their respective states.
In making the Eighteenth Amendment grant of power to interfere
with American freedom, we—the American citizens and
“conventions” of this generation—have been ignored as completely
as if we were not named in the Fifth Article.
We have been trying to ascertain “when” and “how” the American
human beings, now ourselves, ceased to be “citizens of America”
and again became “subjects” of governments. We have gone to the
record of our Congress on those days in 1917, in which it acted on
the assumption that the “when” and “how” were already history. We
have found no Senator or Congressman who vouchsafed any
information or displayed any knowledge of this matter, so vitally
important to us who were born citizens and free men. We have seen
the leader of the House advocates of the new constitution of
government, the Eighteenth Amendment, read a Fifth Article in which
the “conventions” of those who made it and the First Article are not
mentioned. We have seen the leader of the same advocates in the
Senate complacently assert the repudiated thought that the states
made the First Article, our constitution of our government. We have
seen him follow up this error with the Tory mistake of assuming that
the government of the state is the state. We have seen him point out,
to our American amazement, the remarkable and hitherto unknown
fact, never mentioned by the people who made the Fifth Article, that
the state governments are the only tribunal in which our national
constitution of government can be changed, that those governments
are a tribunal in which new enumerated power can be given by
government to government to interfere with our own individual
freedom.
Fresh from our education with the Americans who made that Fifth
Article in “conventions” of the very kind mentioned therein, we see
that those legislators of 1917 know naught of American history or law
or constitution of government of men, that from them we cannot
learn “when” or “how” we ceased to be “citizens” and became
“subjects.” But, there assembled in the Supreme Court in March,
1920, many renowned “constitutional” lawyers. Some came to
challenge, some to uphold the new Amendment, the new
government-made constitution of government right to interfere with
individual human freedom.
To the reading of all their briefs and arguments we bring our
knowledge that the new Amendment never entered our Constitution
unless we were “subjects” before 1917 or unless the new
Amendment was itself a revolution (by government against citizens)
which made us “subjects.”
We expect the lawyers against the new Amendment to challenge
its existence with the facts and knowledge we bring from our
education with the Americans who made themselves free men and
citizens.
We expect the lawyers for the new Amendment to point out the
day and the manner in which they claim that government of the
American people by the American people did disappear from
America.
Unless these lawyers for the Amendment do point out that day and
manner and sustain their claim as to both, we know that the
existence of the new Amendment is successfully challenged by the
facts which we have acquired in our education. Before we listen to
the expositions of these facts by the lawyers against the new
Amendment, let us briefly review the facts themselves as they bear
upon the supposed existence of the new Amendment.
When 1776 opened, the American people were subjects in
rebellion against their omnipotent government. By direct action of
themselves, in July, 1776, they made themselves free men, made
their former colonies independent states and made each of
themselves a citizen of some one of those states. Almost
immediately, the Statute of ’76 having declared the actual fact that
the supreme will in America was possessed by the American people,
at their suggestion and with their permission, the citizens of each
state constituted their own government with its national powers to
interfere with the individual freedom of its own citizens. In strict
conformity to the Statute of ’76 and to the sole American concept of
the relation between government and human being, those grants of
power to interfere with individual freedom, like every other grant of
that kind until the Eighteenth Amendment, were made by the
respective citizens to their respective governments.
In 1777 the committee of the American people known as the
Second Continental Congress proposed a union of states or political
entities and a general government to govern states but not to
interfere directly with the human freedom of the individual. Because
there is a vital distinction between the ability to govern states and the
ability to interfere with individual freedom, those Americans knew
that states or political entities could make federal Articles but that
only citizens could ever validly make national Articles. It was
impossible for these Americans not to know this difference between
the respective abilities of states and citizens of America. Their
Statute of ’76 had declared this sole American concept of the law
controlling the relation of government to human being. They were
actually engaged in their Revolutionary War for the very purpose of
making it forever American law that no governments could ever grant
national power in any matter. Because, therefore, the proposed
Articles of 1777 were only federal Articles with grants of federal
power, it was “felt and acknowledged by all” that the state
legislatures were competent to make those Articles. So we recall,
with intent to remember, that those federal Articles were made in the
exercise of that legislative government ability to make federal
Articles, which is mentioned in our own Fifth Article.
In 1787, from the same Philadelphia, there came the proposal that
the American people, collectively the possessors of the supreme will
in America, create a new nation, with themselves as its members or
citizens and, as its members, constitute its government with national
powers to interfere with their own individual freedom. Because the
legal necessity of deriving powers of that kind from the people
themselves was “felt and acknowledged by all,” the inevitable legal
decision was reached at Philadelphia that the existing ability of
legislative governments to make federal Articles neither then did nor
ever could include the ability to make national Articles like the First
Article and the supposed Eighteenth Amendment. By reason of that
legal necessity and its then recognition by all, because the First
Article contained grants of national power, “by the convention, by
Congress, and by the state legislatures, the instrument was
submitted to the people. They acted upon it in the only manner in
which they can act safely, effectively, and wisely on such a subject,
by assembling in convention.” The reasoning and the decision itself
were embodied in Article VII and in the Resolution which went from
Philadelphia with the proposed seven Articles, including the Fifth
Article.
As the Supreme Court has definitely settled, the Tenth
Amendment merely declares what was in that original proposed
Constitution. Therefore the Constitution gave no new government
ability anywhere except to the government at Washington. It gave to
that government only specific ability to govern human beings, in
certain matters. It merely reserved to each state government some
of its former ability to govern its own citizens. It gave neither to any
state government nor to all state governments collectively any new
ability to govern. And it reserved to the American people themselves
all ability to exercise or to grant any national power to interfere with
the freedom of American citizens except those enumerated powers
in the First Article. The Supreme Court has definitely settled that this
reservation of such power exclusively to themselves, by the makers
of the Fifth Article, is the most important factor in our constitutional
distribution of that kind of power among our American government,
our state governments and, most important of all, ourselves, the
citizens of America. For which reason, until this generation, it has
always been axiomatic that the mention of that exclusive ability of
our own, “conventions” of Americans in their respective states, is the
most important factor in the Fifth Article.
In strict conformity with the Statute of ’76 and without usurping the
reserved powers of the most important factor in both the Tenth
Amendment and the Fifth Article, seventeen federal changes were
made, between 1789 and 1917, in the federal part of our
Constitution, which is both a federal and a national Constitution. The
situation in 1917 was exactly the same as it had been since July 4,
1776, when it was known even to the humble townsmen of Concord
that governments could not make national Articles in American
constitutions. Or rather, the situation in 1917 was the same unless,
somewhere prior to 1917, the Statute of ’76 had been repealed and
the most important factor in both Articles had been eliminated from
the Fifth Article and Tenth Amendment of the American Constitution,
which is the security of the American citizen against usurpation of
power even by governments in America.
We know that Gerry moved to strike that important factor from the
Fifth Article in September, 1789, and that he failed in his effort. We
know that Webb and the legislative advocates of the new Eighteenth
Amendment had a Fifth Article in which that most important factor
was not present. Apparently they based their government proposal
and government ratification of the Eighteenth Amendment upon a
Fifth Article which did not contain that most important factor, the
reference of the makers of the Fifth Article to themselves as the
makers of all future Articles of a national kind, the reference of those
makers to themselves in the words “conventions” of the American
people, assembled in their respective states.
Keeping all these settled facts clearly in our minds, we now take
up the arguments and the briefs in which, in March, 1920, the
constitutional lawyers of America, who disputed the presence of the
new Amendment in our Constitution, should have presented these
irresistible facts. Then we shall take up the arguments and briefs of
those other renowned lawyers in which they presented those other
facts (still unknown to us average Americans) which can alone refute
our knowledge that the new Amendment never went into our
Constitution, because we are still citizens and governments are yet
unable to create government power to interfere with our individual
freedom.
CHAPTER XX
LEST WE FORGET
“The important distinction so well understood in America, between

a Constitution established by the people and unalterable by the
government, and a law established by the government and alterable
by the government, seems to have been little understood and less
observed in any other country.... Even in Great Britain, where the
principles of political and civil liberty have been most discussed, and
where we hear most of the rights of the Constitution, it is maintained
that the authority of the Parliament is transcendent and
uncontrollable, as well with regard to the Constitution, as the
ordinary objects of legislative provision. They [the legislature] have
accordingly, in several instances, actually changed, by legislative
acts, some of the most fundamental Articles of the government.”
(Fed. No. 53.)
Coming from Madison or Hamilton, this is the best kind of
testimony that the earlier Americans, who established that
constitution of government which is the First Article, knew that it was
“unalterable by government.” And it is the best kind of testimony that
the same American makers of the Madison Fifth Article knew that it
did not grant to state governments any ability to add to or subtract
from the First Article enumerated and constituted powers in
government to interfere with the freedom of American citizens. If
Madison and Hamilton had been with us in our Congress of 1917,
their statement would have been slightly altered. They would have
spoken of “the important distinction so well understood in America” in
1787, as one which “seems to have been little understood and less
observed in any other country” and not known or observed at all by
our Senators or Congressmen of 1917.
The Americans of 1787, who “so well understood” the important
distinction, made their knowledge a noticeable thing in the language
of their Statute of ’76 and of their Constitution. With their knowledge
of the important distinction, they permitted the respective states,
through the respective legislatures thereof, to constitute the
government of states, to make the federal Articles of 1781. With their
knowledge of the important distinction and in deference to their own
clear Statute of ’76, these intelligent Americans refused to permit the
states or the legislatures of the states to establish the government of
men, to make the national Article—the First Article—which is the
constitution of government power to interfere with individual human
freedom. Moreover, by their knowledge of the important distinction
and of the Statute, they knew that Constitution, that enumerated
grant of national power over themselves, to be “unalterable by
government.” And that we and all later Americans might also know it,
they, the American people or “conventions” of that day, insisted that
the Tenth Amendment expressly declare that they, those
“conventions” of the American people, reserved to themselves and
their posterity, the “conventions” of any later day, exclusive ability to
alter that constitution of national power, the First Article. And, for the
same purpose, they, the “conventions,” mentioned themselves, the
particular reservee of the exclusive ability to alter that grant of
national power, in one particular earlier part of the Articles they
made, the part we know as the Fifth Article. Naturally, the two men,
who worded that Article at Philadelphia and who paid its later makers
the deserved tribute to their knowledge of the important distinction,
mentioned those makers, “conventions,” in that Fifth Article as future
makers of all grants of national power and mentioned the
legislatures, in the Fifth Article, as competent future makers of
Articles that do not constitute new national government.
Because we have lived through the experience of the Americans
to whom the tribute was paid, we know the distinction between a
constitution of national government, “unalterable by government,”
and Articles constituting government of political entities or states,
alterable by the states or the legislatures of the states. Moreover, by
reason of our experience, we sense the clear recognition of the
distinction in the Fifth Article distinct mention of the people or
“conventions,” as sole makers of national Articles, and the similar
mention of the “legislatures” as competent makers of federal Articles.
To our regret, we have found that our Congress, in 1917, knew
naught of the distinction and naught of its recognition in the language
of the Tenth Amendment and the Fifth Article. It is with relief,
therefore, that we turn to the great litigations in the Supreme Court of
1920, in which the lawyers of the America, where the important
distinction was once so clearly known, attacked and defended the
proposal from the Congress of 1917 and the action of the state
legislatures on that proposal. Fresh from the utter legislative
ignorance of that distinction, it is with relief that, in our first glance at
the briefs of those lawyers, we find what seems the clear echo of the
accurate knowledge we have acquired in the company of those
earlier Americans.
“There is only one great muniment of our liberty which can never
be amended, revoked or withdrawn—the Declaration of
Independence. In this regard, it ranks with the Magna Charta.”
The clear tribute to the unrepealed Statute of ’76 excuses, while it
does not explain, the error of the allusion to Magna Charta. Graduate
students of the history of the advance of Americans from subjects to
free men, we average citizens grasp the error of the statement, “in
this regard [that neither can ever be revoked] the Statute of ’76 ranks
with the Magna Charta.” We know that the Statute was the
revocation of the basic doctrine on which Magna Charta rested.
Magna Charta was the grant of privilege from an omnipotent
government to its subjects. All that subjects ever have are the
revocable privileges granted by the master government. The Statute
of ’76 states the basic American law that there are no subjects in
America, that the human members of any political society or state or
nation, except as they directly grant power over some of their human
rights to secure enjoyment of the rest, need obey the command of no
one except Him who gave them their human rights. In a free nation,
such as the earlier Americans made of themselves, no man has any
privileges granted by a master government. In a free nation, citizens
or members of the society (and the supreme will therein) have their
servant governments to which those citizens give whatever national
powers those governments ever have. Except for the grants of such
power which those citizens so make, the human beings retain, not as
a gift or privilege of government but as the gift of Him Who created
them, all human freedom of action. As citizens, they also possess
the particular privileges which arise from membership in that
particular society of men; but even those privileges are not the gift of
government but the creation and effect of the society itself, just as
every power of the government is also the gift of the society.
We pardon the error of the reference to Magna Charta, however,
when we read on in the brief and find it immediately quoting from our
Statute: “We hold these truths to be self-evident, that all men are
created equal; that they are endowed by their Creator with certain
unalienable Rights; that among these are Life, Liberty and the
pursuit of Happiness. That to secure these Rights, Governments are
instituted among men, deriving their just powers from the consent of
the Governed. That whenever any Form of Government becomes
destructive of these ends, it is the Right of the People to alter or to
abolish it, and to institute new Government, laying its foundation on
such principles and organizing its powers on such form, as to them
shall seem most likely to effect their Safety and Happiness.”
At last, in this brief, we are getting the clear echo of our own
knowledge that, until this Statute is revoked, it is not the right of
“government or governments” to institute new government, laying its
foundation on such principles and organizing its powers in such form
as to “governments” shall seem most likely to effect the safety and
happiness “of governments.” Moreover, in this brief, we are getting
the clear echo of our own knowledge that this Statute can never be
revoked, while we remain free men and citizens instead of the
subjects we were until that Statute was enacted.
And when we turn to another brief for a moment, we are cheered
to find the refutation of the Sheppard ignorance of the identity of
those who made our Constitution, “We, the people of” America, in its
Preamble and its most important factor of the Tenth Amendment, the
“conventions” of ourselves in its Seventh and its Fifth Articles. With
gratification that some “constitutional” lawyers still know and observe
the important distinction between the ability of ourselves, the
“conventions” of the Seventh and Fifth Articles, and the lack of ability
in the “legislatures” of the Fifth Article to give to government national
powers, we average Americans recognize, in the following challenge
of this brief, the challenge we would have made to the Sheppard
proposition that legislatures attempt to constitute such new
government over us. This is the challenge of the brief to Sheppard:
“The Constitution is not a compact between states. It proceeds
directly from the people. As was said by Mr. Chief Justice Marshall in
McCulloch v. Maryland, 4 Wheat. 316, etc.” Then follows the
Marshall clear exposition of how the people themselves, the
“conventions,” made the constitution which is the First Article and
how, if any other constitution of that kind, such as the Eighteenth
Amendment, is ever to be made “safely, effectively, and wisely” it
must be made by ourselves, assembled in the “conventions” named
in the Fifth Article. The full extract from Marshall has been set out
already herein at page 98.
In a second brief, in a different case, the same distinguished
lawyer of 1920 is found bringing into bold relief another part of our
knowledge so intimately connected with the supposed new
constitution of government, the Eighteenth Amendment. And it is a
part of our knowledge which challenges a new constitution made
entirely by governments without any action by ourselves, the people
or the “conventions” named repeatedly in the Constitution made by
themselves. In that other brief, we find him stating as one of the
propositions on which he bases his argument, “What the expression
‘legislatures of the several states’ meant as used in Article V, when
that Article was adopted as a part of the Constitution, it means now.”
The statement being undeniably true, he immediately proceeds to
urge, with equal truth, that “however popular approval or disapproval
[i.e., the direct action of the people themselves, as, for example, in
the ‘conventions’ whence, as he already stated, our Constitution
proceeded ‘directly from the people’] may be invoked, the people do
not become a ‘legislature.’... As well confound the creator and the
creature—the principal and the agent through which he acts.”
This is the echo of Marshall’s clear statement of the vital
distinction between the same “legislatures” (who never are the
people and never have the reserved ability of the people) and the
“people” or “conventions” (which are the people and have the
exclusive ability of the people). We recall the tribute paid to this
distinction at Philadelphia. We recall the legal decision there, a
decision based squarely on that distinction, that the legislative ability
to make federal Articles could not constitute new government of
men, as did the First Article, and that all Articles like it or the new
Eighteenth Amendment must go to the “people” of the Tenth
Amendment, the “conventions” of the Seventh and Fifth Articles. We
recall Marshall’s appreciation of the accuracy of that legal decision,
when he mentioned that the ability of the state governments or
legislatures had been competent to make the federal Articles of 1781
but, when it was proposed to constitute government of men, to vest
the national powers of the national First Article, “the necessity of
deriving those powers directly from the people [the “conventions” of
the Seventh Article] was known and recognized by all.” We
remember that the “people” or “conventions,” so recognizing and
knowing, mentioned themselves in the Fifth Article so that no one
ever should forget the similar legal necessity that every Article like
the First, such as the new Article, must always be made by those
“conventions” so mentioned.
It is, therefore, with considerable satisfaction that we read, in this
brief of 1920, the clear echo of all these settled facts, the knowledge
that “legislatures” never are the people and never become the
people. “As well confound the creator and the creature—the principal
and the agent.”
In our gratitude for such remembrance, we ignore the inaccuracy
of a suggestion that the “legislatures” of the Fifth Article are the
agent of the principal therein mentioned, the “people” of America, the
“conventions” which made the Constitution. Each of those
“legislatures” is an agent of one particular reservee among those
named collectively in the reservation of the Tenth Amendment in the
words “to the states respectively,” while the “conventions” in the Fifth
Article is the one most important reservee in that Tenth Amendment,
“the people” of America, the most important factor in that Tenth
Amendment and in America. For the purpose of making any Articles,
whether federal or national, that important reservee has no
legislative agents. For any purpose, it has but one legislative agent,
the Congress; and to that one legislative agent it has given no power
to make any constitutional Articles; but it has, in the Fifth Article, left
with that agent the mere ability to draft and propose a new Article of
either kind and, as did the Philadelphia Convention, from the nature
of the Article it drafts, whether within the ability of “legislatures” or
within the exclusive unlimited ability of the people or “conventions,”
to ascertain and propose which shall make the drafted Article.
That the state legislatures are not agents of the American citizens,
in that capacity, is self-evident. Each legislature is chosen by the
citizens of a state. Moreover, the Constitution itself distinctly states
that the “conventions” of the American citizens grant no power of any
kind therein to the state “legislatures.”
When the American people created a national legislature,
with certain enumerated powers, it was neither necessary nor
proper to define the powers retained by the states. These
powers proceed, not from the people of America, but from the
people of the several states; and remain, after the adoption of
the Constitution, what they were before, except so far as they
may be abridged by that instrument. (Marshall in Sturges v.
Crowinshield, 4 Wheat. 122.)
That is why anything which these “legislatures” do, when it comes
in conflict with a valid action of our legislature, the Congress, must
always yield. We have the supreme will in America, and when our
agent, the Congress, speaks with authority from us, it speaks for us,
while the inferior agents of other lesser wills never speak for us. That
clear distinction does not detract from the ability of those legislatures
to make federal Articles in our Constitution. They do not get that
ability from us, the citizens of America. They had that ability from
those respective inferior wills, when we made our Constitution. By its
exercise, they had made the federation of states and the federal
Articles of its government. When we made our national Constitution,
we continued that federation and the ability of its component
members to make its federal Articles and put them in our
Constitution, which is both our national Constitution and their federal
Constitution. The ability to make those federal Articles is one of the
powers reserved to those inferior wills by the reservation of the Tenth
Amendment which reads “to the states respectively”; and it is not an
ability to make Articles which is granted in the Fifth Article. No ability
to make Articles is granted in that Fifth Article.
Inasmuch, however, as the writer of the brief in 1920 has known
that “legislatures” do not ever become “the people,” it is quite
probable that his reference did not intend to suggest that the
legislatures of which he spoke and who are the agents respectively
of other citizens, were the agents, for any purpose, of the citizens of
America. With his recognition that legislatures never are the people
and with the other quoted extracts of those briefs of 1920 before us,
echoing the knowledge we have acquired, we feel at least that in the
court of 1920, from the debate of men who know, we will learn
whether and “when” and “how,” we, between 1907 and 1917,
became subjects instead of the free men and citizens which we
clearly were up to 1907.
At least such was the thought of one American citizen, when he
read this quotation, in one of the briefs of 1920, “that the people do
not become a legislature.... As well confound the creator and the
creature—the principal and the agent through which he acts.” It was
almost incredible to this particular American citizen that he found this
statement and the statement that—“The Constitution is not a
compact between states. It proceeds directly from the people.”—both
in the briefs of the foremost champion of the new Amendment. And it
seemed equally incredible to him to find the quotation about the
Statute of ’76 being “one great muniment of our liberty which can
never be amended, revoked or withdrawn” in the brief of the counsel
for the political organization which dictated the new state
government command to the citizens of America.
An unusual method had been adopted for the hearing of what
were later reported under the one title the “National Prohibition
Cases,” 253 U.S. 350. In that hearing, which continued for days,
seven different litigations were argued because all dealt either with
the validity of the Eighteenth Amendment or with the meaning of its
remarkable second section or with the statute enacted under that
section and known as the Volstead Act. For the same reason, the
briefs on both sides of the various litigations were clearly the result of
conference and collaboration. Nearly all of the briefs, challenging the
new Article, made their challenge on the same two main points and
in the expression of those two challenges, made constant reference
to the different expression thereof in the other briefs.
In the litigation and argument of that March, appeared many of the
best known lawyers in America. Among them were distinguished
counsel, appearing on behalf of those legislative governments who
claim and, in the new Article, have attempted to exercise the
omnipotent supremacy over the citizens of America which was
denied by the people of America to the British Parliament. Among
them were other distinguished counsel, appearing on behalf of what
had always been known as the supreme legislative government in
America, our government with its enumerated powers and without
omnipotence over us. Among them were still other distinguished
counsel, appearing on behalf of some separate states or political
entities to contend that there existed no constitutional ability
anywhere, even in ourselves, to take from their particular state any
more of its sovereignty than it had surrendered in those early days
when the states made the Constitution, as Sheppard claimed in the
Congress of 1917. Among them were still other distinguished
counsel, some of them the most distinguished of all, appearing to
oppose, as best they knew how, the total destruction of all legitimate
industry in a business in which it was the human right of Americans
to engage even before Americans wrote their Statute of ’76 and
consequently not a privilege of the citizen of America or the citizen of
any state.
As this fact has been the basis of many errors in that comedy and
tragedy of errors, which is the five-year tale of the Eighteenth
Amendment, we average Americans may well dwell for a moment
upon the certainty of that fact. It is the natural mistake of those, who
have the Tory concept of the relation of men to government, that they
should first confuse the meaning of the words “privilege of a citizen”
with the words “privilege of a subject” and thus believe that the
nature of both privileges, and the source of each are the same. That
mistake is but the echo of the error which confuses the nature of
Magna Charta with that of the Statute of ’76. Magna Charta is the
declaration of certain privileges which government will permit its
subjects to keep as long as the government pleases. The Statute of
’76 is the declaration that destroys the relation of government to
subjects, creates the relation of citizens to their servant
governments, and states that the servants shall have no power to
interfere with the human rights of the masters, given by their Creator,
except such power as the masters choose to give, and that the
servants shall keep that power only so long as the masters will. To
the Tory concept, always concentrated on the relation of subject to
master government, it is difficult of apprehension that the human
being is born with the right to use his human freedom as he himself
wills, so long as he does not interfere with the similar exercise of
human freedom by the rest of us human beings. If men, in the
exercise of their free will, would always obey the defined law of Him
who created them, the exercise of human freedom by one individual
would never interfere with the exercise of human freedom by all
other individuals, and no human government need ever be
constituted.
Among the human rights of Americans, as of all human beings,
when they come into the world, is the human right to do everything
which is forbidden in the first section of the Eighteenth Amendment.
It is true, as we frequently hear stated, that the Supreme Court has
decided that the right to do any of those things is not the “privilege”
of American citizens or of the citizens of any state. It is also equally
true, although the Supreme Court has never been called upon to
decide that very obvious fact, that the right to breathe is not the
“privilege” of an American citizen or of the citizen of a state. Both
rights are among the rights of human beings, as such, and they are
each of them among the rights of themselves, which we, “the people”
of America, established and ordained our Constitution to secure.
When we established that Constitution for that purpose, we
admittedly gave our only American government no power to make
the command of the first section of the Eighteenth Amendment. That
is why the governments of other citizens were asked to make the
command to ourselves, the citizens of America.
Each of the Americans, who created the nation that is America,
already lived as a member and citizen of a state. In that state, when
they had constituted it, the citizens thereof had subjected their
human right (to do what the new Amendment says shall not be done)
to a power in the government of that state (a power which they gave
it and can take back from it) to make that kind of a command to them
in that matter.
We thus have clearly in our minds that the individual in America
has the human right (with which the new Amendment interferes) and
that it is subject to the interference of no government, except as the
citizens of that particular government have given it power so to
interfere with it. The undoubted fact that the right itself is not the
privilege of the citizen of America or the citizen of the state is simply
another way of saying that the original human right itself is not
granted to the human being by government or governments but by
the Creator Who made him. Without the Tory concept, no man would
even make the mistake of believing that a citizen gets any of his
privileges from any government. The privileges of a citizen are the
things which he acquires by his voluntary association with the other
citizens as the members of a political society which is the nation. The
human rights of the same individual are the rights which he brings
into that association and subjects to whatever powers of its
government are granted by himself and those other citizens with
whom he associates as the nation.
Of course, the early Americans, with whom we have now been
educated, not only knew these things clearly and accurately, but on
their knowledge of them based everything that they did in the fifteen
years which we have lived with them. The Americans of today, who
uphold the new constitution of government made entirely by
government, do not know them at all or understand them when they
hear them. Neither would the aristocrats of France, before the
French Revolution, nor the Tories of England, even at the time of our
Revolution, have known or understood them. That is why the
Americans continued their Revolution and won it, so that these
things might be the basis of every government interference with any
human right. Later they made the American Constitution solely to
secure the greatest possible protected enjoyment of all individual
human rights. That security is one of the privileges acquired by
citizenship in the society which that Constitution created. Wherefore,
it is of interest for us to know how clearly Madison, who largely
planned that Constitution and who worded its Fifth Article, did know
and understand these facts in relation even to the very things
forbidden in the new constitution of government made entirely by
government.
In the House of Representatives, in the first session of the new
Congress with the enumerated powers of the First Article, on May
15, there came up for discussion “a proposed bill laying duties on
goods.” Madison “moved to lay an impost of eight cents on all beer
imported. He did not think this would be a monopoly, but he hoped it
would be such an encouragement so as to induce the manufacture
to take deep root in every state of the Union.” (4 Ell. Deb. 345.)
That the knowledge of Madison was not unknown to the Supreme
Court a century later, in 1890, is a matter of record.
That ardent spirits, distilled liquors, ale, and beer are
subjects of exchange, barter, and traffic, like any other
commodity in which a right of traffic exists, and are so
recognized by the usages of the commercial world, the laws
of Congress, and the decisions of courts, is not denied. (Leisy
v. Hardin, 135 U. S. 100.)
Returning to the courtroom of 1920, therefore, we are sincerely
glad to note the appearance of quite an array of eminent counsel on
behalf of those legitimately engaged in a business which is just as
legitimate an exercise of human right, as it was when Madison
hoped that it would take deep root in every state of the America he
loved so well, a business which will continue free from unlawful
usurpation of power by government so long as the Constitution
planned by Madison is obeyed by governments in America. It is too
bad that the eminent counsel, who shared Madison’s views in
relation to that legitimate business, did not also have Madison’s
accurate knowledge of the only way in which legitimate government
power can be created to interfere with that or any other human right,
the way which Madison so clearly stated in the Fifth Article—by grant
from the “conventions” of American citizens.
When we average Americans look over the great array of counsel
and the respective clients whose causes they champion, one fact
lends no encouragement to our hope that we may learn the merits of
the claim that, somehow between 1907 and 1917 we became
subjects and lost our status as free men. Although each client is
represented by his own distinguished attorneys and although
eminent counsel argue and file briefs, as amici curiæ, on behalf of
the state governments which claim that we are subjects and on
behalf of some of the litigating other states and individuals, no
amicus curiæ files any brief on behalf of us, the citizens of America,
the reservees of the Tenth Amendment, the “conventions” of the
Seventh and the Fifth Articles.
There is, however, this comfort. If, because the counsel in
opposition to the new Amendment do not know and urge our legal
protection against any new constitution of national government
except by ourselves, the citizens of America, the “conventions” of the
Fifth Article, and if, because of such ignorance on the part of
counsel, the Court should not be called upon either to consider or
pass upon our protection, no decision of the Court will be intended to
have—as no decision of the Court could have—any effect upon our
protection. If counsel fail to bring before the Court the legal facts
which demonstrate that the new Amendment is not in the
Constitution unless we Americans are “subjects,” our day in Court is
merely postponed. And when that day shall come, when that Court is
addressed by counsel who do represent the citizens of America and
who accurately know the constitutional protection which we have for
all our rights, there is not the slightest danger that the Court,
established and maintained by us for the sole purpose of protecting
our individual rights against usurpation by government, will decide
that we are subjects and that governments can create new
government power to interfere with the freedom of the individual
American citizen.
Meanwhile, let us examine the briefs of March, 1920. In them,
despite our regret that not one of them was written in our behalf, it

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ISBN 978-981-16-7251-4 ISBN 978-981-16-7252-1 (eBook)

Cover illustration: Pattern © Harvey Loake

1 Introduction to Ethnography and the Ethnographic

3 Working as a Diagnostic Radiographer: Relationships with

4 Working as a Diagnostic Radiographer: Structure and

5 Working as a Diagnostic Radiographer: The Role of the

7 Interprofessional Learning and Working 83

8 Relationships with Service Users and Values-Based Practice 95

9 Summary, Conclusions and Recommendations125

Abstract This is an introductory chapter about ethnography as a meth-

Keywords Ethnography • Methodology • Methods • Professional

natural state and setting and be as undisturbed by the researcher as pos-

 utobiographical Information About

research was carried out is one of those placement hospitals. I continue to

The Ethnographic Researcher

 ackground and Rationale for the Book

qualitative and ethnographic research and secondly to how this pervades

Introduction to and Overview of My

Table 1.1 The overarching concepts and themes

Abstract This chapter provides an outline of the research methods used

Keywords Ethnography • Research methods • Participant observation

Access to the Field

to ‘host’ my study and become the gatekeeper in terms of access; NHS

physically harmed unnecessarily because of an interaction. It is important

• The complete participant—takes an insider role, is fully part of the set-

I took on the role of ‘observer as participant’ in my study, although I

radiographer, but I was not ‘being’ a radiographer, Cudmore and

• Space: the physical place/places

There is more information about fieldnotes in my book chapter

Interviews and Focus Groups

people during a focus group are an opportunity to explore the subjective

Reviewing Documents and Artefacts

analysis is the process of making sense of the data. Thematic analysis is

Gold R L (1958) Roles in Sociological fieldwork. Social forces, Vol. 36,

Keywords Professional culture • Diagnostic radiographers •

• Use of dark humour

Each of these themes is explored in detail in this chapter.

Use of Dark Humour

Sometimes the comments turned from humour into derogatory

This radiographer tried to justify laughing about patients and implying

This is a standard and expected response. This radiographer was also

And so, he concludes that radiographers like to treat things a little

Another radiographer was keen to emphasise that the alternative to

Goleman (2004, p135) suggests that ‘being able to pick up on emo-

Teamworking and Communication

This radiographer felt that good communication demonstrated mutual

I think we’ve a good comradeship and teamwork going. (Interview with

One of the student radiographers agreed and stated.

The radiographers had developed their own system of doing things, so

Facial expressions are used to communicate. A patient with an unpleasant

This shared communication between professionals is highlighted in

 iagnostic Radiographer Relationships

include reporting on images and performing examinations, all of which

This feeling was shared by another radiographer in her interview.

reported in imaging departments at the present time, there is still some

Discussion and Story Telling

1 Introduction to Ethnography and the Ethnographic

3 Working as a Diagnostic Radiographer: Relationships with

4 Working as a Diagnostic Radiographer: Structure and

5 Working as a Diagnostic Radiographer: The Role of the

7 Interprofessional Learning and Working 83

8 Relationships with Service Users and Values-Based Practice 95

9 Summary, Conclusions and Recommendations125

utobiographical Information About

The Ethnographic Researcher

ackground and Rationale for the Book

Introduction to and Overview of My

Access to the Field

Interviews and Focus Groups

Reviewing Documents and Artefacts

Use of Dark Humour

Teamworking and Communication

iagnostic Radiographer Relationships

Discussion and Story Telling