Abstract
This paper explores the potential and relevance of an innovative sociological research method known as the Imitation Game for research in health care. Whilst this method and its potential have until recently only been explored within sociology, there are many interesting and promising facets that may render this approach fruitful within the health care field, most notably to questions about the experiential knowledge or ‘expertise’ of chronically ill patients (and the extent to which different health care professionals are able to understand this experiential knowledge). The Imitation Game can be especially useful because it provides a way to map this experiential knowledge more systematically, without falling in the dual trap of either over-relying on in-depth, but highly specific phenomenological ‘insider’-approaches that are hard to generalize, or, alternatively, problematically reducing the rich life-worlds of patients to a set of indicators in a questionnaire. The main focus of this paper is theoretical and conceptual: explaining the Imitation Game method, discussing its usefulness in the health care domain, and exploring the ways in which the approach can be utilized for chronic illness care. The paper presents both a conceptual and empirical exploration of how the Imitation Game method and its underlying theoretical concepts of ‘contributory expertise’ and ‘interactional expertise’ can be transferred from the sociological realm to the field of health care, what kinds of insights can be gained from the method, which methodological issues it may raise, and what potentially fruitful research routes can be explored. I argue that the Imitation Game can be thought of as a ‘social learning experiment’ that simultaneously enables the participants to learn from each other’s perspectives, allows researchers to explore exciting new possibilities, and also offers the tools to intervene in the practice that is being studied.
Similar content being viewed by others
Notes
One of the examples the authors use to illustrate this point, is by pointing to the huge difficulties the developers of natural language-handling computers faced (and still face) in establishing language software that is able to adequately deal with the tacit rules and understandings involved in language.
These examples are drawn from the work of two master students who have conducted initial experiments on this terrain. It is included as it is until now the only empirical work conducted in this particular area.
The ‘Identification Ratio’ is the specific statistical measure that has been invented for this. Judges are asked to try to identity which of the two participants has the target expertise and record one of four confidence levels at each conversational turn: (1) I have little or no idea who is who; (2) I am more unsure than sure; (3) I am more sure than unsure; (4) I am pretty sure I know who is who. At the end of the game the judge’s final confidence level is counted as the ‘outcome’. A ‘don’t know’ option is not provided but, given the open ended nature of the test, all final guesses at confidence levels 1 and 2 are counted as `Don’t Knows’. Levels 3 or 4 are taken as indicating guesses, either right or wrong. Next, any cultural variation in the willingness of judges to make ‘high confidence’ guesses on the basis of limited information must be eliminated. For this reason, the fundamental measure of successful identifications is not the absolute number of correct guesses, or the proportion of correct guesses, but the excess of right guesses over wrong guesses. This procedure recodes the answers into two categories: the excess of right confident guesses over the wrong confident guesses and all other guesses including `don’t knows’. A number called the `Identification Ratio’ (IR) is then generated for each condition by dividing the excess of right guesses by the total number of guesses (Collins and Evans, personal communication).
Even though this is the work of a masters student, the innovative character of the results (these are basically the first Imitation Games on chronic illness experiences that have been conducted in the Netherlands) warrants their inclusion, although they need to be read as preliminary results.
Relevant ethical approvals for the research have been obtained from the medical centre in which the student conducted her research (METC UMC Utrecht, protocol number 13-112).
I would like to thank the anonymous reviewer for raising this point.
And will be explored as well, through a pilot study in which Imitation Games will be conducted with patients with eating disorders and the various professionals treating them. This pilot study will also focus on exploring the added value of additional focus groups and the analysis will look into the what kind of questions are considered important by the judges.
References
Badcott, D. (2005). The expert patient: Valid recognition or false hope? Medicine, Health Care and Philosophy, 8(2), 173–178.
Barry, C. A., Bradley, C. P., Britten, N., Stevenson, F. A., & Barber, N. (2000). Patients’ unvoiced agendas in general practice consultations: Qualitative study. BMJ, 320(7244), 1246–1250.
Van de Bovenkamp, H. (2010). The limits of patient power. Examining active citizenship in Dutch health care. EUR: Doctorate institution.
Boyce, H. (2009). Interactional expertise in practice: Researching dieticians’ knowledge of living with coeliac disease. Master of Science, Cardiff University.
Bury, M. (1991). The sociology of chronic illness: A review of research and prospects. Sociology of Health & Illness, 13(4), 451–468.
Caron-Flinterman, J. F., Broerse, J. E., & Bunders, J. F. (2005). The experiential knowledge of patients: A new resource for biomedical research? Social Science & Medicine, 60(11), 2575–2584.
Clark, N. M., Nothwehr, F., Gong, M., Evans, D., Maiman, L. A., Hurwitz, M. E., et al. (1995). Physician-patient partnership in managing chronic illness. Academic Medicine, 70(11), 957–959.
Collins, H. (2010). Tacit and explicit knowledge. Chicago: University of Chicago Press.
Collins, H., & Evans, R. (2007). Rethinking expertise. Chicago: University of Chicago Press.
Collins, H. M. (2011). A new method for cross-cultural and cross-temporal comparison of societies. European Research Council.
Collins, H. M., & Kusch, M. (1998). The shape of actions: What humans and machines can do. Cambridge: MIT Press.
Collins, H., & Evans R. (2013). Quantifying the tacit: The imitation game and social fluency. Sociology (February 25).
Conrad, P. (1990). Qualitative research on chronic illness: A commentary on method and conceptual development. Social Science and Medicine, 30(11), 1257–1263.
Crookall, D. (1992). Editorial: Debriefing. Simulation & Gaming, 23(2), 141–142.
Department of Health. (2001). The expert patient: A new approach to chronic disease management for the 21st century. London: Department of Health.
Donaldson, L. (2003). Expert patients usher in a new era of opportunity for the NHS. BMJ: British Medical Journal, 326(7402), 1279.
Edgar, A. (2005). The expert patient: Illness as practice. Medicine, Health Care and Philosophy, 8(2), 165–171.
Epstein, S. (1995). The construction of lay expertise: AIDS activism and the forging of credibility in the reform of clinical trials. Science, Technology and Human Values, 20(4), 408–437.
Evans, R., & Crocker, H. (2013). The imitation game as a method for exploring knowledge(s) of chronic illness. Methodological Innovations Online.
Greenhalgh, T. (2009). Chronic illness: Beyond the expert patient. BMJ: British Medical Journal., 338(7695), 629–631.
Gullickson, C. (1993). My death nearing its future: A Heideggerian hermeneutical analysis of the lived experience of persons with chronic illness. Journal of Advanced Nursing, 18(9), 1386–1392.
Hofstede, G. J., de Caluwé, L., & Peters, V. (2010). Why simulation games work-in search of the active substance: A synthesis. Simulation & Gaming, 41(6), 824–843.
Jansen, Y. (2009). Etnografisch onderzoek onder collega’s; voortdurende spanning tussen betrokkenheid en distantie. KWALON, 14, 3.
Jedeloo, S., & van Staa, A. L. (2009). Q-methodologie, een werkelijke mix van kwalitatief en kwantitatief onderzoek? KWALON, 14(2), 5–15. (Q-methodology: A true mix of qualitative and quantitative research?).
Kangas, I. (2002). ‘Lay’ and ‘Expert’: Illness knowledge constructions in the sociology of health and illness. Health, 6(3), 301–304.
Mol, A. (2008). The logic of care and the problem of patient choice. Abingdon: Routledge.
Paterson, B. (2001). Myth of empowerment in chronic illness. Journal of Advanced Nursing, 34(5), 574–581.
Peters, V. A. M., & Vissers, G. A. N. (2004). A simple classification model for debriefing simulation games. Simulation & Gaming, 35(1), 70–84.
Petersen, R. (2013). Interactionale expertise bij chronisch zieken. Master Thesis., Erasmus University.
Price, B. (1996). Illness careers: The chronic illness experience. Journal of Advanced Nursing, 24(2), 275–279.
Prior, L. (2003). Belief, knowledge and expertise: The emergence of the lay expert in medical sociology. Sociology of Health & Illness, 25(3), 41–57.
Scambler, G., ed. (2001). Habermas, critical theory and health. Psychology Press.
van Staa, A. L. (2012) On your own feet: Adolescents with chronic conditions and their preferences and competencies for care. Dissertation Erasmus University Rotterdam, the Netherlands. ISBN 978-90-79059-03-4.
Sullivan, M. (2003). The new subjective medicine: Taking the patient’s point of view on health care and health. Social Science and Medicine, 56(7), 1595–1604.
Thorne, S. (2006). Patient-provider communication in chronic illness: A health promotion window of opportunity. Family & Community Health, 29(1), 4S–11S.
Thorne, S. E., Harris, S. R., Mahoney, K., Con, A., & McGuinness, L. (2004). The context of health care communication in chronic illness. Patient Education and Counseling, 54(3), 299–306.
Thorne, S. E., & Robinson, C. A. (1989). Guarded alliance: Health care relationships in chronic illness. Image: The Journal of Nursing Scholarship, 21(3), 153–157.
Thorne, S. E., Ternulf Nyhlin, K., & Paterson, B. L. (2000). Attitudes toward patient expertise in chronic illness. International Journal of Nursing Studies, 37(4), 303–311.
Thorne, S., & Paterson, B. (1998). Shifting images of chronic illness. Image: The Journal of Nursing Scholarship, 30(2), 173–178.
Thorne, S., Paterson, B., & Russell, C. (2003). The structure of everyday self-care decision making in chronic illness. Qualitative Health Research, 13(10), 1337–1352.
Tyreman, S. (2005). An expert in what?: The need to clarify meaning and expectations in “The expert patient”. Medicine, Health Care and Philosophy, 8(2), 153–157.
Wallenburg, I. (2012). The modern doctor: Unraveling the practices of residency training reform. Dissertation Vrije Universiteit Amsterdam, The Netherlands.
Wilson, P. M., Kendall, S., & Brooks, F. (2007). The expert patients programme: A paradox of patient empowerment and medical dominance. Health and Social Care in the Community, 15(5), 426–438.
Zuiderent-Jerak, T. (2010). Embodied interventions—interventions on bodies: Experiments in practices of science and technology studies and hemophilia care. Science, Technology and Human Values, 35(5), 677–710.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wehrens, R. The Potential of the Imitation Game Method in Exploring Healthcare Professionals’ Understanding of the Lived Experiences and Practical Challenges of Chronically Ill Patients. Health Care Anal 23, 253–271 (2015). https://doi.org/10.1007/s10728-014-0273-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10728-014-0273-8