2: STATE

He and Bittner come to explain this outcome as the result of “good”

organizational reasons for “bad” clinic records. The good organiza-
tional reasons arise from the clinic’s normal operating procedures
“that for them and from their point of view are more or less taken
for granted as right ways of doing things” (Garfinkel 1967: 191).
The authors conceptualize the deficiencies of the records as “normal,
natural troubles.”

The troubles we speak of are those that any investigator – out-

sider or insider – will encounter if he consults the files in order
to answer questions that depart in theoretical or practical import
from organizationally relevant purposes and routines under the
auspices of which the content of the files are routinely assembled
in the first place.
(Garfinkel 1967: 191)

Such organizationally generated troubles have to do with such things

as the anticipated cost of keeping detailed records; the “greater or
lesser dignity of paper work”; the unpredictable possibility of the
records being used in a job review of the performance of the clinic
staff member recording the data on the self-reporting form in the case
folder; the gap between the standardized categories of the reporting
form and what it takes to describe actual practice; and how

the relevance of the reporting form’s terminology to the events it

describes is subject to the stability of the on-going clinic opera-
tions . . . It is disconcerting to find how even small procedural
changes may make large sections of a reporting form hopelessly
ambiguous.
(Garfinkel 1967: 196–197)

These troubles are not, however, incidental features of clinic activities

that might be remedied by strong management, but rather “consist of
procedures and consequences of clinic activities as a medico-legal enterprise”
(Garfinkel 1967: 198, emphasis in original). The heart of that enter-
prise is the relationship between patient and clinic thought of as a
“therapeutic contract” in which “medico-legal responsibility exer-
cises an overriding priority of relevance” (1967: 200) when it comes
to the keeping and interpretation of the clinic records. Thus,

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