GPs in Cyberspace the Sociology of a Virtual Community

8/11/2019 GPs in Cyberspace the Sociology of a Virtual Community

1/29

GPs in cyberspace: the sociology of avirtual community

Nick Fox and Chris Roberts

Abstract

It has been argued that on-line networked communication can enable the

establishment of virtual communities. Empirical data from an elec-

tronic discussion group for general medical practitioners (GPs) are used

to evaluate these claims, and to explore the similarities and discrepancies

between on-line and face-to-face interactions.

A distinct social order for this community is reported, and the strate-

gies to establish this order in a textual environment are discussed.Participants went through a cycle of integration into membership, and

some generated distinctive virtual identities or personae. The notion of a

virtual community is critically discussed. Participants interacted as if

they were part of a community, but it is suggested that the interactions

on the list are best understood as extensions of the wider social relations

of general practice. The study of virtual communities may thus have rele-

vance for wider issues of social inclusion and citizenship. The paper also

includes reflections on cyberethnography, and suggestions for further

research are offered.

Introduction: computer-mediated communication andcommunity

This research explores the shape and social order of a discussion

forum established by means of computer-mediated communication

technologies. Networked computers have through the technologies

of e-mail and the Internet created new forums for human inter-

action, with distinctive characteristics reflecting the limitations and

possibilities of electronic interaction (Rheingold, 1994; Rushkoff,

1994). Computer-mediated communication (henceforth CMC)

may be expected to differ from face-to-face interaction, yet from a

The Editorial Board of The Sociological Review 1999. Published by Blackwell Publishers,108 Cowley Road, Oxford OX4 1JF, UK and 350 Main Street, Malden, MA 02148, USA.

Copyright 1999. All rights reserved.


2/29

sociological perspective, the interactions may be subjected to analy-

sis to discern patternings and routines, social rules and sanctions, as

would an ethnography of a traditional field setting.

This paper is an ethnographic exploration of one example of such

a social order, an electronic discussion list for UK general medical

practitioners (GPs). But it also addresses the claim made by certain

writers on cyberspace that such networked interactions may lead to

the creation of virtual communities (Sardar, 1996: 2831). Thus

Rheingold (1993) entitled his influential book The Virtual

Community, while Baym (1994: 161) suggests that these communi-

ties . . . create shared social realities through interactive negotia-

tion. The debate about whether cyberspace interactions amount to

community fractures along lines of whether community is to be

seen as real and essential, or as a social construction dependent on

imagination. As a protagonist of the former position, Sardar (1996)

raises doubts about whether the features of on-line networks such as

norms, criteria for membership and styles or cultures constitutes

community. Real community, he suggests

. . . creates context. It generates issues which arise with relations

to time and space, history and contemporary circumstances, and

require responsible judgement which is why so many issues are

difficult, they require balancing of opposing pressures. A cyber-

space community is self-selecting, exactly what a real community

is not; it is contingent and transient, depending on a shared

interest of those with an attention span of a thirty-second

soundbite. (1996: 29)

However, as Poster (1995) points out, this opposition between real

and virtual is problematic. While earlier forms of community such

as the village were determined by kinship and residence, later

notions such as the nation are highly dependent on imagination

(1995: 88). Part of the complexity of CMC, Jones (1995) argues, is

that it is not just a tool; it is at once technology, medium and engine

of social relations.

It not only structures social relations, it is the space within whichthe relations occur and the tool that individuals use to inhabit

that space. It is more than the context within which social

relations occur . . . for it is commented on and imaginatively

constructed by symbolic processes initiated and maintained by

individuals and groups. (1995: 16)


644 The Editorial Board of The Sociological Review 1999



3/29

In exploring the sociology of virtually-constructed social spaces,

and the issue whether on-line interactions amount to community,

we can identify various relevant features of CMC. First, there is a

temporal discontinuity to such communication: unlike that other

virtual technology, the telephone, the majority of virtual communi-

ties are currently based on asynchronous communication.

Participants (whether using personal e-mail correspondence or

within a discussion list or bulletin board) need not be on-line at the

same time, and can collect and respond to messages at a time which

is personally convenient. Where participants are geographically dis-

tant, time zone differences can mean communication which spans

hours or days between message and response. This, suggests

Escobar (1996: 123) contributes to a new kind of time, which is nei-

ther circular (as in oral culture), nor linear (as in cultures domi-

nated by books), butpunctual.

Second, electronic mail (and other forms of electronic writing

such as World-Wide web (WWW) pages) provides the possibility for

hypertextual links to other blocks of text, ad infinitum. Poster (1994)

argues that this further distances a text from its author, fostering a

playful, imaginative subjectivity in the users of CMC, while Landow

(1992) sees in hypertext the empirical support for the post-

structuralist analysis of writing as an endless process of referential-

ity and differentiation (Derrida, 1978).

Third, rules of conduct become established in virtual spaces as in

any other, with rewards for good members and sanctions against

those who break them. E-mail netiquette (standards of conduct)

was first developed on the Usenet network of about 5,000 news-

groups or bulletin boards and 11 million participants world-wide

who read and exchange news on topics ranging from computer

software to recreational folk dancing. Violations of these codes lead

to reproaches by other users: potential violations include incor-

rect/novice use of technology, sending lengthy (and thus costly to

download) messages, violations of network-wide or newsgroup-

specific conventions, ethical violations such as inappropriate lan-

guage and factual errors (McLoughlin et al, 1994).

These rules of conduct are driven by economic, cultural, and

socio-psychological factors both within and outside the network.Most CMC develops its own netiquette codes, and these may vary

between communities. A peculiar feature of CMC based on e-mail

technology (discussion lists) is flaming: the sending of inflamma-

tory messages, often because of an alleged violation of standards

of conduct by fellow participants. Flame wars (Dery, 1993;

GPs in cyberspace

The Editorial Board of The Sociological Review 1999 645



4/29

MacKinnon, 1994: 130) may quickly erupt and lead to demands for

expulsions of those responsible.

Fourth, these social spaces generate relationships which become

established despite the lack of face-to-face meetings. Community

spirit might be a good way to describe the

. . . social aggregations that emerge from the net when enough

people carry on those public discussions long enough, with

sufficient human feeling, to form webs of personal relationships

in cyberspace. (Rheingold, 1993)

Rheingold speaks of a gift economy, in which information is given

freely and requests for information are swiftly met: the currency of

this economy is elegantly presented knowledge, while trivia and idle

talk in CMC groups create social cement, as people get a sense of

the others personalities and attitudes.

However, such perceived virtual features of a person may be

wildly inaccurate as a consequence of the mediums anonymity.

MacKinnon (1995) suggests that on-line interactions are conducted

by personae and that the actions and feelings expressed in postings

may not be mirrored either physically or symbolically by their

creators. Gender-bending is one of the more extreme and well-

publicised aspects of this phenomenon. Heavy users of CMC,

according to Baym (1994), thrive on the relational possibilities of

the medium. They form two groups, one technologically astute, the

other relationally astute, the latter social experts focus on the rela-

tional concerns of the group, gaining their power from the ability to

direct the flow of on-line relationships.

Finally, the virtual world is paradoxically both without dimen-

sion, and yet possessing great depths. Rheingold (1993) suggests that

people in virtual communities do everything people do elsewhere,

but we leave our bodies behind, yet our embodiment is socially and

psychologically constructed, and we must acknowledge the complex

psychodynamics of interactions in a virtual community. Stones

research found on-line conference members very frequently referred

to the conference as taking place in an architectural space and to the

mode of interaction in that place as being social (Stone, 1992: 104).Efforts to make networks seem more spatially real include the cre-

ation of dungeons (MUDs and MOOs) with textually-constructed

inhabitants, architecture, furnishings and other virtual artefacts; in

the future, virtual reality technology may supplement text with inter-

active images (Rushkoff, 1994).





5/29

The hidden depths of the dimensionless realms of virtual reality

have been fictionally portrayed in the cyberpunk novels of

William Gibson and such films as Hackers as dangerous and

intense places in which dramas of love and death are played out.

Thus the motivation to construct virtual spaces, Lupton (1995)

argues, is not only intellectual, but also emotional and irrational.

The body of the computer is enigmatic: what is behind the screen

may be perceived as risky or the site of conscious or unconscious

desires. The search for community may consequently reflect both

conscious and unconscious needs of participants in an otherwise

fragmenting world (Springer, 1993: 717).

In summary, CMC is one aspect of a growing dependence on

computers by many people in all aspects of their working and social

lives. The construction of virtual communities may be not only a

substitute for an absence of real-life community, but a place in

which identities are created, developed and perhaps destroyed. It is

also a place invested with power and as such a place in which resis-

tance may be wrought (Critical Art Ensemble, 1994: 25), and real-

world orders challenged (Branscomb, 1993). As such, CMC is

important socially, psychodynamically and philosophically (Land,

1995), and a sociology (or anthropology) of virtual communities

may expect to uncover a richness equivalent to that of a traditional

social grouping or community.

The setting

This study examines the impact of CMC on the social and profes-

sional relationships of British general medical practitioners (GPs).1

The UK National Health Services Information Management and

Technology (IM&T) strategy is committed to establishing an elec-

tronic network, the NHSnet, which will enable clinicians, managers

and GPs to talk to one another in a secure and controlled environ-

ment, both for financial and managerial purposes and for issues con-

cerning clinical effectiveness and quality assurance (Department of

Health, 1997).2 The NHS Executive has funded research into how

clinicians may be trained in this new technology (Fox et al., 1999), andthe authors of this paper are involved in a continuing programme of

research and development in this arena. At the time of writing, many

GPs are now being connected, enabling electronic communication in

geographically delimited intra-nets and across the wider NHS com-

munity, andfire-walledaccess to theInternet.

GPs in cyberspace




6/29

However, there has been a tendency to assume such new CMC

technologies will serve simply as a more efficient method or tool for

manipulating or improving an existing situation (Hiltz and Turoff,

1978). Even at an organizational level, the access to almost limitless

data and people which the technology offers challenges the conven-

tional pattern of who talks to whom and who knows what (Sproull

and Kiesler, 1991). And, as we have suggested already, there are

other substantive issues which a cyber-ethnography of a virtual

medical community may expect to examine.

The research was conducted on the medical electronic discussion

group (or list) gp-uk, one of many such lists made available by the

Mailbase list-server based at the University of Newcastle, UK.

Using e-mail technology, the list-server is the recipient of mail from

members of the discussion group. Once received, the main is distrib-

uted automatically to the electronic mailboxes of all active sub-

scribers to the list, messages are publicly archived on a world-wide

web site. The list is open to all, although a charter for the list speci-

fies that it is intended for the general practitioner community, and

explicitly rules out being used as a medium for members of the pub-

lic to ask for clinical advice.

Joining gp-uk entails sending an e-mail to Mailbase with the

message join gp-uk your name. New subscribers receive an

information pack on how to use the list. Messages sent to the e-mail

address of the list will clearly indicate the senders e-mail address,

and will normally have a title, some text, and the authors signa-

ture. Members can reply to messages, using the same title. A series

of such messages on a topic constitutes a thread.3

Most participants accessed the list from computers in their work-

place or at home via Internet access providers such as CompuServe.

Members of gp-ukrose over the study period (1 August 1995 to 31

July 1996) from 196 to 443 participants; the majority were British

GPs, with a smattering of other medical and non-medical partici-

pants involved in primary care, plus one or two medical journalists.

The list generated an average of 20 messages per day, making it one

of the most active Mailbase lists. Membership continually changed

as new participants joined and other left, or as groups of partici-

pants left gp-uk to form new, more specific, groups such as a listcalled gp-uk-informatics. This was encouraged by the list owners,

recognising that excessive growth of membership could make the list

unwieldy.





7/29

Reflections on cyber-ethnographic method

The cover of Clifford and Marcuss (1986) book Writing Culture

portrays the anthropologist Steven Tyler in the field, in India during

1963. The ethnographer is outside a tribal village hut, writing his

field notes. In the introduction to this book of essays on ethnogra-

phy reflexivity, Clifford suggests that this image is itself unsettling in

that the ethnographer hovers at the edge of the frame, faceless,

almost extraterrestrial, a hand that writes (Clifford, 1986: 1). The

final outcomes of Tylers field notes were a further text: a mono-

graph which sought to interpret a culture to the (academic) outside

world, and much later a commentary in Clifford and Marcuss

book on the process of textual representation (Tyler, 1986). Texts

are thus key elements in ethnography and textual anthropology

has itself focused on the production of texts such as Tylers mono-

graph (see for example Rabinow, 1986; Atkinson, 1990).

The reader of this text should picture the ethnographer sitting,

not in front of a tent, but before a computer screen, typing on a

keyboard to communicate with a computer generated medical

community called gp-uk. The methodology might be described as

cyber-ethnography, in which research was conducted on a virtual

community which communicates entirely through text. Further, the

ethnographer met with his subjects only within this virtual environ-

ment, yet was a true participant observer, sharing with the group as

it communicated. The textual record formed the raw data for the

project, and through various other textual transformations (log and

diary, preliminary analysis) has been transformed into the text you

now read.

Ethnography is naturalistic, attempting to describe and perhaps

explain aspects of a social phenomenon rather than the testing of a

hypothesis: the thickness (Geertz, 1973) of the description is an

essential element. A fundamental characteristic of ethnography is

observer participation (Hammersley and Atkinson, 1989), requiring

a degree of reflexivity both in the observation and the subsequent

analysis and writing. Alongside other realms of technologically

mediated culture (for example, the surgical operating room and the

laboratory), computer-mediated communication is an appropriate

topic for ethnographic effort to research the form and culture of

cuber-communities, and indeed to theorize the kinds of commu-

nity which are possible in cyberspace (Escobar, 1996: 122). The

study of cyberculture, Escobar suggests

GPs in cyberspace




8/29

. . . is particularly concerned with the cultural constructions and

reconstructions on which the new technologies are based and

which they . . . contribute to shaping. The point of departure

(cyber-ethnography) is the belief that any technology represents a

cultural invention, in the sense that technologies bring forth a

world; they emerge out of particular cultural conditions and in

turn help to create new social and cultural situations. (1996: 111)

So cyber-ethnographers will document a virtual social world just as

a traditional ethnographer would document a community or other

cultural form. However gp-uk, like other virtual spaces created for

CMC, is a community which exists not in the real world but in a

virtual or computer generated world, created entirely by electronic

circuitry and the electrical impulses which pass through it. It is ren-

dered habitable for humans by the encoding and decoding of these

impulses into shapes on a screen which resemble letters and perhaps

images. If in traditional ethnography there is ambiguity over the

validity of participants representations of a setting, and the subse-

quent construction of an ethnographic text as a second level repre-

sentation of these representations (Tyler, 1996; Armstrong et al,

1997), in the study of a text-based virtual community this ambigu-

ity is total: there is no fixed point against which an ethnographic

account might be measured, as there is no underpinning reality

upon which participants representations might be based: the com-

munity exists only in peoples heads. In a nutshell, there is only ever

representation, and that representation is totally divorced from the

only reality there is, namely the passage of electrical charges

through computer circuits (Landow, 1992).

A further difference from traditional ethnography arises because,

whereas a traditional social setting and the ethnographic account of

it inhabit different realms of truth (one being a social space, the

other a text), the ethnographic account of a textual virtual commu-

nity exists in the same realm: both are texts. Thus an ethnographic

account has equivalent epistemological status with any other mes-

sage which forms part of the community. The ethnography and the

community can no longer be separated, and reflexivity is also total.

Acknowledging these aspects of researching in a textually-con-structed virtual setting are important, because they bring into sharp

focus the reflexive character of ethnographic interpretation. Just as

participants may construct gp-uk as much more than words on a

screen, the ethnographer may imagine a reality other than the elec-

tronic disturbance caused by participants. Her/his representations,





9/29

fed back to participants either during research or in the form of an

ethnographic account, may dramatically affect that community, in a

way less likely (although well-documented in anthropology) in a tra-

ditional setting which is established in non-textual registers.

This issue reminds us of the need for appropriate ethical guide-

lines for cyber-ethnography (BSA, 1992; Rafaeli and LaRose, 1993).

Researchers must decide upon the ethics of remaining as non-

participant (for example, researching an archive rather than a live

discussion list), to lurk as part of the list but without active partici-

pation (covert research), or to accept the potential for distortion of

the study setting by becoming an active member (overt participant

observer). As with other field settings, ethical disclosure of a

researchers identity and the possibility of observer bias, with conse-

quent loss of validity, are in conflict with each other (Allen, 1996).

If one takes as a basic ethical principle that those researcher

should not come to harm as a consequence of research (the princi-

ple of non-maleficence), then cyber-ethnographers should seek

informed consent from their subjects (Reid, 1996) and respect pri-

vacy and subjects dignity (Marx, 1998). This principle has been

questioned where electronic spaces are public (for example,gp-ukis

archived and anyone with an Internet connection may read the mes-

sages posted without joining the list and disclosing their own iden-

tity). It has been argued by regulatory bodies such as university

review boards that in such situations, researchers are exempt from

normal requirements to gain informed consent (King, 1996).

However, a distinction may be made between that which is publicly

accessible and that which is publicly disseminated. Because interac-

tions may be accessed does not confirm the right to disseminate

them for example through research papers or journalistic articles

(Waskul and Douglass, 1996). Furthermore, researchers must be

aware of the dis-inhibiting effect of on-line communication media,

in which people may disclose more than they might in face-to-face

situations. Researchers should take responsibility to minimize the

harm which might result from such dis-inhibited exposure (Reid,

1996).

In the present study, the decision was made that the researcher

[CR] should become an active member, both for ethical reasons andto enable the kind of enquiry which an ethnographer might adopt in

a traditional setting, not only observing, but also asking questions

and occasionally testing out ideas with participants and key infor-

mants to gain a clearer understanding of a culture, and finally to

experience the list as a participant might. It was acknowledged that

GPs in cyberspace




10/29

this could lead to bias, as participants might alter their on-line

behaviour because there was a researcher present.4 CR introduced

himself to the list as a GP currently studying as a postgraduate stu-

dent who wished to researchgp-uk, and permission was granted for

this research by the list owner. There was open discussion of his

project by participants in the discussion group from time to time,

some of which are documented in this paper. The other author [NF]

joined the list as a lurker or non-participant observer, to get a

sense of the environment as part of his responsibility to supervise

CRs fieldwork. The list was accessed from networked computers in

the Institute of General Practice and Primary Care, University of

Sheffield, using Pegasus Mail for Windows software.

All messages posted to gp-ukover a 12 month period were read,

and these formed the principal database for the study. Other data

included

private mail generated by CRs participation in the list

discussions between the authors of this paper and with other

researchers of virtual communities

searches of thegp-ukarchived messages.

The data was analysed using the computer software package

NUD*IST (Scolari, 1995)5 which permits large quantities of quali-

tative data to be coded and interrogated. In the following section we

offer examples of messages to support the findings. Exact spelling

and format are retained; all mail messages were in plain upper- and

lower-case type only, italics indicate interpolations by the authors of

the paper to clarify meaning.

In this paper we are less interested in the content of gp-ukmes-

sages (which largely comprised discussions of professional issues)

than in the social order of the list. Thus after a brief look at mes-

sage content we focus on the reasons given for participation in the

discussion list, informal rules and norms, and the social construc-

tion of members cyber-identities.

The content ofgp-uk messages

The messages sent (posted) to the discussion list may be categorised

into information offering, information request, opinion offering,

opinion request, and what might be described as formative messages

which help to establish and sustain interaction. As such, the list is

equivalent to most kinds of face-to-face communication media.





11/29

For many participants, the information-sharing aspect of the list

was the most significant, and they sought a model of the list which

has been called a discretionary database (Rafaeli and LaRose,

1993), in which information is provided to meet the needs of the

participants. Such information might be a summary of locally pro-

duced clinical guidelines, the results of a survey, expert knowledge,

or the recommendation by the author of someone deemed a source

of information, or references to published material. On occasions,

participants would send world-wide web (WWW) site addresses

where relevant information was held. Sometimes, information was

given whether asked for or not, because the contributor felt it would

be of mutual interest.

This information may be of use:

DIRECTIVE 95/EC OF THE EUROPEAN PARLIAMENT

AND OF THE COUNCIL ON THE PROTECTION OF INDI-

VIDUALS WITH REGARD TO THE PROCESSING OF

PERSONAL DATA AND THE FREE MOVEMENT OF

SUCH DATA (FINAL) ADOPTED BY THE COUNCIL IN

JULY 1995 [DM]

Information would be requested on occasions, using the list as an

informed resource which could provide information more quickly

than through other search strategies. These might be requests for

examples of good clinical practice, research findings or other

resources.

I am interested in any learning resources that have been or are

being developed for medical student training in general practice.

In particular, I would be grateful for any information about

computer aided learning [SD]

Two days later, this request received the reply Try Bob Price in

Arkansas he has done a great deal of work in this area [JW].

For these participants, the list was principally a place for

information exchange rather than for social or professional func-

tions. Many had joined the list because of an interest in informationtechnology and informatics, and this was reflected in the use of

computer jargon, synonyms, and acronyms which peppered the

messages. Recurring themes of security of computer systems, confi-

dentiality and access to electronic information, and discussions

about the quality of electronic information would lead to highly

GPs in cyberspace




12/29

technical information-sharing about the capacities of different hard-

ware.

However, the list was also a medium for sharing opinions. Once

again, computing and informatics was a frequent theme.

Just as it is unthinkable that an illiterate person could practice as

a GP, so I believe that it is becoming increasingly unacceptable

for GPs to become computer illiterate. In my view the ability to

use computers within the consultation is an essential skill and

should be taught in the vocational training schemes and tested in

the MRCGP (GP Professional Examination). [TL]

However, virtually any topic might become the subject of a posting.

Personally I wonder about looking for a progressive general

practice. I have to ask in what way progressive? If you find a

family doctor who you like on a personal level and respect on a

professional level that is a good start. [IS]

Such messages would often stimulate responses and lead to

threads (series of messages with the same subject line, and on thesame theme) lasting days or weeks. Frequent popular threads con-

cerned the pressures on general practitioners, and the psychological

and social stress the NHS reforms had wrought.

On the same theme, does anybody else think that EBM (evidence-

based medicine) is a backlash against the saintly evaluation of

illness in physical, social and psychological terms that eventually

turns anyone who tries it into a burnt out wreck? [DJ]

I often think that the main reason for the distress of many GPs

these days lies not so much in our working conditions and pay as

in the pressure upon us to change our culture. We are in a position

analogous to a subject people which has been taken over by a

colonial power which not only wishes us to change our behaviour,

but believes that its attitudes and culture are superior. [TL]

The list provided a forum to debate the working conditions in general

practice and given the audience was a place where opinions could

be voiced relatively freely, often leading to extensive discussion.

Wither the exhausted practice? Too few hours currently in the day

for partners to do the management work and see all the patients,





13/29

too little money to employ assistants and locums to give us the

free time to enjoy a lifestyle half-decent compared to that of the

GP in say 1975. [PS]

Finally, a number of messages were reflexive about the list, and

served, intentionally or unintentionally, to support the virtual com-

munity.

I for one have learnt a great deal from this community. I mean

learnt stuff that was relevant to me in the context of medical

practice . . . There is a definite process of dissemination here.

[AR]

[AR] and I are having some quite in-depth communications

directly. Hes really mad like me :-) We are getting on really well.

[DJP]

Participants might encourage the list to continue its interactions,

posting such messages as This is a non-inane posting intended to

stimulate debate [TL], although other postings acted in the oppo-

site direction.

. . . the volume of garbage received over the weekend does not

bode well for this (list) being a useful asset for my general

practice development. [JM]

In summary, the list served as a collaborative medium, in which the

audience was both creator and receiver of the mediums content

(Rafaeli and LaRose, 1993). While information sharing was a fea-ture of the list, contributing to a discretionary database of useful

information, opinion and group support were also strongly featured

in message content.

The social order ofgp-uk

Reasons for membershipThe official rationale for the existence of gp-ukoffered by the list

owners to all new subscribers was that

. . . gp-uk facilitates discussion on new ideas, research workshops,

seminars, conferences, grants, education, software development

GPs in cyberspace




14/29

etc. for the UK General Practice (Family Medicine) community.

Non-UK views are also welcome. Gp-uk intends to promote

collaborative work, problem solving and support.

Some participants appeared to endorse this catholic mix of profes-

sional aims and opportunities to share information.

I like the way the list demonstrates the use of technology to allow

GPs to communicate with one another on a wide range of topics.

[DM]

Im not a clinician, but my job requires an awareness of health

telematics specifically in the NHS. Gp-uk is one source ofinformation, of interest because members have by definition a

greater awareness of, and an interest in the subject. [RW]

Participants were attracted to the list as a community of general

practitioners. The coffee break was a metaphor used more than

once, sometimes nostalgically.

The balance of humour, seriousness, clinical and scientific reflectthe sort of conversations I have with my own local colleagues

over coffee in the practice, but which unfortunately there are less

and less time for. [AC]

. . . gp-uk [is] like morning coffee break. Most people find it

useful. Supportive and cathartic, but there are some who prefer

to shut themselves in their rooms and do paperwork. [JA]

Making contact with colleagues of a like-mind was a reason for reg-

ular participation, and the medium had characteristics of freedom

of expression not easily found elsewhere.

Obviously you have to pick the relevant subjects to read, but the

breadth of opinion and information is relieving (not revealing!).

Im so glad that there are other mad, angry GPs out there! [DP]

From time to time, members would decide to leave, and might offerreasons. Often these reasons concerned one impact of the growth of

gp-uk: the increasing volume of apparently trivial messages.

I do not like the time I spend reading contributions that while

interesting are of little relevance to me. [DM]





15/29

I agree with your sentiments about this list. Having just wasted a

lot of time downloading 47 short unhelpful letters I am leaving

this list. [MD]

Social norms in the community

In a monthly list review, the list owners of gp-ukarticulated general

guidelines (netiquette) for the discussion: for example, a reminder

that gp-uk was an academic list, or that if a member wished to

reply personally to the author of a message, then personal e-mail

should be used rather than a list-wide message which would be irrel-

evant to all but the intended recipient. Against this formal set of

rules, more informal norms emerged. For example, a conventionof the list was that new participants lurked for a while before con-

tributing, to attune to the mores of the list. Indeed some partici-

pants seemed to be permanent lurkers.

I have been lurking on the group for 12 months now, and while I

accept that lurkers contribute little to the community, there is a

lot of general support and ideas to be found from reading

discussions of people with the same job and its problems in the1990s. [AC: private communication]

While lurkers are encouraged to make themselves known by other

members of the list, sometimes the environment seemed threatening

to those who had not become accustomed to the rough-and-tumble

of discussion. Lurking was perceived as secret and perhaps shame-

ful.

I spend a lot of time flicking furtively through the magazine of

gp-uk sometimes I think of buying even though it is likely to

provoke the sort of response that sends a lurker scuttling into the

street to melt into the crowd again. [SB]

While sitting in a seminar of paediatric [doctors] in Newcastle

yesterday I had a rather unnerving experience. I signed and

printed my name on the attendance register and passed it to my

neighbour who said your on gp-uk, arent you. [MP]

Newcomers would learn the rules of interaction, including the

abbreviations used by regulars in messages such as IMHO (in my

humble opinion) and BTW (by-the-way). There was no shortage of

advice for newcomers. An experienced participant suggested that

GPs in cyberspace




16/29

. . . there are plenty of perfectly sensible, useful and practical

discussions and you shouldnt miss out on them just because you

have come across a few GPs letting of steam. [TL]

The social order of the list was continually being negotiated by par-

ticipants who had varying views of its function and how its mem-

bership should behave. Increased volume of trivial messages often

led to exasperated comments.

Am I to expect this is the purpose of the group, and that the

stated aim to be an academic forum is inaccurate? [JM]

The domination of list discussions by a few high profile personali-

ties was raised as a continuing problem for new participants, argu-

ing that their behaviour was inappropriate.

Sadly this list seems dominated by two doctors, whose posts to

this list can be thoughtful, helpful provocative, funny (and other

positive adjectives) and for that I thank them but whom some of

the time clutter up this list with posts which are a waste of space,

composing multiple copies . . . [LM]

These two characters can be quite unpleasant and abusive to

newcomers and make this list an unfriendly place. And they

justify it by claiming freedom of speech. When will they realise

that they are putting off newcomers to this list? [LM]

The targets of such messages were of course party to such criticism.

When accused of being responsible for a mass of inane consequen-tial and pointless communication, IH replied

Unless I am being overly sensitive, which I doubt, you Sir, are

referring (at least in part) to me. Frankly, I am insulted . . . [IH]

The dominant voices on the list were also overwhelmingly male, a

feature which has been recognised as common to many such virtual

fora (Spender, 1995). On one occasion, a participant wonderedwhere were all the female contributors to gp-uk. In response, one

of the few women on the list replied

I think Im it chaps ;-) but FS occasionally feels moved to

comment. [ST]





17/29

Construction of cyber-identities

The nature of an e-mail list necessarily reduces clues to identities

available to people in face-to-face communication. Ongp-ukthere was

not complete anonymity, as e-mail addresses normally contained

some element of an authors name. Furthermore, because names and

other details were required to register on the list, these were available

through the Mailbase web-site, for those who wished to find out more

about a participant. However, most members of the list chose to flesh

out these bare bones of identity in a variety of ways, and the develop-

ment of distinctive personalities or personae by members of gp-uk

was a collaborative activity. One way in which such persona formation

began was through the kinds of messages posted. Thus, one Saturday

afternoon in March 1996, five messages arrived from IH with the dra-

matic titles Defeating Depression, Wet Babies, Burnout, Lateral

Thinking and (Dr) Osteopath. Another frequent poster, AR, was

asked how he could sustain his output on the list.

As for the time bit, well I dont drink, I am now monogamous, I

dont do on-call . . . and I find human company after a long day

spent with a deluge of whinge a little disturbing . . . [AR]

Once a participant had established a persona, s/he might be suffi-

ciently confident that the list had a clear concept of his/her identity

to appreciate an irony.

This will cheer you, though. Ive been asked to be a group leader

at ( . . . ) [a week long accredited GP educational course] next

month! Me! Ha-hah-hah! Can you imagine it? [IH]

Some members sought to locate and define themselves as technical

computing experts, through association with others with technical

expertise, or through their attitude to the lists purpose.

You are posting to several people who wrote or specified parts of

the donkey (GP computing system). I myself pinned tails on

several places. If you can give a clear example of a way in whichone screen of one system can be improved in use or clarify then

you have a very reasonable chance of the improvement appearing

in (commercial GP computing system). [AM]

(We) want to use the Internet to encourage best practice and the

highest standards in primary care. [KH]

GPs in cyberspace




18/29

Even those leaving the list might try to create an identity for them-

selves.

This is a brief good-bye . . . the time taken to wade through bits

that interest me is no longer justified. . . . In the meantime if you

want to include me in circulation on any topic that relates to

information systems please send a personal e-mail to . . . [DM]

The attribution of personality characteristics to others on the list

assisted this persona formation.

I think ARs consulting room is jet black and scarlet, divided by a

dramatic zigzag line extending over two walls. I suspect AH of

magnolia and IT of some sort of government buff. [AM]

An interesting example of this attribution of identity occurred dur-

ing an on-line discussion of the researchers (CR) methodology as

participant observer. One member argued that

you shouldnt be posting on (gp-uk) because by doing so you

disturb the community from its native state. [PJ]

Other participants continued this thread.

In this case Chris isnt really doing research but wishes to create

an e-mail persona that suggests he is. [DM]

Yes I agree this makes me nervous too a bit like time travellers

messing up the future by changing the past. Has any of yournearest and dearest started to disappear from their photographs?

How many posts would not have happened if Chris had not

intervened. How many lurkers have been outed? A mere flap of

the butterflys wing . . . ;-) [JW]

A more stylised mechanism for creating self-identity was through

the use of signatures, added automatically to outgoing messages

by the software, in addition to the e-mail address of the sender and

a name. Generally features which were included in signatures werefull name, main occupation, any additional posts held, and contact

addresses (voice, e-mail and in some cases web sites created by the

holder of the signature). Signatures might be embellished with sim-

ple artwork, using keyboard symbols, as in Figure 1, or with a quo-

tation or slogan.





19/29

-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-)

[ST] Fax 01529 460589 / 01522 569874

Editor Informatics

http://www.ncl.ac.uk/~nphcare/PHCSG/Journal/index.htm

The Journal of Informatics in Primary Care

PHCSG The British Computer Society

-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-):-)

Figure 1 Signature created in keystrokes

Other messages might have only informal signings-off: regards

or cheers, offering no clues to identity, either seeking anonymity or

claiming the familiarity of the well known.Finally, members might try to introduce some identity or aspect

of their personality into messages through the use of symbols built

out of keyboard characters and punctuation marks. These emoti-

cons were used to smile :-) to wink mischievously ;-) or to frown :-(

and offered cues to a reader as to the vein in which the statement

should be taken. For example, in reply to the question posed on the

origin of the expression loo

Why the hell am I bothering to reply to this question?? After all I

knew it was a trap to prove gp-uk junkies will respond to any-

thing ;-) [JW]

The emoticon here tempers what at first sight may have appeared an

irritable outburst. Some users had a more extensive or sophisticated

dictionary of emoticons, such as one representing a bearded face,

used to send a message to a professor of physics, perhaps indicatingthe recipients ascribed wisdom.

Perhaps you can answer that MW? My knowledge of physics is

on par with my knowledge of why the n is silent in autumn ;-|>

[AR]

In summary, many participants sought to establish aspects of their

real identity in the virtual environment. There was no evidence ofthe intentional identity-bending or gender-bending reported by

Rheingold and others, perhaps reflecting the initial registration of

members details and the explicit professional and educational

objectives of the list outlined by the owners and documented earlier

in this paper.

GPs in cyberspace




20/29

Professionalization, inclusions and exclusions

The social order of the list was enhanced by interactions which

addressed issues of professional closure. Discussions around matters

concerning the position of doctors (and general practitioners in par-

ticular) often had the tone of a siege mentality, with anxieties over

perceived challenges or threats in the wider political and social envi-

ronment as frequent themes for threads. Doubts over an alteration in

medico-legal practice concerning disciplinary hearings (service com-

mittee) was raised as a semi-joking addendum to a social posting.

Good luck with your lecture. How many of your audience realise

that since 21.12.95 GPs can now be suspended prior to a discipli-

nary hearing by the chairman of the service committee, and the

right of appeal to the Secretary of State has been abolished? [GP]

The belief that new technology was going to deregulate medicine

and further problematize power relationships received frequent air-

ing.

Dr ARs selective quotation from an e-mail of mine may havegiven the impression that I was only or even mainly consider-

ing the likes of the GMS to be the powerful interests which could

get very scared if the Internet forcibly deregulated the business of

medicine. [RA]

The mood of disillusionment sometimes merged into despair, as

members of gp-ukreflected on the conflicting demands of patients

and their own well being.

I have burnt out once and cut down my work and reorganised my

practice and got my partners to do more and taken a cut income

and still feel that there is no way that I am doing what I entered

medicine for. I cannot do all that I trained for. [TR]

Many of these serious reflexive commentaries would be given a twist

through the use of irony, providing social cement for discussionswhich were often challenging or poignant. Irony might be defined as

the juxtaposition of apparently disparate elements in a manner that

highlights and problematizes each of them (Brown, 1977). For

example, a message entitled barriers suggested that these were

needed to prevent interruptions to work in the surgery.





21/29

. . . with an open surgery every morning and no shortage of

patients willing to open their hearts to me in the time-honoured,

While Im here Doctor fashion, I think I would be better off

trying to raise a few barriers instead of breaking them down. [IH]

The replies to this message suggested that the respondents detected

the irony and countered with what would appear to be further

ironies of their own:

One barrier I have found useful is to dress absolutely formally:

Pinstriped suit, waistcoat . . . it did seem to reduce the length of

chummy, tired all the time consultations . . . perhaps it is time to

revisit other techniques yawning, avoiding eye contact, staring

out of the window, flicking through the files of the patient yet to

be seen, frequent watch checks, or perhaps just falling asleep. [JL]

The use of irony in such messages was not appreciated by all partici-

pants, and it was recognised that sending ironic messages could be

risky, as the absence of cues in electronic mail could cause problems

of interpretation.

With e-mail you click the button and thats it, its [the message]

gone. Something about e-mail deadens the wit, sharpens the

sarcasm and winds up every ones paranoia, so something meant

as a joke can be read as a deadly insult. Weve seen a few exam-

ples of natural paranoia being wound up in recent threads. [AH]

The failure to identify efforts at irony or humour often led to mis-

understandings, and the stability of closure was challenged as

respondents echoed or refuted the sentiments expressed. As such,

the community was continually under negotiation, and from time

to time calming words were needed to sustain its integrity as a

flame war threatened to erupt.

Discussion

In what sense is it reasonable for sociologists to ascribe the term

community to a set of individuals, isolated geographically and

communicating with each other asynchronously? At a trivial level,

the answer to this question might hinge upon characterizing an

essential community, thereby excluding everything which did not

GPs in cyberspace




22/29

possess the appropriate features, such as geographic proximity or

shared interests. It is this approach which leads Sardar (1996: 29) to

reject CMC as constitutive of community, in that it lacks any sense

of commitment, continuity or context.

Other writers within sociology have sought to problematize the

notion of community itself, acknowledging that in post-traditional

societies the creation of a sense of community around such ideas as

the nation and class are largely conceptual and a consequence of

imaginative construction (Anderson, 1991; Poster, 1995; Wagner,

1994). Wagner sees imaginary community as a feature of moder-

nity, while Bauman (1992) connects the construction of imaginary

community to the logic of post-modernity, arguing that what such

communities lack in stability and institutionalized continuity, they

more than compensate with the overwhelming affective commit-

ment of their self-appointed membership (1992: xviiixix). The

work of constructing community or post-modern sociality serves

to elaborate a logic of identification involving personae with vari-

ous masks (Maffesoli, 1990: 92). Poster argues that the virtual com-

munity of cyberspace is suited to a postmodern fluid subjectivity

(1995: 8990).

Virtual communities derive some of the verisimilitude from being

treated as if they were plain communities, allowing members to

experience communications in cyberspace as if they were embod-

ied social interactions. Just as virtual communities are under-

stood as having the attributes of real communities, so real

communities can be seen to depend on the imaginary: what

makes a community vital to its members is their treatment of the

communication as meaningful and important. (Poster, 1995: 90)

As Wagner points out, despite notions such as nation and class

being imagined communities, for participants they seemed very real

and were perceived as the natural locations of human beings in post-

traditional societies (Wagner, 1994: 1834). From such a perspective,

the task of cyber-ethnography is more to do with exploring the on-

going reflexive construction of social spaces and identities than with

arguing whether virtual spaces possess particular attributes of realcommunities. What this research ongp-ukillustrates is that the par-

ticipants behave as ifthey are part of a community. Firstly, there is a

social order to the list, but perhaps more importantly, and contra

Sardar (1996), there is also a context to the interactions, which is the

real-world concerns of general medical practice.





23/29

Considering the social order of the list, this research suggests that

interactions are constrained by rules of conduct, and there are sanc-

tions if these are broken (primarily public denouncement, although

in theory members can be expelled if they behave in a way deemed

unacceptable to the list owners); the messages adopt shorthand and

jargon; there is a perception of the list as having grown organically,

there is a use of humour, and the list is archived. Stone (1992) sug-

gests that a further characteristic of electronic communication is

that participants act as if they were inhabiting physical space, and

this research offers some support for this proposition, for example

in the forms of greetings, which ape face-to-face rather than paper-

written communications, and in references to the list as like a staff

coffee-room.

While there were no obvious characteristics which predicted

whether members would be regular participants or lurkers, the

research suggests distinct stages of participation as identified by

Baym (1994) and McLoughlin et al (1994). Such stages of participa-

tion are not dissimilar from those found in face-to-face groupings,

and no doubt contribute to the reflexive sense of community which

the list engenders. Thus a new participant may move from being a

lurker, to the novice stage, to being a regular contributor and per-

haps to become a frequent contributor or heavy user. Participants

may remain at any stage, regress or in time leave the list temporar-

ily or permanently. Those newly joined togp-ukdescribe the lurking

stage as one of increasing understanding of how the community

works, but also as one of trepidation in contributing. Heavy users

are perhaps the only ones to exploit the full potential of the medium

for play, and have the most clearly defined personae. Castells points

out that the members of virtual discussion groups divide into

. . . a tiny minority of electronic villagers homesteading in the

electronic frontier, and a transient crowd for whom their casual

incursions into various networks is tantamount to exploring

several existences. (Castells, 1996: 362)

In addition, we may see features of a learning community ingp-uk.

Saunders (1995) offers a typology of learning which runs fromimmediate (learning which addresses urgent problems) to organic,

which describes communication between members of a dispersed

group which nevertheless have a strong and well defined set of

shared occupational goals, ethics, objectives and values, is driven by

a high level of professional commitment, and is characterised by

GPs in cyberspace




24/29

informality, scattered topics, and highly volatile structures. This lat-

ter model of learning fairly accurately describes the interactions on

gp-uk, although participants are not explicitly engaged in profes-

sional development.

However, in the light of the earlier discussion of Posters (1995)

critique of an essentialized community, it is inadequate to simply

list the attributes whichgp-ukhas in common with real communi-

ties. Certainly we can see several strategies adopted by participants

to establish and further the illusion. Messages use textual symbols

to mimic facial expressions, signatures establish cues and contexts

for the interpretation of messages, and the informality of the com-

munications fosters warmth and camaraderie. However, what is also

needed is a contextualization: to grasp how the virtual community

is situated within historical circumstances. What are the motivations

of participants, such that they engage in on-going cognitive work to

construct a shared sense of something other than a series of textual

communications on their computer screens? May we understand a

virtual community such as gp-uk in terms of its embedding in the

social and economic relations of the wider society to which partici-

pants belong: a society in which, perhaps significantly, any sense of

community is only weakly present (Robins, 1995).

It is the referentiality of so many messages to a reality beyond

the list which seems to differentiate what happens on a list such as

gp-ukfrom the transient and inconsequential model of cyberspace

which Sardar (1996) invokes. There is evidence from the data in this

research that participants construct friendships and alliances in gp-

uk, as they might among a face-to-face general practice community.

perhaps it is the collegiality of this group which leads it to invest

their virtual interactions with features of community: a spirit of

mutual trust, responsibility and an on-going commitment on one

hand; on the other, the petty spats and flaming which also mirror

the tensions which arise in face-to-face engagements.

We need to understand the sociology of this virtual community

in relation to the wider social and psychological environment which

spawned it. General practice in the UK is a traditionally frag-

mented specialty within medicine, in which small groups of practi-

tioners work in isolation from their peer group, with rareopportunities for collegiality. In addition, it has been the subject of

radical structural and cultural reforms during the 1990s, and it has

been argued that for many GPs, their professional lives are now

characterized by stress, poor rewards and disillusionment (Mathers

and Gask, 1995). Perhaps for this generation of GPs, gp-ukoffers





25/29

an environment which may seem far more secure and communal

than the surgery or staff common room. It may also be a place in

which such beleaguered souls can explore their identities, try out

ideas and opinions not appropriate in face-to-face situations, and

assert their resistance to the oppressive circumstances in which their

real-life personae operate. The liberation which CMC offers may

be libidinal as well as instrumental (Lupton, 1995), while the utopia

of virtual community operates in the context of a dystopic reality.

The social and power relations of general practice are reflected in

the exclusion of patients from discussions (only on one occasion

during the study period did a patient manage to infiltrate the list,

and only then under the sponsorship of a GP member: the subse-

quent discussion was conducted under the subject line Yer Actual

Patient). Issues of power may also be reflected in the gender mix of

active participants in gp-uk. Cyberspace has been recognized as a

peculiarly male-dominated and sexist place to visit (Sardar, 1996:

246), and the lack of regular female voices on the list supports

Spenders (1995) argument that women get even less conversational

space in a virtual world than they do in real life (p. 196). Her discus-

sion of the dynamics of computer-mediated communication notes

that users can behave in a much more abusive and crudely coercive

way when they are anonymous, than they would in face-to-face situ-

ations (1995: 195), and such behaviour is certainly evident in the

occasional flame wars on the list. While the list is a space for

frankness and for the airing of opinions, it is also a public place in

which participants are highly vulnerable to challenge in ways which

are rare in professional circles. Even the hardiest ego may be threat-

ened in such an aggressive environment. There may also be struc-

tural reasons for the gender bias on gp-uk. Given that manyparticipants access the list from home, perhaps at odd times of the

day or night, this may militate against female participation because

of traditional divisions of labour within the home. Once again the

social relations of the virtual space mimic those of reality: medi-

cine remaining a difficult profession in which to combine work and

family commitments.

In conclusion, this research supports Schroeders (1995) argument

that part of the sociological significance of new technologies lies in

their ability to intensify and extend human beings attempts to manip-

ulate the natural and social world. The as-if-it-were-a-community

character of discussion lists ofgp-uk(and participation by the authors

in other lists indicates thatgp-ukis not unique in this respect) demon-

strates an extreme example of the on-going construction of imagined

GPs in cyberspace




26/29

community. The social order of computer-mediated community is

reflected in the social norms of the list, the strategies used to establish

identities by participants, and the closure around professional values.

Yet this social order is also a feature of the wider context of social

relations within which computer-mediated communication takes

place. If the future shape of society includes the proliferation of vir-

tual communities, explorations of these cyber-spaces may give clues to

the social relations beyond the computer screen and world-wide web,

and have implications for social inclusion and citizenship. Thus there

are several avenues for further enquiry. For the cyber-ethnographer

and social theorist there is a rich source of material here, concerning

the construction of virtual communities and virtual identities by those

who use computer-mediated communication and interaction media,

the social relations which develop in such environments, and the rela-

tionship between life in such hypertextual environments and the loss

of certainty in late- or post-modern cultures (Landow, 1992; Poster,

1995). For the educationalist, the use of such virtual environments

suggests possibilities for classrooms in which tutor and students inter-

act as if they were face-to-face. The authors of this paper are

involved in on-going research for the NHS and Department of Health

to explore the possibilities of virtual classroom in professional educa-

tion and the dynamics of discussion groups (Fox et al, 1999). For the

research methodologist, studies of virtual settings (in which reality is

entirely constructed in representation) raise issues concerning the

validity and reliability of research reports which are also pertinent to

the social study of traditional settings (Tyler, 1986; Armstrong et al,

1997).

University of Sheffield Received 29 January 1998Finally accepted 19 November 1998

Notes

1 In the UK, general practitioners are self-employed, and may set up as single-

handed practitioners or more usually within multi-partner practices employing a

range of health care, managerial and administrative staff. They receive government

funding based on capitation payments for their patient list, and for items of service

(consultations, home visits etc.). General practice is the point of first contact with

health services for the overwhelming majority of patients, and this system of pri-

mary care acts as a gatekeeper into free NHS secondary care. NHS reforms in the

early 1990s enabled some GPs to hold funds to purchase secondary care for their

patients, although this system has now been replaced by groupings of practices

(primary care groups) which coordinate primary care in a geographical area and





27/29

commission care from secondary care trusts. The commitment in government pol-

icy to a primary care-led NHS (Department of Health, 1997) has increased the

power of GPs in relation to hospital medicine.

2 The driving force behind the NHSnet has been the possibilities for transferring

patient data electronically for clinical as opposed to managerial purposes. Thetechnology was delayed for some years because of problems of confidentiality, to

create a fire-wall impervious to outsiders while enabling NHS staff to use the

NHSnet as a route into the Internet.

3 The sending of messages and their reception are not necessarily temporally associ-

ated, so on occasions participants may receive or read replies to messages before

the original message which stimulated the response. This contributes to temporal

disruption of communication on the list and to the indeterminacy of message con-

tent.

4 People joining the list after CR declared his role as researcher may have been

unaware that he was gathering data from the list. This raises the unresolved ques-tion of how to establish on-going informed consent in a changing environment

(Waskul and Douglass, 1996), where a researchers presence can only be gleaned

from an archive of messages.

5 NUD*IST is a software package for analysis of qualitative data. It enables coding

and manipulation of large quantities of text generated by qualitative research, and

mimics the activities of cut and paste analysis with the added value of enhanced

confirmability. Its title stands for Non-numerical Unstructured Data Indexing,

Searching and Theory-building.

References

Allen, C., (1996), Whats wrong with the Golden Rule? Conundrums of conduct-

ing ethical research in cyberspace, Information Society, 12: 17587.

Anderson, B., (1991), Imagined Communities: Reflections on the Origin and Spread of

Nationalism, London: Verso.

Armstrong, D., Gosling, A., Weinman, J. and Marteau, T., (1997), The place of

inter-rater reliability in qualitative research; an empirical study, Sociology, 31:597606.

Atkinson, P., (1990), The Ethnographic Imagination, London: Routledge.

Bauman, Z., (1992), Intimations of Postmodernity, London: Routledge.

Baym, N., (1994), The emergence of community in computer-mediated communica-

tion, in S.G. Jones, (ed.), Cybersociety: Computer-mediated Communication and

Community, London: Sage.

Branscomb, A.W., (1993), Jurisdictional quandaries for global networks, in L.M.

Harasim (ed.), Global Networks, Cambridge: MIT Press.

BSA, (1992), BSA Statement of Ethical Practice, Sociology, 26: 7037.

Castells, M., (1996), The Rise of the Network Society, Oxford: Blackwell.

Clifford, J., (1986), Introduction: partial truths, in J. Clifford and G. Marcus (eds),

Writing Culture: the Poetics and Politics of Ethnography, California: University of

California Press.

Clifford, J. and Marcus, G., (1986) (eds), Writing Culture: the Poetics and Politics of

Ethnography, California: University of California Press.

Critical Art Ensemble, (1994), The Electronic Disturbance, New York: Autonomedia.

GPs in cyberspace




28/29

Department of health, (1997), The New NHS, Modern, Dependable, London:

Stationery Office.

Derrida, J., (1978), Writing and Difference, London: Routledge.

Dery, M., (1993), Flame wars, in M. Dery (ed.), Flame Wars: the Discourse of

Cyberculture, Durham, NC: Duke University Press.Escobar, A., (1996), Welcome to Cyberia. Notes on the anthropology of cybercul-

ture, in Z. Sardar and J.R. Ravetz (eds), Cyberfutures. Culture and Politics on the

Information Superhighway, London: Pluto Press.

Fox, N.J., Dolman, E., ORourke, A., Roberts, C. and Lane, P., (1999), The

WISDOM project: a virtual classroom for primary care informatics, Medical

Education, 33: 36570.

Geertz, C., (1973), The Interpretation of Cultures, New York: Basic Books.

Hammersley, M. and Atkinson, P., (1989), Ethnography: Principles In Practice,

London: Routledge.

Hiltz, S.R. and Turoff, M., (1978), The network nation: Human communication viacomputer, Reading, MA: Addison-Wesley.

Jones, S.G., (1995), Understanding computers in the information age, in S.G. Jones

(ed.), Cybersociety: Computer-mediated Communication and Community, London:

Sage.

King, S.A., (1996), Researching Internet communities: proposed ethical guidelines

for the reporting of results, Information Society, 12: 11927.

Land, N., (1995), Meat (or how to hill Oedipus in cyberspace), in M. Featherstone

and R. Burrows (eds), Cyberspace, Cyberbodies, Cyberpunk. Culture of

Technological Embodiment, London: Sage.

Landow, G.P., (1992), Hypertext. The Convergence of Contemporary Literary Theory

and Technology, Baltimore: Johns Hopkins University Press.

Lupton, D., (1995), The embodied computer user, in M. Featherstone and

R. Burrows (eds), Cyberspace, Cyberbodies, Cyberpunk. Cultures of Technological

Embodiment, London: Sage.

MacKinnon, M., (1990), Post-modern sociality, Telos, 23 (85): 8992.

Marx, G., (1998), An ethics for the new surveillance, Information Society, 14.

Mathers, N. and Gask, L., (1995), Surviving the heartsink experience, Family

Practice, 12: 17683.

McLaughlin, M.L., Osborne, K. and Smith, C., (1995), Standards of conduct onUsenet, in S.G. Jones (ed.), Cybersociety: Computer-mediated Communication and

Community, London: Sage.

Poster, M., (1994), The mode of information and postmodernity, in D. Crowley and

D. Mitchell (eds), Communication Theory Today, Cambridge: Polity.

Poster, M., (1995), Postmodern virtualities, in M. Featherstone, and R. Burrows

(eds), Cyberspace, Cyberbodies, Cyberpunk. Cultures of Technological Embodiment,

London: Sage.

Rabinow, P., (1986), Representations are social facts: modernity and post-modernity

in anthropology, in J. Clifford and G. Marcus (eds), Writing Culture: the Poetics

and Politics of Ethnography, California: University of California Press.Rafaeli, S. and LaRose, R., (1993), Electronic bulletin boards and public goods

explanations of collaborative mass media, Communications Research, 20: 27797.

Reid, E., (1996), Informed consent in the study of on-line communities: a reflection

on the effects of computer-mediated social research, Information Society, 12:

16974.

Rheingold, H., (1993), The Virtual Community, New York: Addison-Wesley.





29/29

Robins, K., (1995), Cyberspace and the world we live in, in M. Featherstone, and R.

Burrows (eds), Cyberspace, Cyberbodies, Cyberpunk. Cultures of Technological

Embodiment, London: Sage.

Rushkoff, R., (1994), Cyberia. Life in the Trenches of Cyberspace, Glasgow:

HarperCollins.Sardar, Z., (1996), alt.civilisations.faq. Cyberspace as the darker side of the west, in

Z. Sardar and J.R. Ravetz (eds), Cyberfutures. Culture and Politics on the

Information Superhighway, London: Pluto Press.

Saunders, M., (1995), Researching professional learning, Journal of Computer-

Assisted Learning, 11: 2318.

Schroeder, R., (1995), Disenchantment and its discontents: Weberian perspectives

on science and technology, The Sociological Review, 43 (3): 22750.

Scolari, (1995), NUD*IST 3.0, London: Sage.

Stone, A.R., (1992), Will the real body stand up? Boundary stories about virtual cul-

tures, in M. Benedikt, M. (ed.), Cyberspace. First Steps, Cambridge, Ma: MITPress.

Spender, D., (1995), Nattering on the Net, North Melbourne: Spinifex.

Springer, C., (1993), Sex, memories and angry women, in M. Derv (ed.), Flame

Wars: the Discourse of Cyberculture, Durham, NC: Duke University Press.

Sproull, L. and Kiesler, S., (1992), Computers, networks and work, Scientific

American (September, 1991), 11623.

Tyler, S., (1986), Postmodern ethnography. From document of the occult to occult

document, in J. Clifford and G. Marcus (eds), Writing Culture: the Poetics and

Politics of Ethnography, California: University of California Press.

Wagner, P., (1994), A Sociology of Modernity. Liberty and Discipline, London:

Routledge.

Waskul, D. and Douglass, M., (1996), Considering the electronic participant: some

polemical observations on the ethics of on-line research, Information Society, 12:

12939.

GPs in cyberspace

GPs in Cyberspace the Sociology of a Virtual Community

Documents