ABSTRACT
This chapter examines the various components which together made up the bureaucratic format, and discusses the overall fit between this surface ceremony and the more covert sentiments and actions of the participants. One major source of strain lay in the marked discrepancy between the overt medical emphasis on service to the individual client and the actual setting and timing of that service. Certain potentially offensive matters might be carefully excluded; but the bureaucratic setting, and the medical control of action within that setting, these could not be wished away. The domination of the action by teaching was at its most extreme in the maternity hospital ward-round. The relative ease with which consultations with foster-mothers were conducted emphasizes yet again the many tensions that underlay paediatric consultations with parents. In summary, although there were circumstances in which alliances could be made with some ease the possibility of tension was always there.
