The Physical Therapy Treatment Room as an Information Ground
The health care setting I have chosen to discuss is the main treatment room in a Physical Therapy (PT) office. I have been to several physical therapists myself and have referred patients to many PT offices during my primary care practice. These referrals were usually made for exacerbations of chronic back pain, for acute injury rehabilitation, or for post-op recovery. Patients are usually not referred while in intense pain, because the pain could diminish the benefits from the PT, and the PT could worsen the pain.
The Locale and Basic Social Aspects
The main treatment room in many PT offices is large, with exercise and testing equipment spread out. The rooms usually have a rectangular or "L" shape and are at least 10 feet across in the narrow dimension and more than 20 feet long. The largest I saw was about 16 x 30 feet. The room often has a high ceiling from which equipment sometimes hangs. The rooms have cushioned floors but always have walls that reflect sound well despite the equipment hanging on them. I’ve never been to one where the sound didn’t reverberate and reflect well enough to hear across the room. Although the room is large and open, most "patient stations" are clearly identified by the tables to lay on and maybe a chair for the therapists nearby. Others are clearly separated simply because 
they involve a large exercise machine. These "stations" give the illusion of privacy, although most patients realize that others in the room can hear everything said. This leads to a close conversation with the therapist being followed (after he or she leaves) by a neighboring patient beginning a conversation, "I heard you had some stomach trouble after going to SeaFair last week. So did I. My whole family got sick after eating the chicken. I got so sick I couldn’t do my range-of-motion exercises!"
There are carts to carry equipment to and from patients, and there are usually several tables for patients to lie on during some treatment activity. Many PT offices make coffee, tea or soda pop available, and all make water available to patients. All PT offices have magazines in the waiting area and spread out across the main treatment room. These often have a health or sports theme that connects well to the PT. They include titles such as: "Successful Aging", "Arthritis Today", "Men’s Health" and "Holistic Health", in addition to the usual "People" and "Newsweek" that seem to be ubiquitous in medical offices. Magazines are sometimes the activator of a conversation between patient and therapist, or patient and patient; "Did you read the article in X?" or "I read this article about X in Y magazine. What did you think?" or "I see you have this month’s X magazine. Does it have anything about Y (disease or treatment)?"
Some PT offices specialize or emphasize expertise in one domain of PT, such as chronic back pain, or sport’s medicine. Their patients tend to be a narrower spectrum than those that don’t specialize. For instance, you are likely to meet truck drivers at the back pain clinic, but unlikely to see teenagers after skiing accidents or an elderly patient with arthritis-related knee problems. Some PT offices have a large clientele from just a few orthopedists and their patients reflect the kind of practice in those offices. One PT office I went to had a large Russian clientele, because their receptionist spoke Russian. She would act as a translator, and the patients felt quite comfortable with her because she was a native who knew their background, culture and experiences.
Another "social aspect" that is not obvious is that most PT requires multiple appointments, which are usually scheduled on a weekly basis. For most patients it is easier to remember the appointment at the same time of the day, so a patient might return every Tuesday at 11:00am. Since there is more than one patient in the treatment room at once, this means that a specific set of patients is coming in at the same time every week. Usually there is overlap, so you don’t start and end with the same patient set, but it is very likely you will see the same patients for at least 3 of the 6 visits for a typical PT referral. This means that the PT is an information ground that has "regulars" to a certain extent. If you include the secretary, assistants and physical therapists, you get to see a similar group of people over the repeated visits. It is not unusual to hear one patient ask another "Making any headway with that knee of yours?", or to say "Hey! It looks like you are moving better today." Obviously, some PT treatment rooms are more conducive to cross-talk between patients than others, but I’ve seen it at some point at the PT treatment rooms I’ve gone to.
Participant Movement
Patients move from one place to another as they change equipment to work on different parts of the musculoskeletal system. Therefore, many patients can see, hear and talk to each other. Since the space is open, the therapist can both visually check on patients quickly and easily (and surreptitiously), as well as hear any grunts, groans or verbal requests for help. Patients have been known to throw a towel (or other light object) at the therapist to get his or her attention. Usually this is done in a lighthearted manner. Most PT offices also have individual patient rooms for things like massage and electrical stimulation treatment, but those will not be discussed in this paper, as they lack the social milieu found in the large treatment room.
Overt Information
The main treatment room often has wall-mounted holders for handouts, either those made by the PT office itself or those that are commercially available. These handouts might describe a diagnosis, such as chronic low back pain, or a treatment, such as electrical stimulation or a support group available for those who suffer from a specific problem or disease. The walls often have large diagrams or charts of musculoskeletal anatomy, or how to use the equipment properly. Recently, I have seen more print-outs from the internet posted on the walls or available to patients. Patients often bring information to the therapist to validate it, especially if they got it off the internet. Thus, the main treatment room in a PT office has a wide assortment of written information and visual information (diagrams or charts).
The Ground’s Purpose, and Timing of Events
The singular purpose of the patients and therapists (and their assistants) is to improve the health of patients by using body position, stretching and movement, as well as heat or ice, electrical stimulation and other modalities which patients often describe as "torture" (jokingly of course). These treatments typically last 5 to 15 minutes for each "set", and are repeated a number of times. A typical session might last 45 minutes. During the 15 minutes for a set, the therapist is usually there for 2 to 5 minutes to be sure the patient knows what to do, and then the patient is often left on his or her own while the therapist checks other patients. This leaves patients to interact amongst themselves, which they do depending on their personal preferences. The therapist usually checks on the patient often visually or verbally from across the room or by coming to the patient.
Qualifications in the Small World Context
The Small World concept contains several pertinent concepts:
1. social norms,
2. world view,
3. social types,
4. information behavior
5. legitimized others
A PT treatment room is a place where people need quiet reassurance, where people become angry about their disease, the slow progress with therapy, or the insurance industry. The social norms for this context allow for outbursts of anger and tears that might not be acceptable elsewhere. Civility and formality are maintained to some degree as a comforting measure for all. The "world view" in a PT office depends greatly on the view and approach of the owner who often is a Physical Therapist who works at the office. Some accept alternative medicine views more than others. Some adhere to strict views of the body as a mechanical structure, although I think it is more common now to see a holistic view and mind-body philosophy. The social types or roles are fairly clear in this context, with patients most often in a submissive role. And clearly, there is information behavior taking place on an overt level.
A PT treatment room can be an interesting place. The patients range from someone who is new to the process and is frightened and anxious about everything, to someone who is back for the same thing he has had five times before and knows exactly what to expect (although he knows something new is likely to be brought up, either about the disease state or the treatment guidelines that have changed). A typical example of the latter is a middle-aged male who has had recurrent back strain for over ten years, and has been to PT a half-dozen times. This person is, by now, quite knowledgeable about his problem, and has both real-life knowledge of what to avoid and what to do in everyday life, in addition to the knowledge and experience received in the PT office and other health care venues. These people, in addition to the therapists themselves, constitute the legitimized others. Fisher & Naumer (in press) reviews Chatman’s Small World concept: "The legitimized others place narrow boundaries around the possibilities of these behaviors." (Italics added for emphasis.) It is these people who can "shoot down" ideas they consider outside their experience and knowledge when conversations move into their domain. They are the ones who determine, at least to some extent, how far-ranging the conversation becomes, often by their non-verbal cues (eyes-rolling, curled lip, raised eyebrows).
Qualifications as an Information Ground
Fisher, Durrance and Hinton (2004) … derived the following propositional statements:
1. Information grounds can occur anywhere, in any type of temporal setting and are predicated on the presence of individuals.
2. People gather at information grounds for a primary, instrumental purpose other than information sharing.
3. Information grounds are attended by different social types, most if not all of whom play expected and important, albeit different roles in information flow.
4. Social interaction is a primary activity at information grounds such that information flow is a byproduct.
5. People engage in formal and informal information sharing, and information flow occurs in many directions.
6. People use information obtained at information grounds in alternative ways, and benefit along physical, social, affective and cognitive dimensions.
7. Many sub-contexts exist within an information ground and are based on people’s perspectives and physical factors; together these sub-contexts form a grand context.
As stated, PT treatment rooms, as a location where information behavior takes place, are predicated on the presences of individuals. These include the "legitimized others" who limit or constrain the conversations to define what the "social norm" for the locale is. PT treatment rooms are designed primarily around treatment. I think it fulfills the 2nd criterion, although any health care involves education about disease states and treatment options which do constitute information sharing. Different social types do play a role in the information flow.
The 4th criterion is a difficult one for me to assess. I cannot think of any health care activity, which is only or even primarily a "social interaction". I had some difficulty understanding this when reviewing the Foot Clinic study (Pettigrew 1999). If this criterion is interpreted strictly, then no health care setting can qualify as an information ground, because they all have a primary activity which is something other than "social interactions". The only health care settings I can think of that might fulfill this are disease-related support groups.
The criteria 5, 6 and 7, as has been discussed, also occur in PT treatment rooms.
Summary
In summary, Physical Therapy treatment rooms are a rich "Information Ground". They are filled with people from many social roles, who are brought repeatedly into a setting where conversation takes place freely. There are many contexts and sub-contexts from therapists and patients alike. And all these create a setting where the transmission of information takes place, on wide-ranging topics by both formal and informal means.