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In many respects the office has changed little over the past 200 years. The introduction of the telephone, copier, fax and computer have only served to speed up and proliferate the basic processes. We are now faced with an increasingly complex and difficult environment that requires fundamental changes to humanize the processes. In this paper we address some of the interface issues that now appear to have near term solutions.

Health care organizational research should pay greater attention to the specific settings where health is practiced. An ethnographic account of humor, ritual and defiance is presented from 29 months spent in a private, concierge-type radiation oncology center. A thick description of the setting and interaction among center staff and patients is offered in an attempt to establish why qualitative research of health care settings is so important. Findings are compared to Ellingson’s work on health care setting. Humor, ritual and defiance have therapeutic value and deserve greater attention in cancer treatment centers and health care organizations more broadly. The paper aims to discuss these issues.

An ethnographic account of humor, ritual and defiance is presented from 29 months spent in a private, concierge-type radiation oncology center through thick description.

This study reinforces the literature on the value of institutionalizing humor and ritual to improve patients’ experience in cancer care given the dominance of large public institutions, most easily accessed by academic researchers. Suncoast Coast Radiation Center’s “institutionalized humor” is an important finding that should be examine further. Scholarship can also illuminate the use of ritual in settings where health care is practiced.

This study is limited to a particular research setting which is a private, concierge care radiation oncology treatment center in the Southeastern USA.

Cancer care centers should consider carefully institutionalizing humor and ritual into their daily practices. Further, patient defiance should be reinterpreted not as a patient deficiency but as a therapeutic coping mechanism by patients.

While nearly half of cancer care in the USA is offered in private, for-profit institutions, the vast majority of the understanding of cancer care comes only from non-profit and government-run institutions. Shining a light of these neglected cancer care settings will add to the understanding and the ability to improve the care offered to patients.

This is the first health ethnography in a concierge care, cancer care treatment setting. It tests the proposition that humor, ritual and defiance play an important role in a private concierge cancer care organization.