ABSTRACT

How does ordering a test fit into “new problem” medical consultations? Responding to calls for studies of the overall structural organization of consultations beyond primary care, this article depicts the organization of new problem consultations observed in two large neuroscience centers in the UK. This shows that—in addition to Robinson’s widely cited four main activities (establishing the reason for the visit, gathering information, delivering a diagnosis, recommending treatment)—test ordering is oriented to as an additional, normative activity. We show this numerically (tests were ordered in over 60% of our 65 new problem consultations) and by analyzing how participants orient to the activity of test ordering even when neurologists decide against testing. We argue that test ordering is a distinct activity, which, despite being treatment-oriented, displaces treatment in the here and now. Test ordering is thus consequential for progressivity, serving as both bridge and barrier to accomplishing the overarching medical project. Data are in British English.

摘要

订购测试如何适应“新问题”医疗咨询？响应对除初级保健之外的咨询的整体结构组织的研究的要求，本文描述了在英国两个大型神经科学中心观察到的新问题咨询的组织。这表明，除了罗宾逊广泛引用的四个主要活动（确定探视的原因，收集信息，提供诊断，推荐治疗）之外，测试顺序还旨在作为一种附加的规范性活动。我们以数字方式显示这一点（在65个新问题的咨询中，有60％以上订购了测试），并通过分析参与者如何定向活动来进行显示即使神经病学家决定不进行测试，也应遵循测试顺序。我们认为测试顺序是一项独特的活动，尽管它是面向治疗的，但它在当前和现在都取代了治疗。因此，测试顺序对于提高进度非常重要，既是完成总体医学项目的桥梁，又是障碍。数据使用英式英语。