The Norwegian government has launched a policy titled cancer patient pathways (CPPs), which assigns maximum deadlines to the various phases of the diagnostic investigation. In this article, I examine the starting point of CPPs through the lens of institutional ethnography—that is, how physicians work with the referral of patients in the context of CPPs. Based on qualitative interviews with physicians in both primary and secondary care across Norway (N = 37), the findings reveal that the distinction between CPP or not is by no means clear-cut for either primary or specialist physicians. The starting point of CPPs is mediated by the interaction between physicians and patients and how the referral is composed, as well as how and by whom the referral is interpreted, in conjunction with overarching discourses, policies, and guidelines for practice. The findings challenge the notion that all potential cancer patients can and should be equally prioritized.

挪威政府推出了一项名为癌症患者途径 (CPP) 的政策，该政策为诊断调查的各个阶段指定了最长期限。在这篇文章中，我通过机构民族志的视角来研究 CPPs 的起点——即医生如何在 CPPs 的背景下处理患者的转诊。基于对挪威初级和二级保健医生的定性访谈 ( N= 37)，研究结果表明，对于初级或专科医生来说，CPP 与否的区别绝不是明确的。CPP 的出发点是由医生和患者之间的互动、转诊的构成方式以及转诊的解释方式和人员以及总体话语、政策和实践指南所决定的。这些发现挑战了所有潜在癌症患者都可以而且应该被同等重视的观念。