Inclusive intake screening: shaping medical problems into specialist-appropriate cases.
This paper examines medical intake screening through the process of making appointments with medical specialists. By employing a multi-method, qualitative approach, it shows how decisions to schedule doctors' appointments are based on medical knowledge about physicians' specialties and specific organisational practices. It draws on insights from first-contact interactions between clients and institutional gatekeepers to enrich our understanding of intake screening. In relation to gatekeeping, rationing commonly gets framed as restrictive screening practices, with a preference for denying or limiting access to treatment. Restrictive screening practices are typically organised to elicit a narrow range of information ('facts') relevant to specific eligibility criteria; whereas inclusive intake screening tends to involve less scripted, more complex and open-ended interactional exchanges between workers and clients, wherein workers help clients frame their claims in ways that will increase their chances of getting accepted. Front-office workers hold a preference for inclusive intake screening, a preference that is undergirded by the referral-driven nature of this stage of patient processing, and by a work environment that favours inclusive screening. This finding builds on the literature within medical sociology, but also extends our understanding of frontline decision-making and the distribution of resources within a variety of people-processing institutions.
Department of Sociology, University of California, Los Angeles, CA 90095-1551, USA. yjean@verizon.net
Yvette A
YA
Jean
D001071:Appointments and Schedules; D004608:Eligibility Determination / Q000379:methods / Q000458:organization & administration*; D020793:Gatekeeping / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008329:Managed Care Programs; D008502:Medical Secretaries; D008511:Medicine; D011216:Practice Management, Medical; D013038:Specialization