Categorization in accident departments: ‘good’ patients, ‘bad’ patients and ‘children’

Abstract

Qiildren form a significant proportion of accident services' clientele but have received relatively little attention in the growing ethnographic literature on such organizations. This paper uses data from observation and interviews in four English acddent departments to review Jeffery's influential analysis of medical staffs categorization of patients. After pointing to certain logical difficulties with this account, it is argued that an analysis of the way children are treated allows for these to be remedied by the development of a more sophisticated model of professional decision-making. The paper concludes with a discussion of the way in which the categorization rests on the practical contingencies of accident work and the social organization of emergency work. Attention is drawn to the variation between high-prestige units in teaching hosppitals and lower-status units in general hospitals and the way this limits the ability of the former to identify conditions like child abuse or neglect. IntroductionThe invisibility of children in social scientific work has been a matter for increasing comment (e.g. Mackay, 1973;Skolnick, 1974;Fine and Glassner, 1979;May and Strong, 1980;Prout, 1980). Although there is a great deal of research which purports to be about children, much of this, on examination, merely seems to offer a quasi-scientific warrant for current adult common sense. Such responses as these critiques have provoked, goes mostly in one or other of two directions: first, some investigators (e.g. Speier, 1969Speier, , 1971Qcourel et al. 1974;Fine and Glassner, 1979) have tried to produce descriptions of children's own culture, social competences and practical reasoning; second, other researchers (e.g. Davis and Strong, 1976;Silverman, 1981) have looked at the ways in which adults formulate and assign specific social identities to diildren. While these approaches are undoubtedly extending a sociological understanding of childhood, however, they remain open to Our intention in this paper is to show how 'taking children seriously' requires us to revise some influential recent analyses of the processes by which patients are classified in accident and emergency departments and allows us to bring out the oi^anizational and occupational logic of the scheme which members appear to use.

Qualitative research in obstetrics and gynaecology

“…While these ®ndings are not generalisable or predictive in the statistical sense, the rigour of this piece of research and the evidence presented indicate that it is unlikely that these ®ndings are unique to this group of midwives. This conclusion is supported by previous qualitative research that has identi®ed other assumptions, such as`good' and`rubbish' patients, that in¯uence clinical practice 28,29 .…”

When nurse knows best: some aspects of nurse/doctor interaction in a casualty department

“…* The character of the medical staff serving a department and, to a lesser extent, the stability of the nurse group are likely to be obvious sources of variation. Dingwall et al (1983) in a recent study of child abuse found considerable differences in casualty nurses' influence in the diagnosis of abuse. In two hospitals which relied heavily on low-status overseas doctors, the important role of experienced nursing staff had been institutionally recognised.…”

“…The 'sorting' function of the Department brings staff into contact with a patient population which includes both those suffering from life-threatening conditions, and those who tum out to have no determinable illness or pathology. Patient processing is made all the more difficult because in certain circumstances attenders with serious illness conditions may be almost indistinguishable at first sight from various categories of 'problem' patients -drunks, malingerers, and psychologically disturbed persons -who will in most cases not be admitted to hospital (see Bagley 1971, Dingwall and Murray 1983, Jeffery 1979, Mannon 1976, Roth 1972a, 1972b.…”

Η Ιατρικη Εξουσια Στα Ορια Ζωης Και Θανατου: Μια Ψυχο-Κοινωνιολογικη Αναλυση

“…Πέρα λοιπόν από το ζήτημα των προσδοκιών που φαίνεται να είναι πρωτεύουσας σημα σίας για τον τρόπο που γίνεται αντιληπτός ο ασθενής, ένας άλλος σημα ντικός παράγοντας είναι ο παράγοντας της ηθικής. Ο ασθενής ταξινο μείται ως «καλός» ή «κακός», «πειθαρχικός», «απείθαρχος», «ανάξιος» (Dingwall andMurray, 1983* Kelly andMay, 1982). Συμφωνά με το Jeffery (1979) το κατά πόσο έναν ασθενής αξίζει ή δεν αξίζει τη θερα πεία εξαρτάται από τον τρόπο που γίνεται αντιληπτός από το προσωπι κό.…”