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首页> 外文期刊>Sociology of health & illness >Keeping out and getting in: reframing emergency department gatekeeping as structural competence
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Keeping out and getting in: reframing emergency department gatekeeping as structural competence

机译：保持和进入：将急救部门恢复为结构能力

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Sociologists have tended to frame medical gatekeeping as an exclusionary social practice, delineating how practitioners and clerical staff police the moral boundaries of medicine by keeping out patients who are categorised as bad', deviant', or otherwise problematic. Yet medical gatekeeping, understood more broadly, can include not only keeping patients out of particular clinical settings, but also redirecting them to alternative sources of care. In this article, I draw on qualitative analysis of audio-recorded patient-provider interactions in a United States emergency department (ED) to illustrate medical gatekeeping as a two-step process of, first, categorising certain patient complaints as unsuitable for treatment within a particular setting, and second, diverting patients to alternative sites for care. I refer to these as the restrictive and facilitative components of medical gatekeeping to denote how each relates to patients' access to care, recognising that both components of medical gatekeeping are part of a coordinated organisational strategy for managing resource scarcity. By illustrating how ED providers reveal intimate knowledge of structural vulnerabilities in diverting socioeconomically disadvantaged patients with chronic back pain to clinical sites that are better equipped to provide care, I suggest that we rethink the emphasis on restrictive practices in sociological accounts of medical gatekeeping.
机译：社会学家们倾向于将医疗门徒倾向于作为一种排他性的社会实践，划定从业者和文职人员如何通过将患者保留为糟糕的患者的患者，划定了医学的道德界限。然而，医疗守门员更广泛地理解，不仅可以让患者不应从特定的临床环境中保持，而且还包括将它们重定向到替代的护理来源。在本文中，我借鉴了美国急诊部门（ED）中的音频记录患者提供者互动的定性分析，以说明医学门徒作为一个两步的过程，首先，将某些患者投诉分类为不适合在a内的治疗特定的环境，第二，将患者转移到替代地点进行护理。我将这些称为医疗守望者的限制性和促进组成部分，以表示如何与患者的护理有关，认识到医疗内部的两种组成部分是管理资源稀缺的协调组织战略的一部分。通过说明，ED提供者如何揭示对结构脆弱性的亲密知识，在将慢性背痛转移到慢性背痛的临床部位，以更好地提供护理，我建议我们重新考虑了医学守望的社会学账户的限制性实践。

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