Tinkering with symptoms, causes and solutions: Tracing the enactments of multiple chronic illnesses in specialised outpatient check-ups.

People living with multiple chronic illnesses and an increasing need for acute care is a global health challenge, which questions the conventional ways of managing illness. A central issue is how medical practices can become more patient-centred and aligned with the everyday life of patients. Communicative strategies for eliciting the patient's goals and preferences are often proposed. In this article, we draw on ethnographic data from fieldwork conducted during 2019-2020 in health-care settings and among people living with multiple chronic illness(es) and repeated acute admissions in Denmark. Inspired by science and technology studies of chronic illness and care, we trace the enactments of illness and illness work in a patient trajectory marked by persistent symptoms and medical complexity. We analyse three medical encounters, and we show how 'tinkering' with clinical signs and utterances in each encounter constantly enacts new versions, shaping how the patient could and should live with his illness. We argue that specialised outpatient check-ups for these patients must provide space for continuous tinkering with the concrete effects of illness in everyday life.

Discharge readiness as an infrastructure: Negotiating the transfer of care for elderly patients in medical wards.

The discharge from hospital is an essential care transition for elderly people with chronic illness, specifically because the responsibility for treatment and care is transferred between locations and healthcare staff. To optimise the use of healthcare resources in a time of progressively shorter hospital admissions and increasingly streamlined hospital care, discharges are highlighted as important moments to be handled with caution. Yet, discharges are expected to be "early" and "quick" procedures to maintain a flow of patients through the hospital. In this qualitative article, we use ethnographic methods to investigate how this apparent contradiction unfolds in everyday discharge situations through the work of establishing discharge readiness in three medical wards in a middle-sized Danish hospital. We use the lens of infrastructure to help us see how elements like patient screens, screen meetings, clinical (and embodied) signs and community health care criteria are interrelated in the work of establishing discharge readiness of patients. By looking closely into specific discharge situations, we analyse the way care needs are defined and how care work is transferred, and we identify the inherent uncertainties for health care professionals, patients and relatives. We show how clinical signs take precedence over embodied experience, and how complex situations are reduced to workable problems to enable discharge.