The co-construction of medical disposals in emergency medicine consultations.

ABSTRACT

Waiting times in Accident and Emergency (A&E) Departments are a key performance indicator for the UK National Health Service (NHS) and are linked to medical decision making. We use the concept of medical disposal to consider the ways in which patients' medical problems are remoulded and transformed into a solvable problem enabling what he refers to as 'medical disposal'. Drawing on a study of 16 video-recorded cases from a single A&E Department in the UK, collected in 2014 and 2015, conversation analysis is used to explore how options for disposal (referral and discharge) are constructed and received in interactions between junior doctors and consultants. We consider the potential impact of information imbalances between junior doctors and consultants, as well as orientation to organisation goals in the form of standardised procedures and guidelines and constraints on time. In this way we demonstrate the interactional delicacy of discussions between junior doctors and consultants concerning moving patients on from A&E. We show how when juniors discuss cases with consultants the resultant decision making may be viewed as co-constructed. We make a case for detailed and nuanced understanding of interactions in A&E departments in order to understand the complexity of decision-making in this highly politically visible setting.