Sorting it all out - classifying clients’ conditions and their movements between primary and secondary care

Diagnosis is the main classification tool of modern medicine, and diagnosing is a powerful social process. Understanding this process is critical to interpreting and improving the relationship between doctors, their clients and other health personnel. This study asks how general practitioners diagnose and treat persons with painful hand conditions. We are also interested in why some clients are referred to specialist healthcare while others are referred to self-care. Our theoretical lens is inspired by critical sociocultural approaches to professional and scientific boundary work as well as the work of Annmarie G Jutel on diagnosis, and Pierre Bourdieu on power relations. Empirically we are analysing 23 anonymized electronic medical records (EMR) extracts of texts made by general practitioners (GPs) and in-depth interviews with the same GPs (5-10 GPs) The clients’ type and level of education and work status were registered. According to our analysis, we identified four ways of diagnosing hand conditions: by symptoms, by physical function or activity performance, by formal classification systems (ICD or ICPC) or by a complex process including treatment. We further identified the three treatment trajectories: some clients only met with the GP and were advised to self-care, other clients encountered the GP and a rheumatology specialist, and a third group were referred to an orthopaedic surgeon for treatment. The third group were also frequently referred for further consultations with other health professionals as occupational therapists and physical therapists. We also discovered that clients in the third group had slightly higher (educational) cultural capital than the others.