Andersen Rikke Sand, Aarhus Rikke
Department of Public Health, Faculty of Health, Aarhus University , Aarhus , Denmark.
Department of Culture and Society, Faculty of Arts, Aarhus University , Aarhus , Denmark.
Anthropol Med. 2019 Aug;26(2):213-227. doi: 10.1080/13648470.2017.1334040. Epub 2017 Jul 31.
Health care systems as well as bodies of medical knowledge are dynamic and change as the result of political and social transformations. In recent decades, health care systems have been subjected to a whole assemblage of regulatory practices. The local changes undertaken in Denmark that are being explored here are indicative of a long-term shift that has occurred in many welfare states intended to make public services in the Global North more efficient and transparent. Departing in prolonged field work in Danish general practice and the anthropological literature on audit culture, this paper suggests that the introduction of regulatory practices has enhanced the need for triage as a key organising principle. The term triage literally means separating out and refers to the process of sorting and placing patients in time and space. The paper suggests that an increasing introduction of triage feeds into a reconfiguration of diagnostic work, where the clinical setting is gradually becoming more intertwined with the governing domains of policy, and the work of the secretary is gradually becoming more intertwined with that of the doctor. Finally, the paper argues that an increasing regulation of general practice poses an ethically charged challenge to existing welfare politics of responsibility between the state and the public, as it makes it increasingly difficult to negotiate access to care.
医疗保健系统以及医学知识体系都是动态的，会随着政治和社会变革而变化。近几十年来，医疗保健系统受到了一系列监管措施的影响。本文所探讨的丹麦发生的局部变化，表明了许多福利国家长期以来的一种转变，即旨在提高全球北方公共服务的效率和透明度。基于在丹麦全科医疗领域的长期实地研究以及关于审计文化的人类学文献，本文认为监管措施的引入增加了对分诊作为关键组织原则的需求。“分诊”一词字面意思是分离，指的是在时间和空间上对患者进行分类和安排的过程。本文认为，分诊的日益引入促成了诊断工作的重新配置，临床环境逐渐与政策治理领域更加交织在一起，秘书的工作也逐渐与医生的工作更加交织在一起。最后，本文认为对全科医疗日益严格的监管对国家与公众之间现有的责任福利政治构成了一项充满伦理意味的挑战，因为这使得协商获得医疗服务的机会变得越来越困难。
