Bureaucratic Authority in the "Company of Equals": The Interactional Management of Medical Peer Review

Abstract

The author examines the negotiation of treatment decisions and the management of professional relationships during medical peer review. Using audio recordings of reviews conducted by telephone, he examines three recurrent interactional junctures in the review : (1) the reviewer's formulation of an initial request for information about the patient; (2) the doctor's immediately subsequent description of the patient; and (3) the reviewer's announcement of decision about the appropriateness of the proposed procedure. Through the practices that accomplish these actions, doctors and reviewers orient to tensions between collegial and bureaucratic pressures, and manage these tensions through a set of interactional and institutional resources that may minimize the potential challenge to the collegial relationship. In doing so, the participants work to preserve the ideal of professional autonomy, even while it may be compromised by the review process itself