Organizational constraints as communicative variables in bureaucratic medical settings: A case study of patient‐initiated referral talk in independent practice association‐affiliated practices

Abstract

In complex, bureaucratized settings, organizational code tends to be highly elaborated and concrete, emphasizing the presence of organizational agendas in decision‐making processes. In large, complex, bureaucratically‐organized medical settings, providers and patients alike must regularly construct accounts that incorporate organizational agendas. By contrast, small‐scale private practice has traditionally represented a more personalistic decision‐making domain, wherein the physician's role has tended to dominate, not only as a locus of professional authority, but as a locus of organizational authority as well. Thus, bureaucratic medical settings and small‐scale private practice settings have represented rather distinct organizational models, and their differences have been reflected interactionally. However, this situation is changing, due in part to the rapid rise in private practice of an economic model known as “contract medicine.” This model introduces powerful new organizational constraints on membe...