Inclusive intake screening: shaping medical problems into specialist‐appropriate cases

  This paper examines medical intake screening through the process of making appointments with medical specialists. By employing a multi‐method, qualitative approach, it shows how decisions to schedule doctors’ appointments are based on medical knowledge about physicians’ specialties and specific organisational practices. It draws on insights from first‐contact interactions between clients and institutional gatekeepers to enrich our understanding of intake screening. In relation to gatekeeping, rationing commonly gets framed as restrictive screening practices, with a preference for denying or limiting access to treatment. Restrictive screening practices are typically organised to elicit a narrow range of information (‘facts’) relevant to specific eligibility criteria; whereas inclusive intake screening tends to involve less scripted, more complex and open‐ended interactional exchanges between workers and clients, wherein workers help clients frame their claims in ways that will increase their chances of getting accepted. Front‐office workers hold a preference for inclusive intake screening, a preference that is undergirded by the referral‐driven nature of this stage of patient processing, and by a work environment that favours inclusive screening. This finding builds on the literature within medical sociology, but also extends our understanding of frontline decision‐making and the distribution of resources within a variety of people‐processing institutions.