Staying With the Patient: An Ethnography of Primary Care

Abstract

This dissertation is an ethnography of Primary Care Medicine. It explores the characteristic tools and organizational form of Primary Care, and offers an account of the role of medical records in the production of clinical judgment and patient care in a California County Hospital. This dissertation argues that genres of medical writing play a special role in the provision of medical care by mediating interactions between clinicians, across the sites and specialties that make up a medical system. Since the first decades of the 20th century, Western medicine has conceived of itself as a collective practice requiring multiple specialties, presenting a problem for general medical practitioners. Primary Care Physicians formed professionally around that area of a medical expertise that deals with complex patients, multiple organ systems, and multiple specialties. I argue that Primary Care creates medical, financial, and patient value through the distribution of patient problems across long networks of care through clinical judgment (phronesis), a type of case-based decision-making related to ethical and legal thought that emphasizes health management over diagnosis. Through the description of Primary Care, and its comparison with other social-scientific analyses of clinical medicine, I offer a novel conceptual candidate for the replacement of the concept of biomedicine as the general type of medicine in the West.