OPENNESS AND SPECIALIZATION - DEALING WITH PATIENTS IN A HOSPITAL EMERGENCY SERVICE

The hospital is characterised by a dual orientation: being open to the heterogenous demands for medical care that are spontaneously directed to it, and selecting patients in terms of their match with medical sp ecialties represented in its different services. This tension is at th e heart of the functioning of emergency services. Based on ethnographi c fieldwork in a French teaching hospital, the article examines the co nsequences of this duality on the concrete organisation of work. It sh ows the main dimensions that go to make up the patient's mobilising wo rth: closeness to the core of real emergencies; social demands; the in tellectual interest of the case; questions raised by transfers of resp onsibility between doctors. For each dimension, it studies staff react ions and gives some indications about their complexity. Finally it sug gests some comparisons between these results and the observations made by several studies conducted in American and UK hospitals since the 1 970s.