The normativity of medical tests : Test ordering as a routine activity in ‘new problem’ consultations in secondary care

How does ordering a test fit into new-problem medical consultations? Robinson (2003) has shown that there are four main activities in new problem consultations in primary care (establishing the reason for the visit, gathering information, delivering a diagnosis, recommending treatment), but he speculates that other types of medical consultation may be organised differently. We show a key difference in new problem consultations in secondary care (neurology): clinicians and patients orient to test ordering as a normative activity. Our data come from 65 new problem consultations in two large neuroscience centres in the UK, in which tests were routinely ordered or, if not, their relevance was nonetheless handled by both parties. We argue that test ordering, despite being treatment-oriented, displaces treatment in the here-and-now. It thus serves as both bridge and barrier to accomplishing the overarching medical project. Data are in British English.