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? Responding to calls for studies of the overall structural organization of consultations beyond primary care, this article depicts the organization of new problem consultations observed in two large neuroscience centers in the UK. This shows that—in addition to Robinson’s widely cited four main activities (establishing the reason for the visit, gathering information, delivering a diagnosis, recommending treatment)—test ordering is oriented to as an additional, normative activity. We show this numerically (tests were ordered in over 60% of our 65 new problem consultations) and by analyzing how participants orient to the activity of test ordering even when neurologists decide against testing. We argue that test ordering is a distinct activity, which, despite being treatment-oriented, displaces treatment in the here and now. Test ordering is thus consequential for progressivity, serving as both bridge and barrier to accomplishing the overarching medical project. Data are in British English.