Representations of the patient: conflicts of expertise in a psychiatric emergency department.

Representations are the socially and textually produced patients as presented in clinical discussion and the clinical chart. An understudied aspect of representations in medicine is the way in which they are used to highlight contests of expertise and authority between clinicians, which have consequences over control of critical hospital resources. The author uses ethnographic research in a public urban hospital psychiatry department in New York City to examine the rounds meetings of a psychiatric emergency room, exploring the way in which representatives of a variety of occupational groups portray patients as they present and debate alternative diagnoses. He uses narratives of rounds meetings to illustrate the interactions, debates, and work of psychiatric and nonpsychiatric clinicians as they struggle to diagnose and develop treatment plans for patients. The enhanced authority of nonpsychiatrist clinicians that emerges from successful contests of representations illustrates a possible future for psychiatry as a multidisciplinary medical specialty.