Layers in Sorting Practices: Sorting out Patients with Potential Cancer

Abstract

In the last couple of years, widespread use of standardized cancer pathways has been seen across a range of countries, including Denmark, to improve prognosis of cancer patients. In Denmark, standardized cancer pathways take the form of guidelines prescribing well-defined sequences where steps are planned and pre-booked in order to manage patient trajectories. They are different from typical medical guidelines because they combine both administrative and clinical prescriptions. A key issue related to the enactment of a standardized cancer pathway concerns the decision to initiate a pathway for a particular patient. Due to the limited resources within the Danish healthcare system, initiating cancer pathways for all patients with a remote suspicion of cancer would crash the system, as it would be impossible for healthcare professionals to commit to the prescribed schedules and times defined by the standardized pathways. Thus, sorting patients with symptoms of potential cancer becomes an essential activity. In this paper, we investigate the pre-diagnostic work of sorting patients with symptoms that may potentially be cancer. We identify and conceptualize the sorting practices for potential cancer patients in the pre-diagnostic work as being structured in layers of the interrelated, iterative practices of constructing, organizing, re-organizing, and merging the multiple queues within which each patient is simultaneously situated. We find that the ordering of patients in queues is guided by the formal sorting mechanism, but is handled by informal sorting mechanisms. We identify two informal sorting mechanisms with large impact on the sorting practices, namely subtle categorizing and collective remembering. These informal sorting mechanisms have implications for the design of electronic booking systems because they show that sorting patients before initiating a standardized cancer pathway is not a simple process of deciding on a predefined category that will stipulate particular dates and times. Instead, these informal sorting mechanisms show that the process of sorting patients prior to diagnosis is a collaborative process of merging multiple queues while continuously deciding whether or not a patient’s symptoms point to potential cancer.