Bishop Berkeley and the Adenotonsillectomy Enigma: An Exploration of Variation in the Social Construction of Medical Disposals

TLDR: Observational data gathered in the out-patient clinics of eleven ENT specialists were used to explore the issue of the marked and well-documented variations in the assessment of children for possible adeno-tonsillectomy.

Abstract: Observational data gathered in the out-patient clinics of eleven ENT specialists were used to explore the issue of the marked and well-documented variations in the assessment of children for possible adeno-tonsillectomy. The routinized orientation of the various specialists to the assessment process allowed the comparison of specialists in terms of their routine assessment practices. Inter-specialist variation in routines is described in terms of five parameters of difference—variation in the search procedures used in the examination of the child, variation in the decision rules making for differential stress on the examination findings relative to the history, variation on the search procedures used for the history-taking, variation in the decision rules pertaining to the history, and variation in routines according to the age of the child. Such differences in routines are the means whereby systematic variations in patient assessment are constructed.The very nature of medical knowledge provides for the p...