Openness and specialisation: dealing with patients in a hospital emergency service

The hospital is characterised by a dual orientation: being open to the heterogenous demands for medical care that are spontaneously directed to it, and selecting patients in terms of their match with medical specialties represented in its different services. This tension is at the heart of the functioning of emergency services. Based on ethnographic fieldwork in a French teaching hospital, the article examines the consequences of this duality on the concrete organisation of work. It shows the main dimensions that go to make up the patient's mobilising worth: closeness to the core of real emergencies; social demands; the intellectual interest of the case; questions raised by transfers of responsibility between doctors. For each dimension, it studies staff reactions and gives some indications about their complexity. Finally it suggests some comparisons between these results and the observations made by several studies conducted in American and UK hospitals since the 1970s.