Disciplinary Discourses: Contrasting Representations of the Patient in Medical and Mental Health Handover Interactions

Within a few hours of a patient presenting to an emergency department for treatment, clinical staff must decide whether the patient should be discharged or admitted to a ward of the hospital for ongoing care. Staff must then explain their decision to their peers, typically during face-to-face interactions such as clinical handovers at the end of shifts or during intake meetings. Emergency departments receive both medically and mentally ill patients, and these patients are usually differentiated early on and then assigned to the care of either medical or psychiatric teams. Medicine and psychiatry stand in a complex relationship to one another. Although sharing some common historical antecedents, over the past 200 years they have stabilised institutionally as two identifiably different disciplines in western culture, with medicine defined as diagnosing and treating pathologies of the body, and psychiatry with diagnosing and treating mental, emotional and behavioural disorders. These two disciplines both carry high cultural prestige and exert significant power over cultural, and therefore individual, definitions of and responses to illness.