ABSTRACT
Like clinical arrangements, some administrative arrangements must be continually renegotiated. To understand fully the establishment of negotiative consensus, it is further useful to distinguish, according to the intentions of the contracting parties, between clinical and administrative arrangements. The chief initiator of most clinical arrangements is the physician, the leader of the clinical team. A physician may secretly draw the unit resident into a clinical arrangement, persuading the resident to “work on” the nurses to keep an unruly patient and to take responsibility for blocking potential transfer. Besides advantageous placement, physicians may attempt to gain therapeutic control by leaving orders and talking with the head nurse. The conditions under which physicians do so are worth noting because they reveal something about work co-ordination in this kind of hospital. Like other medical specialists, who bring private patients into general hospitals, PPI’s psychiatrists are principally engaged in organizing treatment for their patients.
