Working diagnosis: The medical labour process and the classification of suffering

Abstract Medical sociologists argue that diagnosis is a critical component of medicine and that diagnosis is most obviously exercised by doctors. This scholarship, however, largely ignores other medical workers. I extend the concept of working diagnosis to help solve this problem. These are partial and preliminary medical classifications of suffering that are imposed between informal experiences of illness and formal classifications of disease. In a complex division of medical labour where doctoring is a minority practice, working diagnoses are critical forces that shape, and are shaped by, the relational conditions of medical production. To illustrate the analytical promise of this concept, I sharpen it through an ethnography of ambulance work in California. Working diagnoses in this case are officially referred to as ‘primary impressions’. I show how these impressions are deeply embedded in the relations of paramedical production. Three are specifically highlighted: the relations between ambulance crews and their patients, the relations between ambulance crews and their nurse and police counterparts and the relations between ambulance crews and their managers. I work towards a simple but rarely stated conclusion: medical sociologists should focus more heavily on how diagnostic processes influence labour processes and vice versa.