Notes that the rapid rise in private practice of an economic model known as "contract medicine" (such as the HMO) has introduced powerful new organizational constraints on interaction between member physicians and their patients. Examines the negotiation of specialty referral in two practices participating in contract plans. (MM)

Examines the relationship between communicative and organizational processes in the medical and financial screening steps of the patient intake process of an urban out-patient clinic. Case studies of conversational routines in medical intake show how these processes elicit and provide information in categories used to reconcile conflicting medical…