Paper short abstract:

Some patients attend their physician more than others for a given state of health. Where provision of health care is the responsibility of a state in austerity, this is considered a problem. These patients are enacted by health care staff and researchers differently at different times during an RCT.

Paper long abstract:

In the UK's socialised primary health care system some patients are considered to be overusers of the health service, attending more frequently than their health status would indicate is necessary. This paper considers the multiple, overlapping and competing ways of enacting this patient group within an ongoing cluster randomised controlled trial. At the outset of the trial, this group was considered by clinicians, researchers, reception and administrative staff alike to pre-exist the trial's identification process and to be consulting their physicians in a way which simultaneously risks their own physical and mental health and causes problems of equity. Frequently attending patients were considered to need an intervention aiming to dissuade them from attending. Physicians and researchers reinterpreted encounters with patients and the patients' reported embodied experiences in line with the fact that these patients already potentially being identified to be 'frequent flyers' in mind. At the same time the patient group were regarded as potentially having bothersome clinically inexplicable symptoms and a right to access their primary care physicians. Confidence about the patient category and the importance of dissuading patients from attending was observed to be less stable when lists of these patients had to be created after reviewing medical records and when physicians considered discussing the decision to place patients on the list with the patients themselves. The paper considers the role of doctors and healthcare administrators in enacting the bodies of their patients through a range of interactions and the role of trial researchers in this process.