Paper short abstract:

This paper examines how health care providers at a safety-net HIV clinic describe their job in terms of “triage work” and create collective understandings of their role as “frontline workers”. I argue that triage work mediates contested visions of urgency and confronts scarcity.

Paper long abstract:

This paper discusses how healthcare workers at a safety-net HIV clinic in San Francisco define their jobs through "triage." Ethnographic interviews and observations reveal how patient navigators, social workers and nurses organize themselves through the collective identity of "frontline workers," and use "triage" to describe numerous facets of their work: "triaging e-mail", "triaging insurance," and creating "triage algorithms" to assess patients' needs. I show how their "triage work" often reaches well beyond the small triage room. I follow triage as practice and analytic for feminist STS (Thompson, 2013). While the implied pace of HIV treatment is rapid and urgent--public health imperatives compel treating people soon after an HIV diagnosis—frontline workers feel swallowed by the tedious and sluggish administrative process of "triaging insurance". Triage metaphors help frontline providers to voice and manage the overwhelming demands on their scarce time, care and attention in the context of an onslaught of patient needs. Strategically, triage mediates the everyday flow of patients and the overflow of information, needs and bodies generated within biomedical bureaucracies. Frontline workers thus become responsible for prioritizing the needs of people who have already been "socially triaged" in the name of efficiency (Sjoberg, Vaughan and Williams, 1984) well before the clinic's doors open. I argue that in this situation, triage becomes a political critique of the limits and possibilities for care work in the confines of stratifying biomedical bureaucracies. Triage work, in this sense, is a technique for confronting scarcity through stratified care.