The Experience of Living with Stroke Sequelae Illuminated by Means of Stories and Metaphors

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Abstract
This study examines the implications of contemporary bureaucratic organizational forms for professionals and their clients by considering the case of doctors working for health maintenance organizations (HMOs). Physicians are gatekeepers who define patient access to health care resources. The study finds that gatekeepers within some HMOs are constrained by the organization of medical practice. The most important organizational constraints over gatekeeping are utilization review and the alteration of traditional relationships between gatekeeping physicians and their consultants. The resulting patterns of interactions, both between professionals and between professionals and their clients, lead physicians to view their HMO patients as characteristically demanding.