基于对A省W医院的田野调查，本文发现地市级医院中存在知识与组织边界错配导致的跨边界诊疗现象。横向跨知识边界源于诊断斗争，边界工作与院内病源协作强化了知识边界的模糊性；纵向跨组织边界则基于同质性组织结构的生产，由亚专业病区间的管辖权竞争和院内外病源交换网络共同塑造。跨边界诊疗虽提升医院创收能力，但也加剧医疗风险与患者就医成本。本文从职业社会学的视角揭示了诊疗边界动态变化的生成机制，对医疗资源配置和诊疗秩序的优化具有借鉴意义。

Based on ethnographic fieldwork conducted at W Hospital in Province A, this paper identifies the phenomenon of cross-boundary diagnosis and treatment in prefecture-level hospitals, resulting from the mismatch between knowledge and organizational boundaries. Horizontally, crossing knowledge boundaries stems from diagnostic struggles, where boundary work and intra- hospital patient-source collaboration reinforce the ambiguity of knowledge boundaries. Vertically, crossing organizational boundaries is rooted in the production of homogeneous organizational structures, shaped by jurisdictional competition among sub-specialty wards and networks of patient- source exchange both within and outside the hospital. While cross-boundary diagnosis and treatment enhance the hospital's revenue-generating capacity, they also exacerbate medical risks and patient healthcare costs. From the perspective of the sociology of professions, this paper reveals that the generative mechanism of the dynamic changes in diagnostic boundaries, offering insights for optimizing the allocation of medical resources and the order of diagnosis and treatment.

本文为江苏省社会科学基金青年项目“健康江苏背景下数字技术对医患信任的影响机制及对策研究”（24SHC008）的阶段性成果。

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