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Paper short abstract:

Who decides when an urgent request for care is legitimate? How is such a decision made? The ER is a space where this question is negotiated daily. The paper discusses how different analytic strategies may reveal or hide vital systemic aspects of the long-troubling issue of ER overcrowding.

Paper long abstract:

These days, there are countless representations of the Emergency Room (ER) on television and in movies, where attention is mostly devoted only to moments of crisis in which health care staff rush off in a frenzy to save lives (and also to exploring the personal and romantic relationships of the ER staff). Perhaps unsurprisingly, during my year-long ethnographic fieldwork in an Italian ER (between 2017 and 2018), most healthcare providers told me that they can’t stand television shows or movies about the ER.

But apart from such melodramatic representations, in real life the ER is also a place which people suffering from chronic conditions visit recurringly. The ER can be alternatively described as a place where social isolation, homelessness, and invisibility, that are not readily apparent in many other public spaces, become tangible and real. The ER is a place of waiting just as much as it is a place of urgency and crisis. It is a space of failure as much as it is a space of healing.

This paper examines the possibility to create an alternative systemic description of a long-standing healthcare problem such as hospital overcrowding, by avoiding to focus on the most critical situations (the red codes). It examines the ethical, analytic and narrative choice to write about the urgency of people’s needs, rather than the one of clinical assessments, a dimension of life in the ER that is generally overlooked, both in health systems research and certainly in popular depictions.