On the edge of care: “Improper users” and socio-medical crises in an Italian emergency ward
An estimated 76% of the people who seek medical care in the emergency wards of the province Emilia Romagna in northern Italy don’t belong there at all. They come to the emergency wards because they are elderly and suffer from chronic conditions that don’t require emergency treatment, because they are immigrants who can rely only on emergency service, because they are tired of the marathon waiting times to get appointments at general clinics, because they are lonely and want some kind of social contact with others. In Italian, such people are called “improper users”, by medical staff. This research will examine the situation of improper users in order to document the fraught relationship between emergency care and grassroots needs. It will focus on how the appropriateness of patients’ presence in the emergency ward is negotiated during the assessment of clinical urgency (Triage), and what the consequences of those assessments are for patients, medical staff, and for the national health care system in Italy more generally. Focusing on interactions, interviews and participant observation in a specific emergency ward over a 12 months period, research will foreground how patients and providers together negotiate an understanding of patients’ experience, and on how those negotiations are influenced by sociological factors such as ethnicity, class, age, gender and personal history. Theoretically, research draws on treatments of vulnerability that conceive of vulnerability as a productive position rather than as only a wretched state from which people should be liberated. I will highlight how the display of vulnerability can be used to access means of care and other important social resources. The research will address how faking medical emergencies may be a critical practice that is actually re-shaping clinical procedures to meet new grassroots needs.
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