Mirko Pasquini: "Economies of Attention as an Analytics for Healthcare Change: The Case of Urgency and Overcrowding in an Italian Emergency Room"

Medical Humanities National Seminar Series

Research presentation by Mirko Pasquini, Uppsala University.


From the very beginning of the COVID-19 pandemic, the level of patient saturation of Emergency Rooms (ERs) and Intensive Care Units (ICUs) and the lack of available beds was broadcast relentlessly, filling everyone with dread – not to say panic. Who is to be attended first? And how should such a decision be made? But, even though it made things worse, hospital overcrowding is not a new phenomenon that the pandemic brought.

Since after 2008, Italian Newspapers and television exposé frequently sound the alarm that one third of the Italian population goes to the ER at least once a year, and 70% of those patients are assigned either low priority or non-urgent care codes. Urgency in the ER is supposed to fit clinical criteria, and is designed to treat heart attacks, broken bones, or head traumas due to car accidents, not provide routine health care and social support.

During the past fifteen years, however, this definition of urgency has undergone massive renegotiation in Italy. The ER has become the go-to place to try to get painkillers for chronic gallstones or back pain; to obtain a routine medical examination because you have grown weary of waiting for your General Practitioner to get back to you with an appointment; to check-up on stitches, catheters and bandages after surgical interventions; to get help consulting specialists such as psychiatrists; to spend the night when nowhere else is available.

The ER has become a venue that people seek out in an attempt to cope with or at least mitigate conditions of existential, social and economic precarity. These forms of precarity are urgent too as they regard lonely elderly people, migrants – only partially under public healthcare coverage – and young people struggling with increasingly harsh mental health conditions.

In my ethnographic research, I explore the everyday life of an Italian ER as a place where urgency is at stake; caught up in and contested, by competing understandings. Here, mistrust is fueled against medical authorities, and violence often sparks in its venues. But the ER is also a creative social space where productive negotiations of more equitable ways to distribute care take place amid ER staff and suffering people struggling for social justice.