In The Moral Evaluation of Emergency Department Patients: An Ethnography of Triage Work in Romania, Marius Wamsiedel examines the social categorization of patients and its consequences at two emergency departments in Romania. Based on long-term ethnographic fieldwork, this work argues that moral evaluation is an attempt on the part of triage nurses and clerks to keep the emergency service afloat in the context of high-care demand, insufficient resources, and uneven access to primary care. At the same time, Wamsiedel argues that moral evaluation is an effort to align the provision of emergency services with socially dominant values, norms, and representations. As such, the moral evaluation of patients becomes a Procrustean bed that reduces some inequities in access to health care while generating or amplifying others. By adopting an interactionist lens, Wamsiedel unravels the underlying social logic of moral evaluation, the criteria and assumptions that inform it, and attempts by triage workers and patient to negotiate access to emergency care. The Moral Evaluation of Emergency Department Patients offers new ways of understanding the work of street-level bureaucracies and informal barriers to care.
Marius Wamsiedel is assistant professor of global health at Duke Kunshan University.
Chapter 1 – The Need for Moral Evaluation
Chapter 2 – Moral Evaluation Criteria
Chapter 3 – Patient Types
Chapter 4 – Credibility Work and the Assessment of Legitimacy
Chapter 5 – Manufacturing Responsibility and Worth
Chapter 6 – Producing Exclusion, Reproducing Racism
This ethnography of moral evaluation is as beautifully written as it is thought provoking. Taking emergency medical triage as a strategic case, Marius Wamsiedel peels back multiple layers to uncover the complex forces shaping how frontline emergency medical workers screen and sort their clients. The Moral Evaluation of Emergency Department Patients is a book that could only be written by a careful and theoretically-driven ethnographer like Wamsiedel.
Based on rich ethnographic data, Wamsiedel offers a perceptive description and insightful analysis of the interaction among triage workers, patients, and companions that shapes the outcome of the classification process in a hospital setting. A superb contribution to medical sociology, symbolic interaction, sociology of morality, and public policy.
Writing in an accessible and compelling style, Marius Wamsiedel unpacks the manners in which healthcare professionals’ triage work embeds broader mechanisms of social exclusion in micro-level interactions. The relevance of this timely book’s fine-tuned analysis reaches far beyond its fieldwork location in Romanian hospitals.
Through a robust empirical study, Marius Wamsiedel offers many insights into the rationalization and provision of emergency healthcare in Romanian hospitals. This thorough and timely book from a health system perspective will be of interest to scholars and practitioners seeking to address health inequities among different socio-economic groups, which remains a huge challenge globally.