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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  13 sign? Can’t they see I’m busy?”) and as an invasion of the current patient’s privacy. But the situation is unclear and hard to navigate without either better signage or an individual assigned to guide people as they arrive at the ED. For example, on one of the days of observation a man brought in his daughter, who had a bloody nose as a result of a fall. After waiting about twenty minutes the man approached the window and asked when his daughter would be seen. “We have more serious cases, sir,” replied the triage nurse. “This is serious,” says the father.” “But I saw her walk in,” returns the nurse.” “Yeah, but now she’s complaining about a headache.” “Well, if she fell on her nose she’s going to have a headache.” Negotiating pain is a complex issue in triage. In the waiting area, there is a tension that exists between patients whose pain can be seen (i.e., those with open wounds) and those whose pain can’t be seen but are nonetheless vocal about it. The severity of pain has shown to be underestimated by healthcare workers (Guru & Dubinsky 2000) and is not always the most significant factor in triage. As mentioned previously, the kinds of people showing up at triage today are different from those that came in the past. The persistent inability to provide integrated mental health and substance abuse services brings many individuals with mental and addictive disorders to the ED. Inability to obtain health insurance brings another group of individuals who are forced to use the ED as their source of primary care. Most of these visitors have learned that the ED cannot legally turn them away, so they become regulars, or what the ED staff

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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sign? Can’t they see I’m busy?”) and as an invasion of the current patient’s
privacy. But the situation is unclear and hard to navigate without either better
signage or an individual assigned to guide people as they arrive at the ED.
For example, on one of the days of observation a man brought in his
daughter, who had a bloody nose as a result of a fall. After waiting about twenty
minutes the man approached the window and asked when his daughter would be
seen. “We have more serious cases, sir,” replied the triage nurse. “This is
serious,” says the father.” “But I saw her walk in,” returns the nurse.” “Yeah,
but now she’s complaining about a headache.” “Well, if she fell on her nose she’s
going to have a headache.” Negotiating pain is a complex issue in triage. In the
waiting area, there is a tension that exists between patients whose pain can be
seen (i.e., those with open wounds) and those whose pain can’t be seen but are
nonetheless vocal about it. The severity of pain has shown to be underestimated
by healthcare workers (Guru & Dubinsky 2000) and is not always the most
significant factor in triage.
As mentioned previously, the kinds of people showing up at triage today are
different from those that came in the past. The persistent inability to provide
integrated mental health and substance abuse services brings many individuals
with mental and addictive disorders to the ED. Inability to obtain health
insurance brings another group of individuals who are forced to use the ED as
their source of primary care. Most of these visitors have learned that the ED
cannot legally turn them away, so they become regulars, or what the ED staff


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