Overcrowding in emergency departments: Revealing the social perspectives through a medical sociological analysis

In the past decade, several studies have evaluated the causes of overcrowding in emergency departments in different healthcare systems. Many of the perspectives, however, have emerged from a biomedically centered conceptual framework. An explanatory model that integrates the concepts and views of medical sociology is generally lacking. This paper argues that a critical and qualitative medical sociological analysis may reveal the salient and multidimensional social factors that underlie emergency department overcrowding. These sociological considerations can assist in understanding the phenomenon and in taking steps to optimize the prevailing conceptual framework. In this paper, the congestion of emergency departments is presented within the sociocultural context of Hong Kong, China, which is a metropolitan city that had nearly 2.2 million recorded emergency attendances at public hospitals in 2017. Evidence from the relevant literature is used to support this analysis. An interplay of social ideologies and factors at different social levels is identified as contributing to emergency department overcrowding. The factors are discussed at the individual, micro-social, intermediate, and macrosocial levels. The sociological hypothesis is that the overcrowding issue may be multidimensional in nature and that a linear explanatory approach that attributes the root cause to the healthcare system per se may not be adequate. This paper sheds light on the importance of a sociocultural analytical approach for explaining the phenomenon. The diverse sociocultural etiologies should be contextualized when formulating strategies to address the global issue of overcrowding in emergency departments.