The unpushed button: The material-semiotic distribution of communicative inequity in a geriatric emergency ward

Effective communication is central in emergency settings, yet is still underexplored particularly in relation to the material and spatial resources through which care is delivered. Drawing on 30 hours of ethnographic observation in a Belgian geriatric emergency ward, this paper examines how everyday objects and ward layout perpetuate communicative asymmetries that can lead to exclusion among older patients. The paper draws on Goffman’s (1981) participation framework, embodied-and-material accounts of interaction (Goodwin, 2000; Mondada, 2019), Angouri and Humonen’s topographies of practice (2023), and Feuerherm et al.’s (2021) macro–meso–micro model of language as a social determinant of health, in order to explore how the ward’s material and spatial configuration shapes the conditions for communicative inclusion and exclusion among older patients. The discussion focuses on two events, each illustrating a distinct competence the ward’s configuration expects patients to possess without explicit instruction. In the first event, the competence at stake is recognising and operating the ward’s material objects without explicit instruction; older patients without this competence employ embodied substitutes. In the second, the competence at stake is reading and restructuring the spatial participation frames the ward’s layout enacts; patients who are not authorised to reconfigure that space are left to repair the frame with whatever resources they hold. Our findings show how in both events, the interpretive labour is shifted onto the patient, with a resulting risk of exclusion and subsequent health penalty.