The Fragile Encounter: Service Interaction Vulnerability in Emergency Department Care

This paper investigates service interaction vulnerability (SIV) within emergency departments, where both patients and providers are susceptible to heightened vulnerability. Providers face exhaustion from long shifts, high patient volumes, challenging patient behaviors, and systemic constraints contributing to emotional exhaustion. Patients, meanwhile, feel vulnerable due to illness or injury and their dependency on providers, compounded by the ways in which presenting certain characteristics, such as intimate partner violence, substance use, or suicidal ideation, can shape how they are perceived and treated in the system. These dynamics often result in unintended negative consequences that exacerbate perceived vulnerability for both patients and providers. Employing a mixed-method approach, including hospital data analysis and netnography, this study introduces a theoretical framework for SIV that illuminates how patient–provider interactions can exacerbate or mitigate vulnerabilities. By examining how these interactions shape the likelihood of service failure or successful service encounters, the study advances understanding of dual vulnerability in high-stakes service contexts.