Accomplishing public secrecy: non-monetary informal practices and their concealment at the emergency department

Abstract

This paper contributes to scholarship on the mobilization of personal connections for securing preferential treatment and other privileges by examining the informal referral of patients at the triage of two emergency departments in Romania. The study focuses on the practical accomplishment of the practice, and argues that the success of informal referrals is contingent upon the social distance between the referrer and the triage worker, and the ability of the former to act in accordance with the etiquette pertaining to informality. It also shows that participants in informal referrals jointly construct public secrecy, obscuring and obliquely revealing the true nature of the practice, in order to maintain their reputation and avoid repercussions for departing from formal rules and procedures. Public secrecy is practically accomplished by creating and maintaining an ambiguous definition of the situation; misrepresenting the practice; minimizing the transgression of formal rules; and shifting the focus away from informality, by embedding the practice into socially acceptable phenomena such as helping family members in need.