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In a study published in Heart, Garin and colleagues demonstrated that patients with an ‘uncommon’ surname presenting with an ST-elevation myocardial infarction (STEMI) had a longer first medical contact (FMC)-to-diagnosis time compared to those with a ‘common’ surname (59.4±87.6 vs 40.6±37.6 min; mean difference +16.8 min; p=0.009).1 This delay was only identified in patients whose FMC was in the emergency department (ED) (mean difference +32.0 min; 95% CI +1.4 to +62.5; p=0.040) and not when the FMC was with ambulance paramedics (mean difference +9.7 min; 95% CI −3.7 to +23.1; p=0.158). The discrepancy points to a concern with the triage process in ED and implies potential bias in the speed of managing patients based on their surname which the authors suggest can be used as a proxy for ethnicity.