Emergency physicians often find themselves treating patients in settings that don’t provide sufficient privacy or confidentiality. These non-private settings can negatively affect the patient encounter, according to a recent study published in Emergency Medicine Journal.1
The researchers found that settings in hallways and those where a companion of the patient is present can render patients reluctant to provide sensitive information. Furthermore, physicians may not perform all the routine examinations they would in a private encounter.
As a result, emergency physicians’ ability to provide the appropriate care for conditions related to human trafficking and other medical, social, and psychiatric conditions can be compromised.
The study applied a cross-sectional convenience sample survey on the emergency physicians present at ACEP15 in Boston. Only practicing emergency physicians were surveyed. A total of 409 completed the survey.
Of the emergency physicians surveyed, 90 percent indicated that they changed their history-taking practices and 56 percent indicated that they changed their physical examination of patients when other people were present during the examination.
Physicians who changed their history-taking processes indicated the two main reasons for doing so were the patient’s location in the hallway or the presence of a family member, friend, or acquaintance.
Regarding deviations from ordinary physical examinations, 90 percent of the emergency physicians surveyed indicated that they altered their patient exam at least “sometimes” based on a patient’s presence in the hallway, while 77 percent did so at least “sometimes” when a companion was present with the patient.
Of the physicians who indicated alterations to history-taking and physical exams either due to hallway encounters or the patient having a companion present, 35 percent and 41 percent, respectively, reported experiencing delays or failures in their diagnoses stemming from those alterations.
This study found that patient-physician encounters in non-private settings caused delays or failures in identifying human trafficking, partner violence, child abuse, substance abuse, and elder abuse.
Implications for Practice
For patients who have previous or current trauma related to abuse, including human trafficking, hallway consultations with emergency physicians may prevent the identification of the abuse and the necessary intervention.
The study calls for informed guidelines for the universal separation of ED patients during their encounters with emergency physicians. Such a mandated separation would allow for private encounters, where incidences of abuse, including human trafficking, may be identified more easily.
- Stoklosa H, Scannell M, Ma Z, et al. Do EPs change their clinical behaviour in the hallway or when a companion is present? A cross-sectional survey. [Published online ahead of print February 3, 2018] .Emerg Med J.