ER overcrowding increases chances of misdiagnosis, report suggests

Patients are more likely to be misdiagnosed or experience treatment delayswhen hospital emergency room overcrowdingleaves them being cared for inhallways, according to a new report.

Doctors are also less likely to pick up on social issues, such as domestic violenceand human trafficking, when providinghallway care,the report published in theEmergency Medicine Journal suggests.

Saint John family doctor Mike Simon says the findings are cause for concern.

"If that was me as a patient [stuck in a hallway], I'd say, 'Look, can we go somewhere else?'"

Ninety per cent of the more than 400emergency room physicians surveyed at amedical conference in Bostonreported sometimes, often or always changing how they conducted physical exams when faced with a lack of privacy, said Simon.

Not surprisingly, the modified approaches were most common when dealing with genital or urinary symptoms, he said.

About three-quarters of the doctors also reportedat least sometimes takingabbreviated medical historiesin situations where strangers could overhear.

"It's pretty straightforward," said Simon. "You're in emergency, you're in pain, you're sick, you're vulnerable first of all, OK? You throw on top of that, when I take a history from you, it's a very subjective, personal, secretive process. You may talk about STDs, marital issues, [or] mental illness.

"You throwanother factor on top now it's suddenly in the public domain, other people can hear and see you. That'seven more difficult. And if you throwon top of that a physical exampart of it that's even more detrimental.

"Soall that stuff changes the interaction between the doctor and the patient."

Only about 20 per cent of doctors said deviating from standard history-taking had not led them to fail to diagnose problems, such as suicidal thinking or elder abuse, said Simon.

And about halfsaid changing the physical exams had not caused them to make a mistake in the diagnosis, he said.

Even when patients had a private room, having a family member or friend present had similar effects, the study found.

A patient might not want to talk about a sexually transmitted disease in front of aspouse, for example, if they're having an affair, said Simon.