Another reason to worry about overcrowded emergency rooms
Lack of privacy affects accurate diagnosis of medical conditions and beyond
Patients are more likely to bemisdiagnosed or experience treatment delays when emergency roomsare so crowded that they receive care in a hallway, a survey ofphysicians suggests.
Privacy and confidentiality are vital in emergency care,particularly for patients who may be reluctant to undress ordivulge sensitive personal information in front of companions inan exam room or strangers in a hallway, researchers note in theEmergency Medicine Journal.
To see how doctors think this lack of privacy affects care,researchers surveyed 440 emergency room physicians attending amedical conference in Boston in 2015.
"What we found is that these non-private encounters not onlyaffect the accurate diagnosis of medical conditions, but also ofsocial and behavioural conditions such as domestic violence,human trafficking, suicidality, and substance use,"said leadstudy author Dr. Hanni Stoklosa, an emergency physician atBrigham and Women's Hospital and Harvard Medical School inBoston.
"This is quite concerning on many levels because emergencydepartments are on the front lines of caring for patients mostvulnerable to these conditions,"Stoklosa said by email.
Overall, nine in 10 doctors surveyed said they changed orshortened how they took patient medical histories when anotherperson was present, and more than half of the physicians alsoaltered how they did physical exams.
More than three-quarters of the doctors said that, at leastsometimes, they did an abbreviated medical history when patientswere treated in hallways. Under these circumstances, nearly allof the doctors also reported sometimes, often or always changinghow they conducted physical exams.
Patients should recognize that they always have the rightto request some space to discuss private matters away from otherindividuals with their doctor.- Dr. Bernard Chang
Even when patients had an exam room, nearly all of thedoctors said they at least occasionally altered how theygathered medical histories or conducted physical exams when afriend or family member was present.
While most physicians said patient gender wasn't a factor,doctors were more likely to change how they did medicalhistories and exams for female patients, the study also found.
Changes to medical histories and exams were most common withgenital and urinary problems, the study found.
Missed cases
Only 26 per cent of doctors said taking an abbreviatedmedical history had not led them to fail to diagnose a socialissue like suicidal thinking or elder abuse, while 54 per centsaid changes in a physical exam due to lack of privacy had notcaused them to miss such issues.
But more than one-third of doctors said they had missedcases of domestic violence under these circumstances, while
about 12 per cent had overlooked instances of child abuse.
In addition, 47 per cent of doctors thought a shortenedmedical history was linked to missing substance abuse and 25per cent said an altered exam had this result.
The study wasn't a controlled experiment designed to provewhether or how care in hallways or without privacy might lead todelays or misdiagnosed patients. It also focused only on theopinions of doctors at a medical conference, and results mightdiffer with a broader, nationally representative group ofemergency physicians.
Even so, the results add to evidence that the environment orsurroundings in which patients are cared for may influence theirtreatment, said Dr. Bernard Chang, a professor of emergencymedicine at Columbia University Medical Center in New York City.
"Past work has found that patients treated in overcrowdedemergency departments often have delays in medical care andincreased risk of medical errors," Chang, who wasn't involved inthe study, said by email.
A lack of privacy may at least partially explain thisincreased risk.
"While an ideal situation would be for patients to havetheir own private space to talk with their providers, in theemergency department, patients are often seen in crowded and attimes high stress situations, and the ability to get a privateroom may just not be practically feasible," Chang said.
"Patients should recognize that they always have the rightto request some space to discuss private matters away from otherindividuals with their doctor," Chang added. "It may not meanthat they will always get a private room, but most emergencystaff will make their best effort to at least temporarily find aplace to discuss sensitive topics in a space away frompotentially prying ears."
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