Another reason to worry about overcrowded emergency rooms

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.

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.

"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."