Journal article
Resuscitating the physician-patient relationship: Emergency department communication in an Academic Medical Center
Annals of emergency medicine, Vol.44(3), pp.262-267
2004
DOI: 10.1016/j.annemergmed.2004.02.035
PMID: 15332069
Abstract
Study objective: We characterize communication in an urban, academic medical center emergency department (ED) with regard to the timing and nature of the medical history survey and physical examination and discharge instructions.
Methods: Audiotaping and coding of 93 ED encounters (62 medical history surveys and physical examinations, 31 discharges) with a convenience sample of 24 emergency medicine residents, 8 nurses, and 93 nonemergency adult patients.
Results: Patients were 68% women and 84% black, with a mean age of 45 years. Emergency medicine providers were 70% men and 80% white. Of 62 medical history surveys and physical examinations, time spent on the introduction and medical history survey and physical examination averaged 7 minutes 31 seconds (range 1 to 20 minutes). Emergency medicine residents introduced themselves in only two thirds of encounters, rarely (8%) indicating their training status. Despite physician tendency (63%) to start with an open-ended question, only 20% of patients completed their presenting complaint without interruption. Average time to interruption (usually a closed question) was 12 seconds. Discharge instructions averaged 76 seconds (range 7 to 202 seconds). Information on diagnosis, expected course of illness, self-care, use of medications, time-specified follow-up, and symptoms that should prompt return to the ED were each discussed less than 65% of the time. Only 16% of patients were asked whether they had questions, and there were no instances in which the provider confirmed patient understanding of the information.
Conclusion: Academic EDs present unique challenges to effective communication. In our study, the physician-patient encounter was brief and lacking in important health information. Provision of patient-centered care in academic EDs will require more provider education and significant system support.
Details
- Title: Subtitle
- Resuscitating the physician-patient relationship: Emergency department communication in an Academic Medical Center
- Creators
- Karin V RHODES - Health Services Research Group, University of Chicago, Chicago, IL, United StatesTeri VIETH - University of Chicago/Pritzker School of Medicine, Chicago, IL, United StatesTheresa HE - University of Chicago/Pritzker School of Medicine, Chicago, IL, United StatesAnnette MILLER - University of ChicagoDavid S HOWES - Section of Emergency Medicine, University of Chicago, Chicago, IL, United StatesOlivia BAILEY - University of Chicago/Pritzker School of Medicine, Chicago, IL, United StatesJames WALTER - University of ChicagoRichard FRANKEL - Indiana University School of Medicine, Indianapolis, IN, United StatesWendy LEVINSON - Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Resource Type
- Journal article
- Publication Details
- Annals of emergency medicine, Vol.44(3), pp.262-267
- DOI
- 10.1016/j.annemergmed.2004.02.035
- PMID
- 15332069
- NLM abbreviation
- Ann Emerg Med
- ISSN
- 0196-0644
- eISSN
- 1097-6760
- Publisher
- Elsevier; New York, NY
- Language
- English
- Date published
- 2004
- Academic Unit
- Emergency Medicine
- Record Identifier
- 9984025288002771
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