An Alternative Narrative

Abstract

Dr. Ash faced what many of us do on an almost daily basis – a patient whose condition does not meet our definition of an emergency, whose use of an emergency department setting could be perceived as “inappropriate”, who has had their “five minutes,” and more than their share of tests, and is now an obstacle to us addressing the real emergency that lies lurking in our waiting room. The breakdown of communication she experienced is one of the great stressors of our specialty. SAEM appointed a task force in 1994 to explore physician-patient communication in the ED and presented its findings in Academic Emergency Medicine. It concluded that, of three major functions of the medical encounter:1) to assess the full spectrum of patients concerns; 2) to develop, maintain and conclude a therapeutic relationship; and 3) to deliver diagnostic information and develop an educational and therapeutic plan with the patient, the emergency physician rarely has time to start to address each of these. Ideally, “a nonjudgmental approach and collaborative outlook allow the physician to use each patient's expertise and understanding of their own problem” but our own biases, or those thrust upon us, get in our way.

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