Emergency physicians and sexual involvement with patients: an Ontario survey.

OBJECTIVE: To describe Ontario emergency physicians' knowledge of colleagues' sexual involvement with patients and former patients, their own personal experience of such involvement, and their attitudes toward postvisit relationships. DESIGN: Mailed survey. SETTING: Ontario. PARTICIPANTS: Emergency physicians practising in Ontario. RESULTS: Of 974 eligible mailed surveys, 599 (61.5%) were returned. Of these respondents, 52 (8.7%) reported being aware of a colleague in emergency practice who had been sexually involved with a patient or former patient. When describing their own behaviour, 37 respondents (6.2%) reported sexual involvement with a former patient. However, of this group, only 9 (25.0%) had met the patient in an emergency department. Thus, of the total number of respondents, only 1.5% (9/599) reported sexual involvement arising out of an emergency department visit. Most respondents (82.4%) agreed that it is inappropriate behaviour to ask a patient for a date after an emergency assessment and before the patient's departure, and 66.4% felt that it is inappropriate to contact the patient after discharge. However, only 10.6% believed it to be unacceptable to request a social meeting after encountering a patient previously cared for in the emergency department in a nonprofessional setting. Most respondents (96.5%) did not believe that sexual involvement could ever be therapeutic for the patient. However, only 66% felt that it was always an abuse of power and 62.4% supported zero tolerance of all sexual involvement between physicians and patients. CONCLUSIONS: Vague regulatory guidelines currently in place have failed to dispel confusion regarding what is acceptable social behaviour for physicians providing emergency care. Our results support the need for clarification, and suggest a basis for guidelines that would be acceptable to the emergency medical community: that an emergency visit should not form the basis for the initiation of personal or sexual relationships, yet neither should it preclude their development in nonmedical settings.

Who will practise emergency medicine? Survey of family medicine graduates.

A survey of recent family medicine graduates showed that two thirds were doing no emergency work. Those who had originally planned to practise emergency medicine were more likely to be doing it than those who had not. More women than men dropped their plans to do emergency work. Two thirds of those who had dropped their plans thought their training had influenced the decision.

Hypnosis training enhances communication skills.

We hypothesized that attending a brief, introductory hypnosis training workshop enhances communication skills. We speculated that attending such a programme would enable residents in a Family Medicine training programme to identify the psycho-social concerns of their patients more rapidly. To test the hypothesis five residents were videotaped interviewing a standardized patient before and after attending a hypnosis workshop. A blinded observer reviewed the tapes. The observer counted the number of comments made by the residents on their patient's non-verbal behaviour and the time required to confront the patient's primary concern. The residents made more comments on their patient's non-verbal communication after training than before, and more than the controls. They also shortened the time until they addressed the primary concern. This difference was not statistically significant. There was however a strong negative correlation (r = -0.92) between the number of these comments made and the time required to unveil the patient's hidden agenda. An increased awareness of non-verbal cues, achieved through hypnosis training, appears to help reveal a patient's hidden agenda. The implications of these findings are discussed.

Part I: the difficult patient: medical and legal approaches.

Difficult patients are defined as those who elicit strong negative emotions from their physicians. If not acknowledged and managed correctly, these feelings can lead to diagnostic errors, unpleasant confrontations, and troublesome complaints or legal claims. The author reviews common personalities and situations that are associated with difficult encounters in emergency departments and describes an approach stressing flexibility in communication and the early establishment of rapport. He discusses diagnostic possibilities in the agitated or confused, unco-operative patient, reviews relevant laws governing restraint and competence to consent, and outlines techniques to reduce medicolegal risks.