The Relationship Between Physician/Nurse Gender and Patients' Correct Identification of Health Care Professional Roles in the Emergency Department.

Background: A 2006 study of emergency medicine (EM) patients found male physicians were more often recognized as doctors that were female physicians. We sought to identify gender awareness of EM physicians and nurses by patients to see whether there has been a reduction in gender bias during the past 12 years. Materials and Methods: Before emergency department (ED) discharge or hospital admission, a convenience sample of 150 patients in an urban academic ED was anonymously surveyed to determine their awareness of the role of the health personnel involved in their care. Results: Our patients recognized male attending physicians as physicians 75.7% of the time and female attending physicians as physicians 58.1% of the time (p < 0.01). No differences were observed for resident physicians. Patients recognized male nurses as nurses 77.1% of the time, and female nurses as nurses 91.1% of the time (p < 0.01). Conclusions: These data indicate that patients continue to exhibit gender bias in the recognition of lead physicians and nurses.

Outcomes of Patients Who Have Do Not Resuscitate Status prior to Being Admitted to an Intensive Care Unit.

Admission of patients who have do not resuscitate (DNR) status to an intensive care unit (ICU) is potentially a misallocation of limited resources to patients who may neither need nor want intensive care. Yet, patients who have DNR status are often admitted to the ICU. This is a retrospective review of patients who had a valid DNR status at the time that they were admitted to an ICU in a single hospital over an eighteen-month period. Thirty-five patients met the criteria for inclusion in the study. The primary reasons for admission to the ICU were respiratory distress (54.2%) and sepsis (45.7%). Sixteen (45.7%) of the patients died, compared to a 5.4% mortality rate for all patients admitted to our ICU during this period (p < 0.001). APACHE II score was a significant predictor of mortality (18.5 ± 1.3 alive and 23.4 ± 1.4 dead; p = 0.038). Of the 19 patients discharged alive, 9 were discharged home, 5 to hospice, and 4 to a post-acute care facility. Conclusions. Patients who have DNR status and are admitted to the ICU have a higher mortality than other ICU patients. Those who survive have a high likelihood of being discharged to hospice or a post-acute care facility. The value of intensive intervention for these patients is not supported by these results. Only a minority of patients were seen by palliative care and chaplain teams, services which the literature supports as valuable for DNR patients. Our study supports the need for less expensive and less intensive but more appropriate resources for patients and families who have chosen DNR status.