Tuesday, September 7, 2010

Patient perception in the ED.....


Article was written by a good friend, and it has certainly caused a stir. From the abstract...

Physician assistants (PAs), nurse practitioners (NPs), and medical residents constitute an increasingly significant part of the American health care workforce, yet patient
assent to be seen by nonphysicians is only presumed and seldom sought. In order to assess the willingness of patients to receive medical care provided by nonphysicians,
we administered provider preference surveys to a random sample of patients attending three emergency departments (EDs). Concurrently, a surveywas sent to a random
selection of ED residents and PAs. All respondents were to assume the role of patient when presented with hypothetical clinical scenarios and standardized provider
definitions. Despite presumptions to the contrary, ED patients are generally unwilling to be seen by PAs, NPs, and residents. While seldom asked in practice, 79.5%
of patients fully expect to see a physician regardless of acuity or potential for cost savings by seeing another provider. Patients are more willing to see residents than

This brings up the subject of educating the public about various providers, and the various discussions of the principles of ethical assent to treatment.

But there are also some flaws in this study. When we look at the methodology, this was done at only 3 academic medical center ED's. This creates an automatic selection bias. While I understand the intention of the authors to examine patient willingness to be seen by residents, as well as PA's and NP's, it could easily be argued that patient expectations in academic tertiary centers are quite different from those in small, community or rural hospitals. Also, the study was conducted only at hospitals in Pittsburgh, or Dallas. There may be a geographic variation in patient attitudes that remains untested.

While this is an important study, and discussion ABOUT this study is imperative, we must also resist the urge to draw extreme extrapolations from a limited study.

Perhaps a validation study, done in a series of smaller community ED's with no residency presence may yield different results, maybe not?

Also, perhaps repeating this, using the HRSA data to break up the country into geographic regions, and examining one academic, one community, and one rural ED in each area would provide a rich data yield, and would be an outstanding validation attempt.

Just a few thoughts....

1 comment:

Texas reader said...

Interesting. If I go to the ER for a kidney stone or something else rather cut and dried I won't mind having a PA or resident handle my case. However, if I have something undetermined and am in significant pain, I'm going to be scared of a delay, which might have serious consequences, and am going to want to see a Dr.

For example, if I have abdominal or chest pain I'm going to worry about appendicitis, intestinal blockage, rupturing aorta, etc. which are all time sensitive issues. If I have a cut that need stitches I'll take whoever can stitch it for me.