New Brunswick

ER overcrowding increases chances of misdiagnosis, report suggests

Patients are more likely to be misdiagnosed or experience treatment delays when hospital emergency room overcrowding leaves them being cared for in hallways, according to a new report.

Because of lack of privacy, doctors alter physical exams of patients and medical history-taking

When New Brunswick hospital emergency rooms become overcrowded, leaving patients on gurneys in hallways is often the only option, but a new study suggests hallway medicine might affect more than just patient comfort. (CBC)

Patients are more likely to be misdiagnosed or experience treatment delays when hospital emergency room overcrowding leaves them being cared for in hallways, according to a new report.

Doctors are also less likely to pick up on social issues, such as domestic violence and human trafficking, when providing hallway care, the report published in the Emergency Medicine Journal suggests.

Saint John family doctor Mike Simon says the findings are cause for concern.

"If that was me as a patient [stuck in a hallway], I'd say, 'Look, can we go somewhere else?'"

Ninety per cent of the more than 400 emergency room physicians surveyed at a medical conference in Boston reported sometimes, often or always changing how they conducted physical exams when faced with a lack of privacy, said Simon.

Not surprisingly, the modified approaches were most common when dealing with genital or urinary symptoms, he said.

About three-quarters of the doctors also reported at least sometimes taking abbreviated medical histories in situations where strangers could overhear.

One-third of the ER doctors surveyed said they had missed cases of domestic violence and about 12 per cent said they had overlooked instances of child abuse, said Dr. Mike Simon of Saint John. (CBC News)

"It's pretty straightforward," said Simon. "You're in emergency, you're in pain, you're sick, you're vulnerable first of all, OK? You throw on top of that, when I take a history from you, it's a very subjective, personal, secretive process. You may talk about STDs, marital issues, [or] mental illness.

"You throw another factor on top — now it's suddenly in the public domain, other people can hear and see you. That's even more difficult. And if you throw on top of that a physical exam part of it … that's even more detrimental.

"So all that stuff changes the interaction between the doctor and the patient."

Only about 20 per cent of doctors said deviating from standard history-taking had not led them to fail to diagnose problems, such as suicidal thinking or elder abuse, said Simon.

And about half said changing the physical exams had not caused them to make a mistake in the diagnosis, he said.

Even when patients had a private room, having a family member or friend present had similar effects, the study found.

A patient might not want to talk about a sexually transmitted disease in front of a spouse, for example, if they're having an affair, said Simon.

With files from Information Morning Saint John