SAEM Wellness Consensus Conference
Background: Mistreatment and disrespect of healthcare providers by patients is relatively commonplace in the clinical setting. Providers may feel that being mistreated may be an expected part of the job. This problem and the attitude towards it are prevalent through all settings in the healthcare system, but perhaps nowhere more than the emergency department (ED). Yet, there are few studies examining provider mistreatment by patients and families. The objective of this study was to determine the extent and types of mistreatment.
Methods: Residents across nineteen training programs at a single academic medical center were recruited to complete an anonymous survey assessing their experience with mistreatment instigated by patients and families. Six unique mistreatment behaviors were adapted from the AAMC Graduation Questionnaire, allowing residents to report behaviors they experienced. Emergency Medicine (EM) resident responses were compared against residents aggregated across the other eighteen programs to detect group differences for each behavior using Chi-squared and Fisher’s exact test. This study was IRB exempt.
Results: 303 residents of 428 (71%) completed the survey. 40 respondents did not complete the patient mistreatment section and were excluded from analysis. Of the 303 respondents, 37 were EM and 266 were nonEM. There was a significant difference between EM and nonEM residents on experiencing patient mistreatment at least once during residency (69% EM, 45% nonEM, p=.007), being threatened with physical harm (58% EM, 28% nonEM, p<.001), being physically harmed, (11% EM, 3% nonEM, p=.034), and being subjected to offensive sexist remarks (6% EM, 23% nonEM, p=.015). There was no significant difference between EM and nonEM residents on unwanted sexual advances, racially/ethnically offensive remakes/names, or offensive remarks/names related to sexual orientation (p<.05).
Conclusion: Our study demonstrates that EM residents experience significantly more mistreatment from patients than their nonEM counterparts. Various factors including wait times, crowded facilities, lack of long-term relationships with patients, and many others have been identified as contributing to increased mistreatment of EM providers. Given this, interventions to improve the culture of mistreatment in healthcare must be multimodal to fully address the issues at hand.