Fiona Webster1, Kathleen Rice, Katie N Dainty, Merrick Zwarenstein, Steve Durant, Ayelet Kuper. 1. Dr. Webster is assistant professor and educational scientist, Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Ms. Rice is a PhD candidate, Department of Anthropology, University of Toronto, Toronto, Ontario, Canada. Dr. Dainty is a postdoctoral fellow, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Zwarenstein is director, Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada. Mr. Durant is a PhD candidate, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Dr. Kuper is assistant professor, Department of Medicine, Faculty of Medicine, University of Toronto, scientist, Wilson Centre for Research in Education, University Health Network/University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Abstract
PURPOSE: The study explored optimal intraprofessional collaboration between physicians in the emergency department (ED) and those from general internal medicine (GIM). Prior to the study, a policy was initiated that mandated reductions in ED wait times. The researchers examined the impact of these changes on clinical practice and trainee education. METHOD: In 2010-2011, an ethnographic study was undertaken to observe consults between GIM and ED at an urban teaching hospital in Ontario, Canada. Additional ad hoc interviews were conducted with residents, nurses, and faculty from both departments as well as formal one-on-one interviews with 12 physicians. Data were coded and analyzed using concepts of institutional ethnography. RESULTS: Participants perceived that efficiency was more important than education and was in fact the new definition of "good" patient care. The informal label "failure to cope" to describe high-needs patients suggested that in many instances, patients were experienced as a barrier to optimal efficiency. This resulted in tension during consults as well as reduced opportunities for education. CONCLUSIONS: The authors suggest that the emphasis on wait times resulted in more importance being placed on "getting the patient out" of the ED than on providing safe, compassionate, person-centered medical care. Resource constraints were hidden within a discourse that shifted the problem of overcrowding in the ED to patients with complex chronic conditions. The term "failure to cope" became activated when overworked physicians tried to avoid assuming care for high-needs patients, masking institutionally produced stress and possibly altering the way patients are perceived.
PURPOSE: The study explored optimal intraprofessional collaboration between physicians in the emergency department (ED) and those from general internal medicine (GIM). Prior to the study, a policy was initiated that mandated reductions in ED wait times. The researchers examined the impact of these changes on clinical practice and trainee education. METHOD: In 2010-2011, an ethnographic study was undertaken to observe consults between GIM and ED at an urban teaching hospital in Ontario, Canada. Additional ad hoc interviews were conducted with residents, nurses, and faculty from both departments as well as formal one-on-one interviews with 12 physicians. Data were coded and analyzed using concepts of institutional ethnography. RESULTS:Participants perceived that efficiency was more important than education and was in fact the new definition of "good" patient care. The informal label "failure to cope" to describe high-needs patients suggested that in many instances, patients were experienced as a barrier to optimal efficiency. This resulted in tension during consults as well as reduced opportunities for education. CONCLUSIONS: The authors suggest that the emphasis on wait times resulted in more importance being placed on "getting the patient out" of the ED than on providing safe, compassionate, person-centered medical care. Resource constraints were hidden within a discourse that shifted the problem of overcrowding in the ED to patients with complex chronic conditions. The term "failure to cope" became activated when overworked physicians tried to avoid assuming care for high-needs patients, masking institutionally produced stress and possibly altering the way patients are perceived.
Authors: Yang Yann Foo; Kevin Tan; Xiaohui Xin; Wee Shiong Lim; Qianhui Cheng; Jai Rao; Nigel Ck Tan Journal: Singapore Med J Date: 2021-10 Impact factor: 1.858
Authors: Fiona Webster; Jennifer Christian; Elizabeth Mansfield; Onil Bhattacharyya; Gillian Hawker; Wendy Levinson; Gary Naglie; Thuy-Nga Pham; Louise Rose; Michael Schull; Samir Sinha; Vicky Stergiopoulos; Ross Upshur; Lynn Wilson Journal: BMJ Open Date: 2015-09-08 Impact factor: 2.692
Authors: P Kontos; A Grigorovich; B Nowrouzi; B Sharma; J Lewko; T Mollayeva; A Colantonio Journal: BMC Public Health Date: 2017-10-18 Impact factor: 3.295
Authors: Jennifer Anders; Alexandra Hill; Shang-En Chung; Arlene Butz; Richard Rothman; Charlotte Gaydos; Jamie Perin; Maria Trent Journal: Trauma Emerg Care Date: 2017-08-25