What is an emergency? The judgments of two physicians.

How an "emergency" is defined by an internist and an emergency physician is the focus of this paper, which originated in a study of nonemergency use of two urban hospital emergency departments by Medicaid, uninsured, and commercially insured patients. Retrospective medical record reviews of 219 patients conducted independently by these two physicians revealed agreement on clinical impressions but dramatic divergence regarding the designation of visits as "emergencies" and the appropriate treatment location. Subsequent interviews with each physician suggested that the divergence of opinion regarding the definition of a true emergency is ideologically motivated and specialty related. Considered in the context of ED studies, which show enormous variations in the percentage of cases judged to be "emergencies," defining an "emergency" may be more a matter of physician training, specialty, and beliefs than of science. Further analysis revealed no correlation between patients' perceptions and either physician's judgments concerning what constitutes an "emergency," suggesting that neither specialty's assumptions are sensitive to patients' experience of the physical pain and anxiety that frequently lead them to present to the ED.