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All emergency medicine practitioners will have experienced the results of increased demand and exit block on our EDs. Crowded departments have made practising hallway/corridor-based medicine a daily occurrence. We already know that length of stay in hospital and mortality rates increase with crowding and that working in these conditions1 suggests patients are receiving substandard management. Certainly, there is the loss of privacy which all healthcare systems have gone to great lengths to protect and on which much of our medical teaching is premised.
Stoklosa et al2 describe two distinct non-private clinical encounters, one where the patient was seen and assessed in a hallway and the other when the patient was seen along with a companion. Both which are said to impinge on the physician’s assessment of the patient. At closer reading, the premise of the survey is to determine if the assessing physician believes that their practice is changed by the presence of other individuals accompanying the patient. The setting of the encounter is then looked at as an additional factor, rather than in isolation.
The survey demonstrates a belief that physicians feel they alter the way they take histories from and carry out physical examination of patients with a companion. A significant proportion of these physicians also believed that their assessment of patients was affected by the patient being in a hallway, and that their change of practice when assessing patients in non-private settings resulted in diagnostic errors and delay.2
Effective communication is key for the doctor–patient dyad and good quality care. Communication skills teaching has more significance in the medical curriculum today. However, there is a difference between taught communication skills in a protected environment and those learnt over time and many encounters, with an understanding of the barriers that affect our communication. This is …
Footnotes
Contributors JMH and KW had equal contribution to writing this commentary.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent This article is a commentary on an article to be published in the EMJ and we have been requested by the editors to provide this.
Provenance and peer review Commissioned; internally peer reviewed.
Data sharing statement This is an editorial / commentary on an article to be published in the EMJ.
Author note Jacky Hanson is a Consultant in Emergency Medicine, Clinical Director of Simulation and Associate Undergraduate Dean at Lancashire Teaching Hospitals. She has been involved in developing and delivering training in human factors and simulation based education for 12 years. She was previously Director of CPD, Director of Revalidation and on the simulation group for the Royal College of Emergency Medicine. Kirsten is a final year registrar in Emergency Medicine with 10 years of experience in delivering human factors and simulation-based education.