Many Have Misconceptions About Emergency Medicine

June 21, 2000 -- If you ever have to be rushed to a hospital, your fate may lie in the hands of emergency physicians. But just how much do you know about these doctors and their work?

Here's a quick quiz to test your knowledge. True or false? Emergency medicine is not a medical specialty; Emergency physicians have practices outside of hospital emergency departments; Emergency doctors continue to care for patients once they admit them to the hospital.

All of these statements are false. But don't be discouraged if you got them wrong. According to a recent survey done by emergency physicians in Chicago, misconceptions about emergency medicine and emergency physicians are common. Their findings were published in the American Journal of Emergency Medicine.

Study author Jon C. Olsen, MD, and his colleagues surveyed more than 500 patients entering a suburban community hospital and an urban teaching hospital from May through July 1998. The survey included 13 questions about patients' knowledge of the specialty of emergency medicine, including physician duties, salary, board certification, and employment arrangements. The questionnaires were distributed in the hospitals' treatment areas to patients who were at least 18, fluent in English, not in significant distress or pain, and had a normal mental status.

Sixty-two percent of the respondents knew that emergency medicine is a specialty, and 71% realized that emergency physicians (EPs) are board-certified. But approximately one-fifth of patients believed that EPs maintained practices outside the emergency department (they do not), while 61% thought they were hospital employees (they aren't).

A quarter of patients thought that emergency doctors performed surgery, such as appendix or gallbladder removal (they don't), and 19% thought that EPs cared for patients at the hospital after they leave the emergency department (they don't).

Among patients who had their own family physician, 26% thought those physicians would see them in the emergency department, which is a very rare occurrence. Fifteen percent of the patients thought paramedics were emergency physicians (they aren't). The patients estimated the mean annual salary of EPs at $100,000, when it is in fact $175,000.

The authors recommend more education to raise public awareness about the governing body of emergency medicine, the American College of Emergency Physicians (ACEP), and to make sure people have an accurate idea of what emergency physicians do.

Interestingly, over half of the patients reported being regular viewers of the television series "ER," and of those people, the majority said the program had had a positive influence on their perception of emergency physicians.

Steven R. Levinson, MD, a resident at the University of Chicago Hospitals and one of the authors of the study, tells WebMD that he and his colleagues decided to conduct the survey to see just how common certain misconceptions were about the practice of emergency medicine. "Patients would ask us on a regular basis if they could see us in our office, or if we would care for them on the floor after they were admitted," he says.

Questions like that are a "huge, huge compliment" to an emergency physician, says Richard O'Brien, MD, an ACEP spokesman who reviewed the study for WebMD. "It means you've hit a home run, out of the park."

Still, some misconceptions could affect the patient-doctor bond, Levinson warns. Referring to the finding that about a fourth of patients expected to be seen by their primary care physician in the emergency department, he says: "That's kind of a dangerous fallacy, and it might create a barrier to communication. It could make it difficult [for the emergency physician] to have a good rapport with the patient."

That rapport can express itself in unexpected ways. O'Brien recalls a middle-aged man who came into his emergency department with a facial injury. Once the man's condition was stabilized, he started asking O'Brien questions about Viagra. That showed "he trusted me enough to ask me about it -- I considered that a huge compliment," O'Brien says. "Emergency physicians are unique in that nobody chooses us to be their physician. We must make a connection with the patient within the first two or three minutes and get them to trust us, and that is a gift."

Adds Levinson, "I always like it when people [ask us questions like that]. It means people have respect for what we do -- it does make you feel good."

"This is a fascinating, well-thought-out study," O'Brien says. "I think it's important for consumers to realize that [emergency medicine] is the one specialty that is open 24 hours a day, seven days a week. We will see all comers, and that is pretty much unique to [emergency medicine]. It is a special part of medicine."