Emergency Clinicians’ Emotional Reactions to Psychiatric Patients Affect Care, Well-Being
By Stacey Kusterbeck
Emergency clinicians face an array of daunting challenges when caring for patients with psychiatric conditions and/or substance use disorders.1 “The ED is a high-risk practice environment, and additional efforts can and should be made to reduce this risk. It seems things truly are approaching, or at, a breaking point,” says Linda M. Isbell, PhD, professor of psychology at the University of Massachusetts Amherst.
Isbell and colleagues interviewed 86 ED physicians and nurses from eight hospitals. Participants reported a variety of emotional, diagnostic, and logistical challenges.
“When clinicians have powerful reactions — emotional and cognitive — to a patient, it has the potential to cloud their judgment. We were interested in knowing more about emotional reactions that might influence medical decision-making and treatment of these patients,” says Edwin Boudreaux, PhD, professor of emergency medicine, psychiatry, and quantitative health sciences at UMass Medical School.
For example, emergency clinicians might not order a test that could reveal serious pathology, or might interact with psychiatric patients in a uncompassionate manner. Frequent negative emotions also take a toll on ED clinicians’ own well-being. “This can erode their own sense of happiness and satisfaction derived from caring for patients,” Boudreaux explains.
Some respondents acknowledged the challenges they face lead to errors or negative outcomes for psychiatric patients. Others described a sense of inefficacy and frustration that led them to spend less time with this group of patients. “Sometimes, providers felt that certain populations, especially substance users, were so unreceptive to their help that they felt hopeless, and just moved on to other patients who they thought they may be able to help,” Isbell reports.
Adverse outcomes are possible due to premature closure — when the provider reaches a conclusion about a patient’s condition (e.g., symptoms are due to the patient’s history of bipolar disorder), and then stops considering alternatives (e.g., a physical health condition). “This can and does cause harm to patients, including diagnostic and treatment delays and errors,” Isbell warns.
Study participants also expressed frustration over waiting rooms filled with patients, some of whom would be better served in outpatient settings. “The ED is typically not a therapeutic environment for patients with mental illness and/or substance use,” Boudreaux notes.
One nurse described the ED environment as a “recipe for disaster” due to how hectic and stimulating it can be. “There is a national shortage of psychiatrists, which has compounded the problem of patients needing to seek psychiatric care in the ED,” Isbell laments.
Taken as a whole, the participants painted a picture of negative healthcare experiences, for both patients and clinicians, that are adversely affecting the quality of care and staff well-being. “Change is badly needed to ensure these vulnerable patient populations receive care — and to support our ED providers, who are often stretched way too thin,” Isbell concludes.
1. Isbell LM, Chimowitz H, Huff NR, et al. A qualitative study of emergency physicians’ and nurses’ experiences caring for patients with psychiatric conditions and/or substance use disorders. Ann Emerg Med 2023 doi: 10.1016/j.annemergmed.2022.10.014.
Survey participants painted a picture of negative healthcare experiences, for both patients and clinicians, that are adversely affecting the quality of care and staff well-being. Change is badly needed to ensure these vulnerable patient populations receive care — and to support ED providers.
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