Ensuring patient dignity in the emergency department

The Emergency Department (ED) is the ultimate crucible for society. I challenge you to think of a place that everyone uses and relies on more than the ED. It’s not the post office, grocery store, voting booth, school, church, park, bus, or train. The ED is the only place that I can think of where I regularly meet people from all walks of life: politicians, executives, people with housing insecurity, tradesmen, drivers, teachers, and, yes, other doctors. You just don’t know, before you walk into an exam room, who you are going to be talking to, and I think that’s a pretty cool thing.

In that sense, the ED is probably society’s only true collective space. Patients come to the ED asking for help, with the hope that they will be seen and treated with dignity, regardless of their ability to pay, background, or creed.

My colleagues and I do our best to provide safe and timely medical care to all patients who come to the ED. Part of providing this care is ensuring that patients and their family members feel that their dignity is taken into account. A patient’s experience of care and their medical outcomes depend on the alchemy of clinical competence and human connection.

Here’s what that means to me: Dignity is the inherent worth that every human possesses simply because they are human. Human-ness is valuable, to be cherished and acknowledged through the provision of respect to individuals regardless of their circumstances or background.

Compassion and dignity are poles on the same planet. When I attempt to put myself in the mind of a patient in the ED – perhaps this is her first visit ever, and she is worried about some chest discomfort she had earlier in the day and wants to make sure that she isn’t having a heart attack; the same thing that killed her mother at the same age – a protracted wait is understandably unnerving. More disconcerting, though, is the depersonalization of being forgotten or devalued. The pain of being unseen can be worse, in some ways, than the fear of harm. This emotional distress not only affects patient satisfaction but can impact patient safety when individuals feel too intimidated to communicate important symptoms or concerns.

We talk about moral injury a lot in emergency medicine and broader medical circles. These discussions typically focus on the difficulty we face in doing our jobs of taking care of patients in a system that seems, for all intents and purposes, to be undermining that effort. But we also need to realize that patients similarly experience this moral injury when clinicians are forced — by medical necessity, operational efficiency, clerical overhead — to prioritize taking care of one patient over another. To the uninitiated, our method of treating the sickest first can seem unfair or incomprehensible – especially when they are also in the ED for a valid and potentially life-threatening concern. I certainly don’t blame patients who feel this way. I would be hurt and indignant, too, if I was passed over without explanation.

The single best way to ameliorate the stress and pain of this type of depersonalization for our patients is to improve healthcare communication. Let them know that we see them, that we are thinking about them, and that they are important. Unfortunately, in the ED and hospital, this is easier said than done. Anyone who has worked in the acute care setting knows that communication is the first thing we abandon when we have to focus on patient safety and saving lives. It is seen as a nice-to-have rather than a critical action. Unfortunately, it is also when we are busiest that the need for open and frequent communication is at its greatest.

When my co-founder, Aaron and I were first starting Vital.io, we would frequently have philosophical discussions about the operational and clinical aspects of healthcare and how it appears from the inside and outside. After much debate, we decided to focus on fixing the healthcare communication problem in the hospital. It just felt right to apply the newest generation of technology and sound consumer-design principles to a domain that has been under-resourced for so long. Initially, we built software to help patients and their families understand their care in the Emergency Department, and eventually, for the same reasons, inside the hospital itself.

As an emergency medicine physician, I consider myself to be fortunate to live in a time when we have the technology to solve this communication problem. While legacy EHR vendors continue to push patient portals–technology which has failed to address the healthcare communication needs of the modern patient, new companies, like Vital.io, are approaching this core problem with intention and focus. Without asking our clinically busy staff to do “one more thing,” we are seeing the value and potential of bringing modern consumer software into the hospital.