Do residents cherry-pick patients?

Short Attention Span Summary

Do residents "cherry pick" simpler patients?  In this study, residents signed up for patients more quickly who had simpler chief complaints like "ankle injury," "allergic reaction," or "wrist pain" and were slower to sign up for complaints like "abdominal pain," numbness/tingling," or "vaginal bleeding."  Whether this reflects a preference for simpler problems or aversion to perceived complaints with greater complexity (or for performing a pelvic exam) could not be determined on the basis of this study.  For a well rounded education, it's important to sign up for all kinds of patients and to beware of potential bias toward simpler patient problems.  I covered this back in March but it was officially published in June, which is timely for the start of a new academic year.  EM Lit of Note has an enjoyable review of this article.


Abstract

Acad Emerg Med. 2016 Jun;23(6):679-84. doi: 10.1111/acem.12895. Epub 2016 Feb 13.

Cherry Picking Patients: Examining the Interval Between Patient Rooming and Resident Self-assignment.

Patterson BW1, Batt RJ1,2, Wilbanks MD1, Otles E1, Westergaard MC1, Shah MN1.

Author information:

1BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI.

2Wisconsin School of Business, the University of Wisconsin-Madison, Madison, WI.

Abstract

OBJECTIVE:

We aimed to evaluate the association between patient chief complaint and the time interval between patient rooming and resident physician self-assignment ("pickup time"). We hypothesized that significant variation in pickup time would exist based on chief complaint, thereby uncovering resident preferences in patient presentations.

METHODS:

A retrospective medical record review was performed on consecutive patients at a single, academic, university-based emergency department with over 50,000 visits per year. All patients who presented from August 1, 2012, to July 31, 2013, and were initially seen by a resident were included in the analysis. Patients were excluded if not seen primarily by a resident or if registered with a chief complaint associated with trauma team activation. Data were abstracted from the electronic health record (EHR). The outcome measured was "pickup time," defined as the time interval between room assignment and resident self-assignment. We examined all complaints with >100 visits, with the remaining complaints included in the model in an "other" category. A proportional hazards model was created to control for the following prespecified demographic and clinical factors: age, race, sex, arrival mode, admission vital signs, Emergency Severity Index code, waiting room time before rooming, and waiting room census at time of rooming.

RESULTS:

Of the 30,382 patients eligible for the study, the median time to pickup was 6 minutes (interquartile range = 2-15 minutes). After controlling for the above factors, we found systematic and significant variation in the pickup time by chief complaint, with the longest times for patients with complaints of abdominal problems, numbness/tingling, and vaginal bleeding and shortest times for patients with ankle injury, allergic reaction, and wrist injury.

CONCLUSIONS:

A consistent variation in resident pickup time exists for common chief complaints. We suspect that this reflects residents preferentially choosing patients with simpler workups and less perceived diagnostic ambiguity. This work introduces pickup time as a metric that may be useful in the future to uncover and address potential physician bias. Further work is necessary to establish whether practice patterns in this study are carried beyond residency and persist among attendings in the community and how these patterns are shaped by the information presented via the EHR.

© 2016 by the Society for Academic Emergency Medicine.

PMID: 26874338 [PubMed - in process]