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The emergency clinic—a study of its role in a teaching hospital
Volume 60 Number 1
Abstracts--A. Ambulatory Pediat. Services
physician of a suitable doctor-patient relationship was thought, therefore, not to be hindered perceptibly by the physical facilities, nor by the structure of the clinic operation. Specific positive attributes of the physician's manner in the establishment of rapport with mother and child were evaluated; these included qualities such as interest, seriousness, pleasantness, unhurriedness, confidence, familiarity with the case, and responsiveness to child and to mother. As a group the Fellows exhibited these traits and attitudes more consistently than did the residents, who in turn evidenced them more frequently than did the interns. In general the doctors were moderately responsive to the needs of the mother and child for reassurance and support, with the Fellows exhibiting the highest level of this aspect of the relationship. The doctor's communications with the mother and child, although involving more complexity in the Fellow group, were, nonetheless, imparted with more clarity by that group than were the less complex communications of the residents or interns. Elements of verbal and nonverbal communication of potential disturbance to mother and child, occasionally seen in the
14 3
interchange between doctor and mother or between doctors, tended to be of minimal significance. The mothers, who were passively cooperative but not very expressive, were somewhat more responsive to establishment of a relationship with the Fellows than with the residents or interns. The children, however, showed no significant differences in responsiveness to the 3 categories of doctors. That the real needs, expectations, and feeling tones of the mothers and children were often unrevealed was shown from subsequent interviews and test procedures conducted with them by the study group. The over-all relationships of these 80 doctors-in-training with the mothers and children were moderately satisfactory, with the Fellows again achieving the highest levels of the group. The differences noted between doctor categories in the establishment of patient relationships were thought possibly to be attributable not only to such factors as the physician's training, experience, and sharpening of focus, but also to the amount of time spent with the patient, the severity of the child's illness, and the extent of continuity of patient contact.
The emergency clinic--a study of its role in a teaching hospital A. Bergman, M.D., and R. J. Haggerty, M.D. BOSTON,
MASS.
I N T H E past decade there has been an average increase of 400 per cent in the use of emergency clinics throughout the United States. This increase raises many problems From the Children's Hospital Medical Center, Boston, Mass.
in a pediatric teaching hospital in relation to use of this service for teaching, in staffing, and in providing optimal service. At the Children's Hospital Medical Center, Boston, the use of the Medical Emergency Clinic has increased from about 900 visits per year in 1947 to over 14,000 in 1960.
1 44
Abstracts
A. Ambulatory Pedlar. Services
In the spring of 1960, a study was made of all patients seen for the first time for a new illness over a 6-week period in order to answer some of the questions raised by this increase in use such as: Who are the patients? Why do they come to this clinic at the time they do? What are their health needs? H o w can one provide better service for this group and best utilize this resource for teaching? Data were collected by questionnaire and chart review on 768 consecutive patients, and coded on standard I.B.M. cards. Analysis and correlation of the answers to 52 questions were made and compared with standard census tract data for the area served. Although the patients were found to be from all social classes in about the same proportion as in the community, a surprising 47 per cent of the children were seen by physicians only when ill. Race and economic status were the only variables significantly associated with this lack of regular health care. The severity of the illness, or acuteness of
January 1962
symptoms, did not influence the hour the patient was seen. The types of illness seen were more comparable to those seen in pediatric practice than are those usually seen in inpatient pediatric hospitals, emphasizing the need to utilize this facility in medical student and resident teaching. In this clinic, as in most emergency-care facilities, care is given only for the presenting problem. The cost to the patient of such limited care was very high, equaling or exceeding the cost of the best private medical care in the area. The large number of patients without regular medical care and the number of social problems in these families suggest that more comprehensive care, such as immunizations and social service, should be available at the time of the emergency clinic visit. Limiting the care only to the presenting problem does not take into consideration the more important underlying social problems that contribute to both the lack of routine care and some of the unnecessary repeated visits to this clinic.
Abstracts--A. Ambulatory Pediat. Services
physician of a suitable doctor-patient relationship was thought, therefore, not to be hindered perceptibly by the physical facilities, nor by the structure of the clinic operation. Specific positive attributes of the physician's manner in the establishment of rapport with mother and child were evaluated; these included qualities such as interest, seriousness, pleasantness, unhurriedness, confidence, familiarity with the case, and responsiveness to child and to mother. As a group the Fellows exhibited these traits and attitudes more consistently than did the residents, who in turn evidenced them more frequently than did the interns. In general the doctors were moderately responsive to the needs of the mother and child for reassurance and support, with the Fellows exhibiting the highest level of this aspect of the relationship. The doctor's communications with the mother and child, although involving more complexity in the Fellow group, were, nonetheless, imparted with more clarity by that group than were the less complex communications of the residents or interns. Elements of verbal and nonverbal communication of potential disturbance to mother and child, occasionally seen in the
14 3
interchange between doctor and mother or between doctors, tended to be of minimal significance. The mothers, who were passively cooperative but not very expressive, were somewhat more responsive to establishment of a relationship with the Fellows than with the residents or interns. The children, however, showed no significant differences in responsiveness to the 3 categories of doctors. That the real needs, expectations, and feeling tones of the mothers and children were often unrevealed was shown from subsequent interviews and test procedures conducted with them by the study group. The over-all relationships of these 80 doctors-in-training with the mothers and children were moderately satisfactory, with the Fellows again achieving the highest levels of the group. The differences noted between doctor categories in the establishment of patient relationships were thought possibly to be attributable not only to such factors as the physician's training, experience, and sharpening of focus, but also to the amount of time spent with the patient, the severity of the child's illness, and the extent of continuity of patient contact.
The emergency clinic--a study of its role in a teaching hospital A. Bergman, M.D., and R. J. Haggerty, M.D. BOSTON,
MASS.
I N T H E past decade there has been an average increase of 400 per cent in the use of emergency clinics throughout the United States. This increase raises many problems From the Children's Hospital Medical Center, Boston, Mass.
in a pediatric teaching hospital in relation to use of this service for teaching, in staffing, and in providing optimal service. At the Children's Hospital Medical Center, Boston, the use of the Medical Emergency Clinic has increased from about 900 visits per year in 1947 to over 14,000 in 1960.
1 44
Abstracts
A. Ambulatory Pedlar. Services
In the spring of 1960, a study was made of all patients seen for the first time for a new illness over a 6-week period in order to answer some of the questions raised by this increase in use such as: Who are the patients? Why do they come to this clinic at the time they do? What are their health needs? H o w can one provide better service for this group and best utilize this resource for teaching? Data were collected by questionnaire and chart review on 768 consecutive patients, and coded on standard I.B.M. cards. Analysis and correlation of the answers to 52 questions were made and compared with standard census tract data for the area served. Although the patients were found to be from all social classes in about the same proportion as in the community, a surprising 47 per cent of the children were seen by physicians only when ill. Race and economic status were the only variables significantly associated with this lack of regular health care. The severity of the illness, or acuteness of
January 1962
symptoms, did not influence the hour the patient was seen. The types of illness seen were more comparable to those seen in pediatric practice than are those usually seen in inpatient pediatric hospitals, emphasizing the need to utilize this facility in medical student and resident teaching. In this clinic, as in most emergency-care facilities, care is given only for the presenting problem. The cost to the patient of such limited care was very high, equaling or exceeding the cost of the best private medical care in the area. The large number of patients without regular medical care and the number of social problems in these families suggest that more comprehensive care, such as immunizations and social service, should be available at the time of the emergency clinic visit. Limiting the care only to the presenting problem does not take into consideration the more important underlying social problems that contribute to both the lack of routine care and some of the unnecessary repeated visits to this clinic.