Assessment of emergency department physician perspectives on people with functional seizures

Abstract

Background and objectives

People with Functional Seizures (PwFS) often face stigma and mismanagement in the emergency department (ED), which may include misdiagnosis, unnecessary treatment, and delayed care [1]. Negative biases among providers may contribute to these challenges, affecting patient outcomes. This study examines explicit and implicit stigma toward functional seizures (FS) among ED physicians to identify factors that reduce bias and inform strategies for improving care.

Methods

40 ED physicians were recruited via email to complete a 15-minute Qualtrics survey. This survey asked participants about their perspectives of PwFS. Questions were based on a previously validated stigma questionnaire, the Opening Minds Stigma Scale for Health Care Providers (OMS-HC). This was followed by an Implicit Association Test (IAT), which assessed participant’s subconscious biases towards FS compared with other behavioral health disorders. Of the 40 participants, 25 completed the IAT.

Results

Responses reflected mixed implicit and explicit attitudes. Explicitly, while participants acknowledged negative reactions toward PwFS, they rejected beliefs that PwFS lack effort and supported advocacy, indicating generally positive explicit attitudes. Implicitly, 56% of IAT respondents demonstrated negative bias towards FS, though average scores did not significantly differ from neutrality. Lower implicit bias was observed among those treating both pediatric and adult patients and those with moderate FS patient exposure.

Discussion

These findings reflect a complex picture of provider attitudes, with explicit support for PwFS coexisting alongside some indications of implicit bias. Variability in implicit responses by patient exposure and clinical scope suggests that provider experiences may influence underlying attitudes towards FS.