Emergency medicine journal : EMJ最新文献

{"title":"Multiple clear fluid-filled blisters over body in an unconscious female.","authors":"Yashdeep Singh Pathania, Anil Budania, Siyaram Didel","doi":"10.1136/emermed-2021-211202","DOIUrl":"https://doi.org/10.1136/emermed-2021-211202","url":null,"abstract":"Provenance and peer review Not commissioned; internally peer reviewed. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peerreviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"520-539"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40194800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a nurse-led alternate care site for the management of the surge of patients with COVID-19 in an Italian emergency department.","authors":"Matteo Paganini,&nbsp;Michele Pizzato,&nbsp;Eric Weinstein,&nbsp;Elena Vecchiato,&nbsp;Andrea Bitetti,&nbsp;Caterina Compostella,&nbsp;Caterina Onesto,&nbsp;Andrea Favaro","doi":"10.1136/emermed-2021-212056","DOIUrl":"https://doi.org/10.1136/emermed-2021-212056","url":null,"abstract":"<p><strong>Background: </strong>To accommodate and separate the large numbers of patients going to hospital with COVID-19, many EDs had to create new pathways for patients. We describe the outcomes of patients treated in a nurse-led alternate care site (ACS) at our hospital.</p><p><strong>Methods: </strong>This was a retrospective study of outcomes of patients managed at the ACS of 'San Bassiano' Hospital ED, Bassano del Grappa, Italy between 9 March and 16 April 2020. Self-presenting patients aged 5 years and older, suspected of having COVID-19, were initially diverted to the ACS. Patients with a National Early Warning Score ≥5 or with a desaturation ≥4% after the walking test were sent back to the main ED COVID-19 path for further evaluation and medical attention and were not further followed up. In the ACS, patients received a CXR, blood samples and a nasopharyngeal swab to test for SARS-CoV-2, and were sent home. An emergency physician reviewed the results later and called the patient back 5-6 hours later with instructions to return for medical evaluation of abnormal findings, or to seek their general practitioner's attention. Patients received a follow-up phone call 15 days later to learn of their course.</p><p><strong>Results: </strong>A total of 487 patients were fully managed in the ACS and discharged home. Of the 392 (80.5%) patients with no abnormalities after the workup and instructed to stay at home, 29 reattended the ED in the next 15 days, and 13 were admitted. Among the 95 patients asked to return and receive medical attention, 20 were admitted and of those discharged, 3 reattended the ED within 15 days. At 15 days, no patient was deceased or received invasive ventilation; one admitted patient received non-invasive ventilation.</p><p><strong>Conclusions: </strong>A nurse-led ACS diverted a substantial proportion of patients from main ED resources without associated negative clinical outcomes.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"554-558"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40318448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neck stiffness and dysphagia.","authors":"Rene Monzon,&nbsp;Paul Jhun","doi":"10.1136/emermed-2021-212070","DOIUrl":"https://doi.org/10.1136/emermed-2021-212070","url":null,"abstract":"REFERENCES 1 Gräsner JT, Wnent J, Herlitz J, et al. Survival after outofhospital cardiac arrest in Europe Results of the EuReCa TWO study. Resuscitation 2020;148:218–26. 2 Nichol G, Thomas E, Callaway CW, et al. Regional variation in outofhospital cardiac arrest incidence and outcome. JAMA 2008;300:1423. 3 MEH O, Shin SD, De Souza NNA. Outcomes for outofhospital cardiac arrests across 7 countries in Asia: the pan Asian resuscitation outcomes study (PAROS). Resuscitation 2015 http://linkinghub.elsevier.com/retrieve/pii/S030095721500338X 4 Yan S, Gan Y, Jiang N, et al. The global survival rate among adult outofhospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and metaanalysis. Crit Care 2020;24:61. 5 Sasson C, Rogers MAM, Dahl J, et al. Predictors of survival from outofhospital cardiac arrest: a systematic review and metaanalysis. Circ Cardiovasc Qual Outcomes 2010;3:63–81. 6 Wengenmayer T, Staudacher DL. Need for speed in outofhospital cardiac arrest. Resuscitation 2019;144:187–8. 7 Chocron R, Loeb T, Lamhaut L, et al. Ambulance density and outcomes after outofhospital cardiac arrest. Circulation 2019;139:1262–71. 8 Grunau B, Kawano T, Dick W, et al. Trends in care processes and survival following prehospital resuscitation improvement initiatives for outofhospital cardiac arrest in British Columbia, 20062016. Resuscitation 2018;125:118–25. 9 Okubo M, Schmicker RH, Wallace DJ, et al. Variation in survival after outofhospital cardiac arrest between emergency medical services agencies. JAMA Cardiol 2018;3:989. 10 Starks MA, Schmicker RH, Peterson ED, et al. Association of neighborhood demographics with outofhospital cardiac arrest treatment and outcomes: where you live may matter. JAMA Cardiol 2017;2:1110. 11 Brooks SC. Bystander CPR: location, location, location. Resuscitation 2013;84:711–2. 12 Sanders AB, Kern KB. Surviving cardiac arrest: location, location, location. JAMA 2008;300:1462. 13 Mell HK, Mumma SN, Hiestand B, et al. Emergency medical services response times in rural, suburban, and urban areas. JAMA Surg 2017;152:983. 14 Silverman RA, Galea S, Blaney S. The “vertical response time”: barriers to ambulance response in an urban area. Acad Emerg Med 2007;14:772–8. 15 Morrison LJ, Angelini MP, Vermeulen MJ, et al. Measuring the EMS patient access time interval and the impact of responding to highrise buildings. Prehosp Emerg Care 2005;9:14–18. 16 Morrison LJ, Nichol G, Rea TD, et al. Rationale, development and implementation of the resuscitation outcomes Consortium EpistryCardiac arrest. Resuscitation 2008;78:161–9. 17 Gräsner JT, Lefering R, Koster RW, et al. EuReCa ONE27 nations, one Europe, one registry. Resuscitation 2016;105:188–95. 18 Doctor NE, Ahmad NSB, Pek PP, et al. The PanAsian resuscitation outcomes study (PAROS) clinical research network: what, where, why and how. Singapore Med J 2017;58:456–8. 19 Beck B, Bray J, Smith K, et al. Establishing the AusROC Australian and New Zealand ou","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"553-566"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40194799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal update monthly top five.","authors":"Monica Saxena,&nbsp;Jonathan Altamirano,&nbsp;Christian Rose,&nbsp;Christopher Bennett,&nbsp;Prasha Govindarajan,&nbsp;Angela Lumba-Brown,&nbsp;Robert Hirst","doi":"10.1136/emermed-2022-212603","DOIUrl":"https://doi.org/10.1136/emermed-2022-212603","url":null,"abstract":"This month’s update comes from authors from the Department of Emergency Medicine, Stanford Medicine. We used a multimodal search strategy that drew on free openaccess medical education resources and literature searches. We reviewed all papers published between 15 March 2022 and 15 April 2022. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper. The papers are placed into one of three categories, allowing you to assess those which are most relevant to your practice: Worth a peek—interesting, but not yet ready for prime time. Head turner—new concepts. Game changer—this paper could/should change practice.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"561-562"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40194801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SONO case series: right upper quadrant point-of-care ultrasound in assessment of the gallbladder.","authors":"Elaine Hsiang,&nbsp;Sally Graglia","doi":"10.1136/emermed-2021-211923","DOIUrl":"https://doi.org/10.1136/emermed-2021-211923","url":null,"abstract":"2 the epigastrium and of-","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"479-482"},"PeriodicalIF":3.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39741955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department admission and mortality of the non-transported emergency medical service patients: a cohort study from Northern Finland.","authors":"Lauri Laukkanen,&nbsp;Sanna Lahtinen,&nbsp;Lasse Raatiniemi,&nbsp;Ari Ehrola,&nbsp;Timo Kaakinen,&nbsp;Janne Liisanantti","doi":"10.1136/emermed-2020-209914","DOIUrl":"https://doi.org/10.1136/emermed-2020-209914","url":null,"abstract":"<p><strong>Objectives: </strong>A high number of emergency medical service (EMS) patients are not transported to hospital by ambulance. Various non-transport protocols and guidelines have been implemented by different EMS providers. The present study examines subsequent tertiary care ED and hospital admission and mortality of the patients assessed and not transported by EMS in Northern Finland and evaluates the factors predicting these outcomes.</p><p><strong>Methods: </strong>Data from EMS missions with a registered non-transportation code during 1 January 2018-31 December 2018 were screened retrospectively. EMS charts were retrieved from a local EMS database and data concerning hospital admission and mortality were collected from the medical records of Oulu University Hospital, Oulu, Finland.</p><p><strong>Results: </strong>A total of 12 530 EMS non-transport missions were included. Of those, a total of 344 (2.7%) patients were admitted to tertiary care ED in 48 hours after the EMS contact, and 229 (1.8%) of them were further admitted to the hospital. Patients with the dispatch code 'abdominal pain', clinical presentation with fever or hyperglycaemia, physician phone consultation and a decision not to transport during night hours were associated with a higher risk of ED admission within 48 hours after EMS contact. Overall 48-hour and 30-day mortalities of non-transported patients were 0.2% (n=25) and 1.0% (n=128), respectively.</p><p><strong>Conclusion: </strong>In this cohort, the rate of subsequent tertiary care ED admission and mortality in the non-transported EMS patients was low. Dispatch code abdominal pain, clinical presentation with fever or hyperglycaemia, physician phone consultation and night-hours increased the risk of ED admission within 48 hours after EMS contact.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"443-450"},"PeriodicalIF":3.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38899574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing emergency department attendances in central London with methamphetamine toxicity and associated harms.","authors":"James T Harnett,&nbsp;Paul I Dargan,&nbsp;Alison M Dines,&nbsp;John R H Archer,&nbsp;Shaun L Greene,&nbsp;Laura J Hunter,&nbsp;David M Wood","doi":"10.1136/emermed-2020-209550","DOIUrl":"https://doi.org/10.1136/emermed-2020-209550","url":null,"abstract":"<p><strong>Background: </strong>Methamphetamine is a stimulant drug of abuse with increasing prevalence of use worldwide leading to public health concern. While previous research by our group a decade ago found no evidence of increasing harms associated with methamphetamine use in the UK, there are conflicting data on whether or not this is still the case. This paper aims to identify trends in methamphetamine-related harms and characterise the clinical features of ED presentations involving methamphetamine with gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL).</p><p><strong>Methods: </strong>We retrospectively interrogated a database of all toxicology-related presentations to two central London EDs, extracting data on drugs involved for presentations relating to methamphetamine between 2005 and 2018 to enable analysis of trends. Further clinical data were extracted for presentations between 2014 and 2018 to give a 4-year case series.</p><p><strong>Results: </strong>A total of 1244 presentations involving the use of methamphetamine were identified. The number of presentations rose from 4 in 2005 (1.9% of all recreational drug presentations) to 294 (16.2%) in 2018. A total of 850 cases were identified for the 2014-2018 case series, 94.9% were male with a median (range) age of 35.1 (16-67) years. The most common clinical features in the methamphetamine presentations were neuropsychiatric: agitation (41.5%), anxiety (35.2%), hallucinations (16.5%) and psychosis (14.8%). GHB/GBL was co-used in 54.2% of presentations and appeared to attenuate the neuropsychiatric features seen. Use of GHB/GBL was associated with a higher Poisoning Severity Score and requirement for level 2/3 (high dependency unit/intensive care unit (ICU)) care.</p><p><strong>Conclusion: </strong>ED attendances in central London relating to methamphetamine use have risen over the last decade. Combining methamphetamine with GHB/GBL is common and is associated with a higher Poisoning Severity Score and need for ICU level care. Further work is required to establish whether further resources need to be directed at this clinical and public health problem.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"463-466"},"PeriodicalIF":3.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39520993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ball magnet ingestion in children: a stronger and more dangerous attraction?","authors":"James Price,&nbsp;Georgina Malakounides,&nbsp;Sarah Stibbards,&nbsp;Shruti Agrawal","doi":"10.1136/emermed-2021-211767","DOIUrl":"https://doi.org/10.1136/emermed-2021-211767","url":null,"abstract":"<p><strong>Introduction: </strong>The ingestion of small, strong, rare-earth magnets, also termed 'ball magnets', can rapidly result in life-threatening bowel injuries. The objective of this study was to report the incidence and management of 'ball magnet' ingestion in children across the UK and to discuss the potential implications for policy-makers and public awareness campaigns.</p><p><strong>Methods: </strong>In this multi-centre survey of UK major trauma centres (MTCs), paediatric patients admitted to hospital following 'ball magnet' ingestion from 1 January 2020 to 31 December 2020 were included.</p><p><strong>Results: </strong>Responses were received from 11 MTCs (52%) reporting a total of 53 children admitted with 'ball magnet' ingestion over the 1-year study period. Most patients (n=51) presented following unintentional ingestion. 36 (68%) patients presented asymptomatically following witnessed or reported ingestion. In symptomatic patients, abdominal pain and vomiting were the the most common symptoms. The median number of 'ball magnets' ingested was 5.0 (IQR 3.0-7.8), range 1 to 63. 27 (51%) patients underwent operative intervention; laparotomy being the the most common (n=24, 89%). There were no deaths reported during the study period.</p><p><strong>Conclusion: </strong>This multi-centre survey from the UK demonstrates the serious impact of 'ball magnet' ingestion in children. Clinicians, regulators and caregivers must work symbiotically in order to prevent, recognise and reduce life-threatening bowel injuries.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"467-470"},"PeriodicalIF":3.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39433546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic and clinical factors, visit expectations and driving factors for emergency department attendance for uncomplicated upper respiratory tract infection.","authors":"Angela Chow,&nbsp;Bryan Keng,&nbsp;Huiling Guo,&nbsp;Aung Hein Aung,&nbsp;Zhilian Huang,&nbsp;Yanyi Weng,&nbsp;Hou Ang","doi":"10.1136/emermed-2021-211718","DOIUrl":"https://doi.org/10.1136/emermed-2021-211718","url":null,"abstract":"<p><strong>Background: </strong>Upper respiratory tract infections (URTIs) account for substantial non-urgent ED attendances. Hence, we explored the reasons for such attendances using a mixed-methods approach.</p><p><strong>Methods: </strong>We interviewed adult patients with URTI who visited the second busiest adult ED in Singapore from June 2016 to November 2018 on their expectations and reasons for attendance. A structured questionnaire, with one open-ended question was used. Using the Andersen's Behavioural Model for Healthcare Utilisation, the topmost reasons for ED attendances were categorised into (1) contextual predisposing factors (referral by primary care physician, family, friends or coworkers), (2) contextual enabling factors (convenience, accessibility, employment requirements), (3) individual enablers (personal preference and trust in hospital-perceived care quality and efficiency) and (4) individual needs (perceived illness severity and non-improvement). Multivariable multinomial logistic regression was used to assess associations between sociodemographic and clinical factors, patient expectations for ED visits and the drivers for ED attendance.</p><p><strong>Results: </strong>There were 717 patients in the cohort. The mean age of participants was 40.5 (SD 14.7) years, 61.2% were males, 66.5% without comorbidities and 40.7% were tertiary educated. Half had sought prior medical consultation (52.4%) and expected laboratory tests (55.7%) and radiological investigations (46.9%). Individual needs (32.8%) and enablers (25.1%) were the main drivers for ED attendance. Compared with ED attendances due to contextual enabling factors, attendances due to other drivers were more likely to be aged ≥45 years, had prior medical consultation and expected radiological investigations. Having a pre-existing medical condition (adjusted OR (aOR) 1.78, 95% CI 1.05 to 3.04) and an expectation for laboratory tests (aOR 1.64, 95% CI 1.01 to 2.64) were associated with individual needs while being non-tertiary educated (aOR 2.04, 95% CI 1.22 to 3.45) and having pre-existing comorbidities (aOR 1.79, 95% CI 1.04 to 3.10) were associated with individual enablers.</p><p><strong>Conclusions: </strong>Meeting individual needs of perceived illness severity or non-improvement was the topmost driver of ED visits for URTI, while contextual enabling factors such as convenience was the lowest. Patients' sociodemographic and clinical factors and visit expectations influence their motivations for ED attendances. Addressing these factors and expectations can alleviate the overutilisation of ED services.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"427-435"},"PeriodicalIF":3.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39620025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empathy can be taught and learned with evidence-based education.","authors":"Helen Riess","doi":"10.1136/emermed-2021-212078","DOIUrl":"https://doi.org/10.1136/emermed-2021-212078","url":null,"abstract":"Empathy is a reigning topic in healthcare because of its relationship to the aims of medical practice: improved health outcomes adherence to treatment recommendations, improved quality of care and improved patient and provider experience. At the same time, empathy reduces clinician burnout by providing meaningful connection with patients and alignment with the purpose of the medical profession: to reduce suffering and enhance wellbeing while also reducing the risk of medical errors and malpractice claims. While many believe some people are empathic by nature, the capacity to act empathically is mutable and can be depleted in challenging times. Studies have shown that empathy decreases during medical training, and the science of empathy shows that empathy can be downregulated and also upregulated by neurosciencebased interventions. Certainly, the last nearly 2 years of practicing in a pandemic has beaten empathy out of many of us, due to the difficult working conditions, persistently high workload and personal anxieties. However, particularly in times like these it is important to pause and find ways to teach—or reteach it. Empathy is a capacity that includes the ability to perceive the emotions and thoughts of others, the ability to process that input with perspective taking and selfregulation skills and the ability to experience empathic concern that ideally leads to empathic responses from the physician. When we teach empathy, we are not just asking healthcare providers to act like they care; we are teaching medical communication skills that result in a gratifying connection (on both sides) between the physician and their patients. There are many offerings for physician training in empathy and most published studies of these suggest a benefit. While acknowledging this evidence, Pettit et al set out to create an emergency medicinespecific programme; however, they found no improvement in physician selfassessment of their empathy. To be sure, emergency medicine has several unique features, including rapid pace, high intensity interactions, lack of privacy, frequent interruptions and lack of preexisting relationships between physicians and patients. However, given the variety of specialties (including some not known for their bedside manner) in which empathy teaching has been successful, the results of the emergency medicine intervention are surprising. Should we conclude that emergency physicians are inherently unteachable or inherently so empathic that interventions will show no difference? Are their working conditions so exceptional? And, does this mean further efforts to teach empathy are futile? I believe the answer is no. To create their programme, the authors combined concepts from a review of influences on patient behaviours studies a focus group study of patient preferences for communication and aspects of an empathy training programme from our unit which was shown in a randomised trial to improve both physician and patient perception of e","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"418-419"},"PeriodicalIF":3.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39622866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}