A study examines that patients are more likely to be misdiagnosed or experience treatment delays when emergency rooms are so crowded that they receive care in a hallway. Privacy and confidentiality are vital in emergency care, particularly for patients who may be reluctant to undress or divulge sensitive personal information in front of companions in an exam room. The study has published in the journal Emergency Medicine.

To see how doctors think this lack of privacy affects care, researchers surveyed 440 emergency room physicians attending a medical conference in Boston in 2015. Overall, nine in 10 doctors surveyed said they changed or shortened how they took patient medical histories when another person was present, and more than half of the physicians also altered how they did physical exams.

Even when patients had an exam room, nearly all of the doctors said they at least occasionally altered how they gathered medical histories or conducted physical exams when a friend or family member was present. While most physicians said patient gender wasn’t a factor, doctors were more likely to change how they did medical histories and exams for female patients, the study also found.

Only 26% of doctors said taking an abbreviated medical history had not led them to fail to diagnose a social issue like suicidal thinking or elder abuse, while 54% said changes in a physical exam due to lack of privacy had not caused them to miss such issues. But more than one-third of doctors said they had missed cases of domestic violence under these circumstances, while about 12% had overlooked instances of child abuse.

The study wasn’t a controlled experiment designed to prove whether or how care in hallways or without privacy might lead to delays or misdiagnosed patients. It also focused only on the opinions of doctors at a medical conference, and results might differ with a broader, nationally representative group of emergency physicians. 

“While an ideal situation would be for patients to have their own private space to talk with their providers, in the emergency department, patients are often seen in crowded and at times high stress situations, and the ability to get a private room may just not be practically feasible,” Chang said. “Patients should recognize that they always have the right to request some space to discuss private matters away from other individuals with their doctor,” Chang added.

Usually they will always get a private room, but most emergency staff will make their best effort to at least temporarily find a place to discuss sensitive topics in a space away from potentially prying ears.