Emergency Medicine’s Framing Problem
Imagine being a doctor in the ED on a busier-than-usual weekend night. Out in the waiting room is a couple that has been sitting patiently, waiting to be seen. When you finally get to them, you discover one is a patient complaining of pain and the other is the spouse. You set about treating the patient in the best way you know how.
As you go about your business, the spouse pulls out a smartphone and begins recording everything on video. What do you do? You could gently remind the spouse that recording in the ED is against hospital policy and a potential violation of HIPPA regulations. In the back of your mind though, you wonder if you are being set up.
Emergency medicine has a growing problem with patient framing. Emergency Medicine News contributor Dr. Carlo Reyes wrote an excellent piece published in the April 2018 edition. Dr. Reyes explained the concept of framing and how ED doctors can handle it. This post will not go through his discussion in detail, but there are some important points to be gleaned from it.
Why Patients May Do It
First and foremost, framing is not limited only to hospital employees. Residents and locums can be targeted as well. Patients who do this sort of thing really do not care who they target as long as they get what they want. That leads to the inevitable question of why patients do it.
Reyes explains that the end goal is to provide video evidence that allows a patient to lodge a complaint with the hospital. He goes on to explain that framers can be working any number of different angles. A patient may be attempting to manipulate the doctor into writing a prescription for narcotics. This is apparently more common than people outside of the ED know.
Another angle is to provoke the doctor to the point of causing him or her to lose control. The resulting video can then be posted online, leading the hospital to patch things up with an apology and a financial settlement. And if the hospital is not forthcoming, the video can be used as evidence in a civil trial.
How to Protect Yourself
Dr. Reyes maintains that framing occurs in America’s EDs every day. Some cases are more severe than others, but that is of little comfort to the doctor who feels he or she is being manipulated. Reyes recommends a number of strategies for protecting yourself:
- De-Escalation – One of the first things doctors can do is learn de-escalation techniques. These are techniques that can help get a situation back under control when the doctor feels he or she is losing his/her temper.
- Recognition – Next is learning to recognize when you are being manipulated. Reyes mentions numerous signs in his piece, including patients asking for a specific narcotic or claiming they need a new prescription because someone stole previously prescribed medication.
- Avoiding Anchoring – Lastly, Reyes recommends doctors make every effort to avoid anchoring. Every case needs to be treated as though it is independent – even if a patient is being seen for the third or fourth time by the same doctor. Yes, things are related, but each visit to the ED should be taken on its own merits.
There is no way to prevent framing in the ED. Locums, residents, and employed emergency medicine doctors have to deal with it as part of the job. The key is to not allow yourself to be manipulated into a trap. Learn de-escalation techniques, learn to recognize the telltale signs of framing, and avoid the temptation to anchor.