Gender Affects EPs’ Decision-Making on Restraint Use
Gender affects the way emergency physicians (EPs) approach decision-making for management of agitated patients, according to a recent qualitative study.1
“There’s been a lot of research into best practices about managing agitation in the emergency department. We wanted to drill down to the individual level of clinical decision-making surrounding restraint use and explore if and how gender of the clinician may play a role,” says Michelle Suh, MD, MAT, one of the study authors and an emergency medicine physician at University of Chicago. The researchers interviewed 18 attending EPs about experiences of restraint use in the ED, as well as their decision-making process and interactions with the team.
Female physicians felt like they had to do more consensus building to get buy-in from the clinical team. For example, women verbalized their thought process and solicited others’ opinions on whether restraints were necessary. In contrast, male physicians described just deciding what to do and moving on.
“The former approach likely requires more time, as well as the emotional labor of trying to read and manage the team. Most EDs would say a doctor is a doctor, but our research shows different doctors have different experiences of being a doctor,” says Suh.
All men unequivocally stated that it was their decision whether to use restraints in a behavioral crisis. Only two men stated explicitly that they valued consensus of other team members. In contrast, seven women stated that while they were the ultimate decision-makers, they also valued team input — especially from nurses. Two women said that the decision to use restraints was a consensus between them and psychiatry or nursing.
Overall, the study suggests that a woman may face more skepticism and questioning than a man if she does not proactively explain her reasoning and build consensus, according to Suh. Future training for ED staff and awareness of gender bias could help mitigate some of these effects, the authors suggested. “Management of agitated patients in the ED requires close coordination of all members of the team. Maybe we should also be encouraging men to share their thought process and decision-making more,” suggests Suh.
REFERENCE
- Chary A, Torres B, Brickhouse E, et al. Gender and emergency physicians’ experiences of leading decision making about restraint use: A qualitative study. Acad Emerg Med 2023; Dec 14. doi: 10.1111/acem.14851. [Online ahead of print].
Gender affects the way emergency physicians (EPs) approach decision-making for management of agitated patients, according to a recent qualitative study.
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