Stressors arising from nonmedical issues within the professional environment as well as from a physician's personal environment can also compound the difficulties in providing quality emergency care.
In urban areas, anywhere from 30 to 50 percent of patients receive all of their medical care from the emergency department. Their needs can be immense, including such basic needs as food, shelter, heat, and transportation, which makes assisting these patients much more difficult. Additionally, a physician may be drawn into a patient's dependency needs, creating interpersonal conflict.
Emergency departments and physicians are commonly required to become agents of the police and courts. Laws exist that compel emergency physicians' involvement with intoxicated, violent, and psychotic patients. This also may include victims of personal crimes, such as sexual assault and abuse, where physicians must collect evidence for legal proceedings.
Victims of major trauma are frequently victims of crime, and physicians are frequently subpoenaed to provided testimony in legal proceedings, which are inconvenient. In addition, in such settings, it is not unusual to be cross-examined with hostility.
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