Trust and equity in emergency departments

Penn Medicine is working to improve the emergency department experience for all patients, including those with distrust of the medical system at large.

Going to the emergency department means, inherently, that something has gone wrong. For those coming in, it’s a time of pain, anxiety, maybe fear, maybe even anger. None of the patients or their loved ones who show up for emergency care on a given day woke up that morning and envisioned taking that trip before they put their head back down at night.

“Emergency departments are, by their nature, high-emotion and high-stake settings,” says Anish Agarwal, an assistant professor of emergency medicine who works in the Penn Presbyterian Medical Center emergency department.

A medical professional talking with someone waiting in an emergency department waiting room.
Image: iStock/Dragos Condrea

That’s a tough role to play when the emergency department is also considered the hospital’s “front door,” Agarwal says.

A hospital and an emergency department that works to make itself a better community partner, one that looks more like the people it serves and shows that it has their interests at heart, can be an invaluable asset for both the public and socioeconomic health of its neighbors.

“Trust in any relationship is built through a series of small actions that demonstrate that words are real,” says Eugenia C. South, the Ralph Muller Presidential Associate Professor and associate vice president of Health Justice for the University of Pennsylvania Health System. “Justice is an action.”

Agarwal, South, and colleagues published work in JAMA Health Forum detailing interviews conducted in 2021 and 2022 with 25 Black patients who’d visited an urban hospital’s emergency department. The patients were asked about their experiences and what they might improve.

One of the main points the researchers find in their analysis of the patient interviews was a feeling of distrust of the medical system at large. This could trace back to ancestral or personal experiences with health care—or both—and could affect a patient’s feelings before they even came through the door.

That, Agarwal notes, is a significant factor that practitioners of emergency medicine across the United States need to build into their work. 

“We need to recognize that we have blind spots in health care, that Black communities have significant and valid historical distrust in medicine, and really try to be sensitive to that,” Agarwal says.

Read more at Penn Medicine News.