Why do we ignore distress in adults?

We spend a lot of time talking about making the emergency department experience better for children, and we probably still have a long way to go. The emergency department is an inherently scary place, to which we add a series of painful tests and procedures. No one visits the emergency department for fun. Decreasing anxiety and pain is an essential job in any emergency department. However, none of that is unique to pediatrics.

The emergency department is a scary place for children, but that is also true for adults. There is noise, chaos, and uncertainty no matter what your age. You come through the doors feeling sick, no matter what your age. Sutures, IVs, and blood draws hurt no matter what your age.

True, adults can rationalize some of the pain (I know this IV hurts, but they are doing it for my own good) and are generally better at advocating for themselves. However, I fear we may be ignoring adult distress because older patients aren’t nearly as cute.

On a recent shift, I was watching an episode of SpongeBob Square Pants with a child while we completed his exam. It got me thinking. If I was sick enough find myself in the emergency department, and had to lie on an uncomfortable stretcher for hours, surrounded by frightening alarms, worrying that I might be dying, wouldn’t I also want a TV so I could watch that delightful sponge who lives in a pineapple under the sea? (Or, I guess, something more age appropriate.)

EMLA for IVs and LET for lacerations are considered routine in children, but I have never seen them offered to an adult. Why?

3 hour waits will always be annoying, but in most emergency departments they are currently intolerable. You sit on uncomfortable chairs, inhaling the germs of the multitude of sick patients surrounding you, without easy access to water, or the other necessities of life such as WIFI, and never knowing whether you have 10 minutes or 10 hours left to wait. (Not to mention, all this time you are wondering if your abdominal pain might mean you are dying.) Most airports are more comfortable than hospital waiting rooms, and that is not a standard we should aspire to.

We can do better. The basic principles are the same. Take the time to introduce yourself and develop a relationship before jumping right into the physical exam. Explain why exams and tests are important, and let patients know what to expect. The specific techniques will vary (I am not routinely searching for frogs in my adult patients’ ears), but the underlying principle is the same: recognize the individual as a (potentially scared) human first and a patient second.

This post isn’t about solutions. Perhaps future posts can tackle the many ways hospitals can be improved. Today, I simply want to point out that emergency departments are inherently distressing environments; that adults get scared too. Adults, after all, are just big children. We should all embrace our inner pediatrician, and focus on making emergency departments less scary of patients of all ages.


If you have thoughts on ways to improve the emergency department experience and make it a more humane place for patients of all ages, please share them below.

Cite this article as: Justin Morgenstern, "Why do we ignore distress in adults?", First10EM blog, August 20, 2019. Available at: https://first10em.com/why-do-we-ignore-distress-in-adults/.

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