Experiences of Pediatric Emergency Physicians in Providing Alcohol-Related Care to Adolescents in the Emergency Department

Abstract

The emergency department (ED) is a key clinical care setting for identifying and managing patients with alcohol-related presentations. We explored the experiences of emergency physicians in providing alcohol-related care to adolescents. Purposeful sampling was used to identify pediatric emergency physicians with at least 1 year of experience (n = 12) from pediatric EDs across Canada. Data were collected via telephone using a semistructured interview guide. Hermeneutic phenomenology was used to identify common and unique experiences among respondents, using Moustakas' immersion/crystallization procedures. Physicians expressed frustration with patient behaviors accompanying intoxication and described providing care as a struggle; developing an effective therapeutic alliance was challenging. Physicians believed intoxicated adolescent patients required more clinical time and resources than they could offer. Although physicians described the ED as unsuitable for ensuring continuity of care and addressing the broader social issues that accompany alcohol use, they did view the ED as a place to medically stabilize the patient and initiate a discussion on alcohol use and its harmful effects. Pediatric ED physicians struggled during the caring experience and were skeptical that broader, more chronic social issues that are often associated with adolescent alcohol misuse can be effectively managed in a clinical setting where they feel primarily responsible for providing medical stabilization. Physicians did believe the ED was an appropriate place to ensure medical stability of a patient and then initiate a conversation regarding alcohol use and its harmful effects.