MP40: Do doctors cherry pick?

Abstract

Introduction: Physician access to presenting complaint information may lead to cherry picking if some patients are seen as more attractive than others. Our objective was to determine whether chief complaint CC descriptors are associated with differing wait time to MD, hence whether physicians preferentially see patients with selected presenting complaints. Methods: We collated administrative data on all Calgary ED patients from 2016. Those in CTAS categories 1 and 5 were excluded, as well as fast track patients (because of single coverage). We described most common chief complaint (CC) categories and their median wait time to MD, adjusted for ED arrival site, patient sex, triage acuity, and need for admission. Results: We studied 128,812 subjects (54% CTAS2, 46% CTAS34) with 56,243 males and 72,569 females. Mean age was 50.6 years (sd=20), and most common CC categories (%) were abdominal pain (22%), chest pain (14.6%), musculoskeletal problems (7.2%), flank pain (5.2%), URI/Fever (4.7%), dyspnea (4.6%), headache (4.6%), and back pain (4.0%). Median TTMD was 84 min and admission rate in the study cohort was 30.4%. Multiple linear regression modeling showed that, in addition to CC category and ED arrival site, CTAS level, female sex, and need for admission changed TTMD by 18.6 min (per CTAS level), 6.6 min, -19.2 min respectively. Based on adjusted TTMD, the least attractive CC categories (adjusted median TTMD) were constipation (104 min), back pain (103), Depression/anxiety (103), abdominal pain (102), and dizziness/sensory disturbance (98); while the most attractive were trauma (44 min), allergic reaction (46), stroke symptoms (49), palpitations (61), and overdoses (66). Conclusion: There is a larger than expected difference in waiting times associated with specific chief complaint categories. This has implications for the way that patients are assigned to physicians or perhaps the way that chief complaint data is transmitted.