Understanding the Impact of Residents' Interpersonal Relationships During Emergency Department Referrals and Consultations

BACKGROUND: Communicating with colleagues is a key physician competency. Yet few studies have sought to uncover the complex nature of relationships between referring and consulting physicians, which may be affected by the inherent relationships between the participants. OBJECTIVE: Our study examines themes identified from discussions about communications and the role of relationships during the referral-consultation process. METHODS: From March to September 2010, 30 residents (10 emergency medicine, 10 general surgery, 10 internal medicine) were interviewed using a semistructured focus group protocol. Two investigators independently reviewed the transcripts using inductive methods and grounded theory to generate themes (using codes for ease of analysis) until saturation was reached. Disagreements were resolved by consensus, yielding an inventory of themes and subthemes. Measures for ensuring trustworthiness of the analysis included generating an audit trail and external auditing of the material by investigators not involved with the initial analysis. RESULTS: Two main relationship-related themes affected the referral-consultation process: familiarity and trust. Various subthemes were further delineated and studied in the context of pertinent literature. CONCLUSIONS: Relationships between physicians have a powerful influence on the emergency department referral-consultation dynamic. The emergency department referral-consultation may be significantly altered by the familiarity and perceived trustworthiness of the referring and consulting physicians. Our proposed framework may further inform and improve instructional methods for teaching interpersonal communication. Most importantly, it may help junior learners understand inherent difficulties they may encounter during the referral process between emergency and consulting physicians.