title: Cynicism and other attitudes towards patients in an emergency department in a middle eastern tertiary care center.
abstract: BACKGROUND
  A caring, compassionate practitioner of the medical arts is the idealized version of what makes a good doctor. If asked to think of a painting of a doctor we most likely conjure an image of a physician sitting at a patient's bedside checking the pulse with a concerned look on his face. The reality is however that cynicism, among other negative attitudes, is becoming more prominent among physicians and medical staff. The causes and extent of cynicism likely vary among medical departments and different cultures. In this study, we aimed to assess attitudes of medical students and physicians in an Emergency Department (ED) in Lebanon that accommodates both local patients and is also known to attract patients from around the Middle East.
  
  
  METHODS
  A total of 30 students, residents and attending physicians at the American University of Beirut Medical Center were invited to participate. All participants underwent semi-structured interviews that were recorded, transcribed and then analyzed for common themes.
  
  
  RESULTS
  More negative emotions were expressed among participants than positive ones. Negative emotions were more frequently expressed among medical students, interns and residents than attending physicians. Cynicism in the ED was commonly reported however, maintenance of professionalism and adequate patient care were underscored. While empathy was recurrently found among participants, a trend towards a decrease in empathy with career progression was noted among attending physicians. Further, negative feelings towards patient families were prominent. Participants tended to categorize patients based on willingness to cooperate, gender, age, case acuity, ethnic origins and social status.
  
  
  CONCLUSIONS
  Cynicism emerged as a prominent theme among medical students and staff in our study. However, participants were also empathetic. These attitudes were generally attributed to the peculiar stressors associated with the Lebanese culture, low acuity cases and "VIP" patients. It is crucial to explore methods in order to decrease cynicism and improve patient care. Also, the implications of these attitudes on patient care remain to be discovered.
authors.affiliation: Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon. nb28@aub.edu.lb.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Batley
authors.affiliation: Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon. zn15@aub.edu.lb.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Nasreddine
authors.affiliation: Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon. ali.chami89@gmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Chami
authors.affiliation: Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon. dz12@aub.edu.lb.
authors.forename: Dina
authors.initials: D
authors.lastname: Zebian
authors.affiliation: Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon. rb25@aub.edu.lb.
authors.forename: Rana
authors.initials: R
authors.lastname: Bachir
authors.affiliation: Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon. habbas@mdanderson.org.|Current Address: Department of Molecular and Cellular Oncology, University of Texas M D Anderson Cancer Center, Houston, TX, 77030, USA. habbas@mdanderson.org.
authors.forename: Hussein A
authors.initials: HA
authors.lastname: Abbas
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital; D004645:Empathy; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007407:Interviews as Topic; D007861:Lebanon; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D009341:Negativism; D010817:Physician-Patient Relations; D036301:Qualitative Research; D013337:Students, Medical / Q000523:psychology*; D062606:Tertiary Care Centers; D000078329:Workforce
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