July 2024 Pick of the Month

Flags with Two Faces

The Janus face may be one of the most overused metaphors in science. Janus, researched at the highest scholarly level (Wikipedia), was a Roman god in charge of lots of stuff, such as beginnings, transitions, and ends. Maybe all the pressure got to Janus because centuries later, his legacy has become a moniker for all manner of two-edged swords in clinical medicine. An apt example of a Janus-faced event occurs when a provider documents a “behavioral flag,” a topic explored by Gonzales et al. in this month’s POTM: Patient perceptions of behavioral flags in the emergency department: A qualitative analysis.

These flags are warning notes created in the electronic medical record by healthcare providers who have been assaulted or have other reasons to believe that a patient may pose a threat to future providers. Therein lies a duality of good and bad. For providers, these flags can serve as a justifiable tool to convey threat perception, worth the small risk of being used as retaliatory labels. But what do patients think? That is the question that Gonzales and colleagues address with qualitative methods, leading to valuable insights, such as those found in Table 2. The quotes in this table, representing themes of good and bad, show that while patients have compassion and concern for emergency care providers, they are also concerned about potential bias and inequity. 

This paper is the POTM because of its comprehensive view of threat perception in emergency care and its offering of information that could help align providers with patients in how to handle unwanted behavior.

Jeffrey A. Kline, MD
Wayne State University School of Medicine
Editor-in-Chief

Source: Kirsty Challen, BSc, MBChB, MRes, PhD, Lancashire Teaching Hospitals | AEM Editor of Infographics