LACK OF EMPATHY IN INTERACTION BETWEEN PATIENT/FAMILY AND HEALTHCARE PROFESSIONALS IN AN IRANIAN EMERGENCY DEPARTMENT: A FOCUSED ETHNOGRAPHIC STUDY

Background & Aims: The approach of reciprocity and mutuality in the patient/family and healthcare professional relationship is of great importance in achieving patient- and family-centered care in emergency departments (EDs). This study aimed to explore and describe the current status of reciprocity between patient/family and healthcare professionals in an Iranian ED with a particular focus on cultural features. Materials & Methods: A focused ethnographic approach was used in the ED of a tertiary academic medical center in the northwest of Iran from April 2018 to February 2019. A total of 54 participants including patients, family members, healthcare professionals, and other stakeholders were selected by applying the purposive sampling technique. Data were collected using three methods of participant observation, ethnographic interviews, and examination of related documents and artifacts until data saturation was achieved. Results: The overarching cultural pattern of “lack of reciprocity in providing and receiving emergency care” emerged within which there were two main themes: (a) responsibility avoidance (includes three sub-themes of evasion of liability; a sense of superiority; and slacking off at work) and (b) self-seeking (includes three sub-themes of me first, others later; emotional expressiveness; and destructive convergence). Conclusion: Lack of reciprocal interaction between patient/family and healthcare professionals is one of the main cultural barriers in providing and receiving optimal care in EDs. Findings indicate the need to change the extent, nature, and approach of interactions in the EDs by focusing on divergent behaviors and evasion of liability which leads to the establishment of mutual trust and rapport.