Editing Emergency medicine (section)

==== Patient–provider relationships ====
As stated above, EMTALA includes provisions that protect patients from being turned away or transferred before adequate stabilisation. Upon making contact with a patient, EMS providers are responsible for diagnosing and stabilising a patient's condition without regard for the ability to pay. In the pre-hospital setting, providers must exercise appropriate judgement in choosing a suitable hospital for transport. Hospitals can only turn away incoming ambulances if they are on diversion and incapable of providing adequate care. However, once a patient has arrived on hospital property, care must be provided. At the hospital, a triage nurse first contacts the patient, who determines the appropriate level of care needed.

According to ''Mead v. Legacy Health System'',<ref>{{Citation|title=Mead v. Legacy Health System|date=26 July 2012|url=https://scholar.google.com/scholar_case?case=3832184832260263822&q=Mead+v.+Legacy+Health+System,+283+P.3d+904,+352+Or.+267+(2012).&hl=en&as_sdt=2006|volume=283|pages=904|access-date=2016-11-21}}</ref> a patient-physician relationship is established when "the physician takes an affirmative action with regard to the care of the patient". Initiating such a relationship forms a legal contract in which the physician must continue to provide treatment or adequately terminate the relationship.<ref>{{cite journal |doi=10.1001/virtualmentor.2012.14.5.hlaw1-1205 |pmid=23351207 |title=When is a Patient-Physician Relationship Established? |journal=Virtual Mentor |volume=14 |issue=5 |pages=403–6 |year=2012 |last1=Blake |first1=V}}</ref> This legal responsibility can extend to physician consultations and on-call physicians even without direct patient contact. In emergency medicine, termination of the patient–provider relationship prior to stabilization or without handoff to another qualified provider is considered abandonment. In order to initiate an outside transfer, a physician must verify that the next hospital can provide a similar or higher level of care. Hospitals and physicians must also ensure that the patient's condition will not be further aggravated by the transfer process.

The setting of emergency medicine presents a challenge for delivering high quality, patient-centered care. Clear, effective communication can be particularly difficult due to noise, frequent interruptions, and high patient turnover.<ref name=":5">{{cite journal |pmid=15332069 |year=2004 |last1=Rhodes |first1=K. V. |title=Resuscitating the physician-patient relationship: Emergency department communication in an academic medical center |journal=Annals of Emergency Medicine |volume=44 |issue=3 |pages=262–7 |last2=Vieth |first2=T |last3=He |first3=T |last4=Miller |first4=A |last5=Howes |first5=D. S. |last6=Bailey |first6=O |last7=Walter |first7=J |last8=Frankel |first8=R |last9=Levinson |first9=W |doi= 10.1016/j.annemergmed.2004.02.035|url=https://repository.upenn.edu/spp_papers/108}}</ref> The Society for Academic Emergency Medicine has identified five essential tasks for patient-physician communication: establishing rapport, gathering information, giving information, providing comfort, and collaboration.<ref name=":5" /> The miscommunication of patient information is a crucial source of medical error; minimising shortcoming in communication remains a topic of current and future research.<ref>{{cite journal |doi=10.4300/JGME-D-11-00256.1 |pmid=24294436 |pmc=3546588 |title=Patient Communication During Handovers Between Emergency Medicine and Internal Medicine Residents |journal=Journal of Graduate Medical Education |volume=4 |issue=4 |pages=533–7 |year=2012 |last1=Fischer |first1=Miriam |last2=Hemphill |first2=Robin R. |last3=Rimler |first3=Eva |last4=Marshall |first4=Stephanie |last5=Brownfield |first5=Erica |last6=Shayne |first6=Philip |last7=Di Francesco |first7=Lorenzo |last8=Santen |first8=Sally A.}}</ref>