“They Align Themselves With Us, Whereas I'm Aligned With the Patient”: A Multi‐Site Qualitative Study of Resident Physicians' Experiences With Law Enforcement in the Emergency Department

Background: Law enforcement is a common yet complicated presence in the emergency department (ED). Studies have found emergency medicine (EM) attending physicians have varied interactions with and attitudes toward law enforcement. EM resident physicians are in a uniquely formative professional period. However, the experiences and perspectives of EM resident physicians have not been previously explored in depth. Methods: We recruited EM resident physicians from three geopolitically distinct urban academic EDs in the United States to participate in semi-structured interviews regarding their experiences with law enforcement in the ED. We analyzed the transcripts thematically, looking for unifying concepts across institutions and latent meaning. A codebook was created and iteratively refined based on review of transcripts, after which salient themes were developed through ongoing discussions with the research team. Results: Twenty-four resident physicians across three sites participated. Three salient themes emerged from our study: ambiguity of authority between emergency physicians and law enforcement, concerns about the impact of law enforcement presence on patients, and disruptions to the ED team workflow. First, as trainees learning professional norms in the ED, participants reported difficulty navigating situations in which law enforcement attempted to assert authority over patient care. Second, participants perceived negative impacts of law enforcement presence on patients in custody and non-incarcerated patients of color receiving care in the ED. Finally, participants described frequent disruptions to the ED team workflow due to the presence of law enforcement. Participants relied on hospital security, rather than law enforcement, to ensure the safety of patients and staff. Conclusion: Emergency resident physicians described ambiguous boundaries and complex interactions among law enforcement, patients, and themselves in the ED. Although our study found several concerning impacts of law enforcement in the ED, these represent opportunities to clarify roles and responsibilities in the emergency physician-law enforcement relationship and improve patient care. Further research is needed, including eliciting perspectives of law enforcement and patients, particularly those with substance use disorders, trauma, and serious mental illness.