Quote from quazar
I have been surprised on a number of occasions by the most innocuous looking patients giving the most shocking answers to screening questions. Had the questions not been there, I likely wouldn't have asked, and never would have known the (in some cases very large and dangerous) risk was there. Yes, the screening questions are annoying, but I think of them like a giant sieve: they are useful filters that catch small things that would otherwise be missed. You never know.
I have no doubt that screening can be very useful in various settings or when performed in specific ways
I must say that I can't recall a time that I was shocked about a reply to a screening question. Please know I'm not saying that to be argumentative or to question your own personal experiences.
There may be different methods - such as being able to answer a question on a computer screen, or having the screen take place in private that "make sense" in my mind as things that might produce more useful results.
But in the ED the setting is thus: We're already putting every single patient through our giant sieve to filter out existing physical ailments that might kill someone in the next 24 hours. We don't have the time to figure out if we should exclude visitors from this screen or anything like that. We don't have time to sit and ask our screening questions in a therapeutic/open-ended way. We need to get everyone who is waiting through the "emergent physical problem" sieve ASAP.
The effect, therefore, is that I will be mostly looking at a computer screen, clicking or typing, and you will be sitting in a chair next to your partner, your boss, or your grandchild or 10 of your closest friends, when I ask you if you are in a safe living situation 0.5 seconds after you answer whether or not you smoke, which was asked 0.5 seconds after I asked you if you have any allergies...and you'll answer those questions with your child, your friend, your boss, your abuser, your pimp...whoever, standing right there with you.
Or in the case of smoking...15 years ago when you'd ask someone that question they might lie, they might answer sheepishly, etc. Nowadays, they know the routine. They say "yep!" They know we're moving right on to the next question just like Katie mentioned above. Our ED screening routines have been successful at letting them know that we don't care about the answer, and nothing is going to be done about it.