A Call for Action

5 Comments

Today’s healthcare environment has put emergency medicine against the ropes. The next generation of emergency physicians needs to be ready to get involved, fighting for our patients and our specialty. 

Emergency Medicine – a bold idea that changed the face of medicine – continues to push for constructive change. Our early pioneers – individuals like Wiegenstein, Wagner, Krome, Mills, Hannas and Podgorny – created a strong foundation for the tremendous growth and academic achievement that we have today. These first leaders had a mission to establish the specialty, and to gain recognition and respect from organized and academic medicine – and they succeeded. If our specialty is to stay strong and vibrant, this generation’s emergency physicians must commit to a mission that is just as challenging as our forefathers’ mission in 1970.

Emergency medicine is under threat from legislators, the media, accountants, government, and the courts. Some issues specifically threaten our specialty, while other issues pose dangers to the practice of medicine in general.


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Legislators repeatedly use political agendas to interfere with the physician-patient relationship in areas as diverse as palliative care, end-of-life, diagnostic testing, requirements for patient information, and the reporting of hazardous chemicals that can affect public safety [1]. For example, North Carolina is attempting to ban doctors or psychiatrists from asking patients whether they have access to guns, and physicians would be banned from passing that information along to anyone, even law enforcement (until after adjudication) even if the patient expressed the intent to harm himself or others [2]. Similar legislation has been attempted in Florida [1].

Recently, a North Carolina hospital was threatened with government sanctions after being cited by CMS for ‘failing to provide a safe environment’ for one of the most violent and dangerous patients ever encountered in its emergency department [3]. The 281-page report stated that ‘the patient injured a security guard, punched and spat at health care staff, and vowed to kill hospital employees and his own family’. CMS did not appear to analyze the need to provide a safe environment for hospital and security staff and other ED patients. The report seemed to blame the lack of inpatient psychiatric beds for the problem. While the details of the case have not been reported, illogical government actions such as this interfere with our struggles to stabilize increasingly violent psychiatric patients in our EDs.

Media frequently propagate misinformation about emergency medicine. On May 2, 2015, Maureen Dowd published the article ‘Stroke of Fate’ in The New York Times, in which she chronicled the experience of a young woman with a stroke [4]. Dr. Louis Caplan, the young woman’s treating neurologist, made inflammatory statements about emergency departments, stating that emergency physicians receive insufficient neurology training, proclaiming the ED “unsafe,” “dangerous,” and stating that he was “afraid to go the emergency room” – all of which Ms. Dowd was only too happy to publish. What a pity. In her enthusiasm for misinformation, Ms. Dowd missed a great opportunity to inform her readers about the importance of going quickly to an ED if someone developed acute neurologic symptoms. On May 6, 2015, the New York Times published an op-ed article by Dr. Ezekiel J. Emanuel, an oncologist and former presidential advisor who helped devise the Affordable Care Act. The article, entitled “How to Solve the E.R. Problem”– was provided despite the fact that Dr. Emanuel has likely had little contact or experience with emergency medicine [5].


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The challenges emergency physicians face are different and more complex in 2015 than they were in 1970. Legislators and the government restrict our practice without clear goals, outcomes, or any consideration of unanticipated consequences. The media often misrepresent us, or provide half-truths about what we do.  We are criticized by professionals who have little understanding of the ED environment or our practice.

These new threats give us a new mission. We need to fight for our profession and our patients. Whether it is writing a letter to the editor, correcting inaccurate reporting, becoming involved in our state and national professional societies, joining a hospital committee, or even running for elected office, we need to translate our new mission into action. Do something! Get involved!

Four Ways to Get Involved

  1. STAY INFORMED: Bone up on emergency medicine issues by read- ing top EM periodicals and blogs
  2. JOIN THE LOBBY: The Emergency Medicine Foundation offers a range of ways to contribute to national efforts
  3. JOIN A COMMITTEE: Represent the ED at the hospital level so that the ED’s needs are under- stood and considered
  4. RUN FOR OFFICE: Join the dozens of emergency physicians who have sought local and national office

REFERENCES
1. Weinberger SE et al ‘Legislative Interference with the Patient-Physician Relationship’ NEJM 2012; 367:1557 October 18, 2012
2. http://www.wral.com/sweeping-gun-law-headed-for-house-vote/14610483  (House Bill 562)
3. http://www.newsobserver.com/news/business/ May 6, 2015 by John Murawski
4. Dowd, M ‘Stroke of Fate’ Sunday Review, New York Times, May 2, 2015.
5. Emanuel, EJ ‘How to Solve the E.R. Problem’ May 6, 2015, New York Times.


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ABOUT THE AUTHOR

Dr. Tintinalli is currently a professor and Chair Emeritus of Emergency Medicine at the University of North Carolina. In addition to teaching in the emergency medicine department, she is an adjunct professor at the UNC Gillings School of Global Public, and a frequent lecturer in the School of Journalism and Mass Communication. Dr. Tintinalli is double boarded in emergency medicine and internal medicine. She was the founder and first president of the Council of Emergency Medicine Residency Directors. She is a former president of ABEM as well as the Association of Academic Chairs in Emergency Medicine. She is a past winner of ACEP's James Mills award as well as ACEP's National Education Award. And of course, she is the Editor-in-Chief of 7 editions of her eponymous textbook, which is arguably the best-known EM text in the world.

5 Comments

  1. Andrew I. Bern, MD on

    Congratulations on your call for action. You are so right. I call your attention to the Triple E campaign (Expand, Enhance, Engage) and the revisions of our advocacy efforts through the 911 Advocacy Network and revised microsite (www.acepadvocacy.com) where you can sign up to be a member of the 911 network and receive weekly updates on the political environment that affects our specialty and our patients.
    Sincerely,
    Andrew I. Bern, MD, FACEP,
    National Coordinator for the 911 Advocacy Network Triple E Campaign,
    Past Chair of the ACEP Board and past Board Member

  2. I propose a more radical response because the stated “Stay Informed, Join the Lobby, Join a committee and/or Run for Office” option, while both laudable and respectable, affects little to no change in a timely manner. The result is our establishment continues in the same disparate system which pits EP’s against our patients and their needs through out the course of the current generation of EP’s.

    I propose instead that the College aggressively litigate those who deliberately mis-inform the public we serve for their own social and political gain. The College also needs to have a more “in your face” attitude when it comes to interacting with media and individuals who speak out with such perspicacity. When we do not, it is ultimately our patients who suffer the ill effects of an anti-EM climate because there is no one else to do what we do.

  3. Mike Lozano Jr., MD on

    Completely agree with the call to arms. We can sit and grouse about how things are so bad, or we can give of our time or our money (or both) to advocate. Join NEMPAC and your state PAC if your chapter has one. Give at the top level.

  4. William Linnik on

    Academia should not have to provide all the legwork for the growth of the specialty. The definition of a board certified ED MD should include both good patient care and some contribution to growth of your specialty. Those who can lead should lead. Those who are not good leaders should write a check to those leaders, and those who run for political office as ED MD’s. Residency directors should teach final year departing residents the “cost” of keeping the specialty healthy. Yearly give some time or some money and be a ACEP member for life. 1 shift worth per year is a ideal mantra. Cal-ACEP has had several great legislator writing campaigns that worked. Teach residents to take advantage of these formats. It allowed us to defeat MICRA attacks and save alcohol / cigarette taxes for ED’s.

  5. Keith Raymond,MD on

    Thank you Dr. Tintinalli. The stand alone EDs have led the charge. So long as EDs remain under Hospital control real action will be stymied. I recommend a move to cleave all EDs from Hospital control. This will empower the Department and Physician. When we control the contracts we become the gatekeepers. Legislators will change from adversaries to co-conspirators. Administrators will ask permission instead demand our forgiveness. The physician patient relationship will be supported rather than eroded. We can unify ourselves and the EMRs under a single flag. Or, we can do the same old same old. It takes a paradigm shift.

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