Hello America and all ships at sea. It’s Greg Henry, cub reporter, coming to you with my annual summary of the resolutions and activities from the 2015 ACEP Council floor. Some of you may find these proceedings dull, but that’s the democratic process. (I’m certain there was some bodice-ripping passion, betrayal and intrigue somewhere at ACEP, but it didn’t happen on the council floor. In fact, it’s been years since I’ve had my bodice ripped and I’m tired of waiting.)
To be fair, we did see some incredulity, incivility and even some downright ad hominem attacks. But no fisticuffs, so shivs. So the process was a success, albeit a bit painful to endure at times.
First, we had the annual commendation and memorial resolutions. This is our business. If we don’t extol the virtues of our own, who will? All deserving, all good people. But I would like to exercise my author’s prerogative to say that the commendation for Marsha Ford especially touched my heart. She is retiring after a long and exciting career in emergency medicine. She broke many glass ceilings, mostly with her head, and I respect her for it. I love you, Marsha. Best of luck. I’m a better person for having known you.
Next, space does not permit me to review every action taken. But there is some important deep water in these selected pools of resolution:
Resolution 5: EMRA Councilor Allocation
This resolution increased the number of Emergency Medicine Residents Association slots from four to eight on the Council floor. This was the right thing to do. When they got their first councilor seats years ago, there were only 195 members of the Council. Today, the Council is just short of 400 members and residents are at least 35 percent of the active College membership. So as an honorary EMRA member, I entreat you EMRA councilors to use your new seats and power wisely.
Resolution 6: Fellowship Criteria
This bylaws resolution had to do with fellowship criteria. Just shoot me. When I die I will know if I’m in heaven or in hell as I wake up in my new world; if they are debating fellowship, I know I’ve sent straight to hell. Move on.
Resolution 11: Ethical Violations by Non-ACEP Members
This resolution needs some time. It deals with the ethical violations by non-ACEP members in the arena of liability and expert witness testimony. Such liability problems, lawsuits, mandatory reviews by state boards are one of the big reasons members join an organization such as ACEP. We have a process for dealing with members whose egregious testimony stuns belief. But the problem of non-ACEP testimony is real. It is quite revolting and it is our problem. If we don’t fix it, who will? This resolution directs the board to deal with emergency doctors who are nonmembers and people from other specialties who in some states are permitted by law to speak to the standard of care of emergency physicians. Great. That’s just what we need: some retired gynecologist from Cleveland telling us what we should do in the emergency department.
The Council has directed the board to review all such testimony when requested and when found to be scientifically wrong and morally insulting to our members, they are directed to take an action. We cannot censure or expel nonmembers. But we can send a letter of our outrage and disgust to their hospital, state medical boards, their specialty societies and most importantly, to the collected bank of defense lawyers who will then have that information for future trials.
I spoke very little at this year’s meeting but I spoke with both passion and pugnacity in support of this resolution. Having counseled hundreds of physicians going through the psychological maelstrom of the medical legal process, we need to protect our members as much as possible from the slings and arrows of this miscarriage of justice. Good for you, Council. Now it’s up to the board to act. Carpe diem. Sic semper tyrannis.
Resolution 13: ACEP and the Pharmaceutical Industry
This is also our issue. It has to do with big pharma and emergency medicine. Why are certain drugs which are both economical and effective disappearing from our shelves? Why is Compazine essentially gone for the treatment of migraine? Droperidol got a black box warning for no good reason. The triad of “cheap, effective and gone” is no longer tolerable. We need to act and the direction has been given.
Resolution 19: Graduate Medical Education Funding
The transparency of graduate medical education funding is almost a no brainer. It should be fully transparent how much money the training institutions get for the residency programs and where that money is spent. News flash: Residencies are in most institutions a moneymaking proposition for the administration because of many different sources of funding. Let’s just lay it out and decide the big questions with data, not platitudes. Show me the money.
Motherhood and Apple Fritters
There are always a group of resolutions, which on the surface are motherhood and apple fritters. Who can be against reimbursement for ultrasound if the emergency doc uses it for decision-making at that moment in time? Who can be against drug takeback programs that are cost-free for the patient? And who could be against ACEP fighting to protect us from the extensive long-term boarding of patients, particularly psych patients in the emergency department? I’m not sure any of this really needed much of a vote, but they are on their way. Proper healthcare information exchanges, again, no problem; we need them. Nobody really needed to present a resolution on most of these things because your College is already working on it. But I suppose if it made someone feel better to send another message to the board, great.
Resolution 23: Integrating Emergency Care into the Greater Health Care System
This is deep water. It speaks to integrating emergency care into the greater healthcare system. I said in a speech 20 years ago [no, not my Cooper Union speech] that the emergency department would become the central hub of the medical community. This resolution asked that we get properly paid and is therefore a self-serving resolution. But it’s okay to be self-serving if you are actually right. Yes, we need to run the system. And yes, we need to get paid. Nothing wrong in that. There are big changes abroad in the land and our board must figure out ways for us to be reimbursed for taking care of populations en masse and not one disease at a time.
This resolution looks into the future. Don’t blow this one. Urgent cares, minute clinics, telemedicine, end-of- life care are all up for grabs. The membership wants this one decided in our direction. It is in fact our future. If we are just to be another piggy at the payment trough and not actually solving the distribution of care problems, then we deserve what we get. There is no short-term solution. But we will all look back in ten years and it will be clear whether we met this challenge or not.
Resolution 32: Critical Communications for ED Radiology Findings
This one is proof that we don’t learn from the lessons of history and no real problem ever goes away. This is the ancient question as to communications between radiology and emergency clinicians. As I write this piece, I have just gotten off the phone about an emergency physician being dissed by the radiologist in deposition. The radiologist said, ‘I might have picked up the X-ray finding if I’d been given better clinical information from the emergency doctor’. What a snake. It’s unbelievable to me that we are having this fight 20 years after I had to carry it on with radiology. This is perverse thinking that still exists. It’s wrong. How smart do you have to be to know that you need to communicate what you’ve seen on the film to the emergency doctor when it’s abnormal?
I will reiterate what I said about radiology 20 years ago. We [in Emergency Medicine]get paid fee-for-service. You [radiology]practice fee-for-no-service if you don’t give us a reading when we need it. Period. End of story. It’s just remarkable that it continues to go on ad infinitum.
Resolution 33: Defining and Transparency in Urgent Care Centers
To paraphrase Oscar Wilde, sometimes, “Telling the truth is not only an obligation but a pleasure.” The resolution concerning what’s in a name is important to the American people. This has to do with what we call these places that provide unscheduled care outside the traditional hospital emergency department. Let’s just take as an axiom: The patients don’t know and shouldn’t have to know what all these different names mean. We need standard definitions to meet the expectations of the unknowing public. A freestanding emergency department versus an urgent care versus a minute clinic is confusing for the average person. And even the best of the public can’t figure it out. This is in the interest of all; we need to be involved in this discussion. There are billing implications, state and federal regulations and patient perceptions, which are involved in this misnomer. This is an excellent use of our time and our treasure.
Resolution 38: Patient Satisfaction Scores and Safe Prescribing
Occasionally the Council gets to vent both its spleen and it’s sigmoid colon on things that have been seething for years. Resolution 38 had to do with patient satisfaction scores, as it pertains to safe prescribing. This is really simple. We don’t want forms for patient satisfaction filled out by people who have just been informed that they are not getting more drugs. The Council did not use the term Press Ganey, but they might as well have. Nobody likes to be judged after you’ve worked in the best interests of the patient and they don’t like it. But when you tell a strung-out, addicted patient that you are not renewing their Vicodin, it never goes well. Worse yet, these people now get to decide if we gave them good service. Even worse, some piece of crap administrator gets to decide whether you get the good doctor bonus financial reward based on these scores. Well, you get the picture. Oh, surprise, this one passed practically by acclamation.
So on the resolutions go, trying to solve both discreet local problems and expansive national issues. Let’s just say if you view the entire Council process from a distance, we coalesce as a group and have feelings that are pretty clear. We feel we are overworked and underpaid. We are afraid too many people are judging us as to how we did, what we do, what we should study and what the role of physician should really be. We hate the idea that administrators require redundancy in CME courses and that we have to be the solution to the entire healthcare system’s problems. And we further don’t get, as Rodney Dangerfield said, any respect. Gee, as I look back over my 40 years, I see that not a lot has changed since 1976.
Vox clamantis in deserto.