Medical Degree: MD, University of Southern California School of Medicine, Los Angeles (1990)
The other night, during a busy shift, a mid-60s woman came into my ED via ambulance with hypotension and inferior changes concerning for a ST-elevation MI on the EMS-transmitted ECG. Upon arrival, we confirmed the ECG changes and activated the catheter lab, and shortly thereafter, the patient went upstairs for catheterization and stenting. The system worked—a life was saved! Unfortunately, our dysfunctional, fragmented U.S. healthcare system is under siege and threatened from many directions, both internally and externally. While the system worked today for my patient, will it work tomorrow for your patient or family member with a life-threatening emergency?
Assuring appropriate financial and societal support remains a critical external threat to EM. Longtime emergency physician Paul Seward recently penned an article on Stat News describing EDs as “the ‘chewing gum and duct tape’ holding together U.S. healthcare.” As the cost of healthcare in the U.S. has skyrocketed, EDs are viewed as the healthcare safety net—or as stated by a previous U.S. president: “I mean, people have access to healthcare in America,” he said. “After all, you just go to an ER.” Out-of-pocket medical expenses are mounting astronomically while insurance companies are making record profits. Many Americans are only one medical emergency away from poverty or homelessness. We, as frontline providers, see this on a daily basis. Our EDs may be our neighbors’ front door to the hospital, but it is our window to the problems seen in our communities.