Dr. Janiak was so confident in his dissenting vision that while in his residency, he said if he were a betting man, he “wouldn’t bet against me.” This statement was noted with-in the exhibits commemorating ACEP’s 50th anniversary, displayed at the 2018 ACEP Scientific Assembly in San Diego. Time has certainly proven Dr. Janiak to be right.

3. Laboring in Dissent

Organized dissent by many explains how emergency medicine became an official specialty within ABMS. ABMS voted in September 1977 (100 to five) to reject emergency medicine’s application for specialty board status. Not content to accept failure, numerous visionary founders of our specialty, such as Drs. John Wiegenstein, George Podgorny, David Wagner and Ron Krome, led the efforts to labor effectively in dissent. Two years later in September 1979, through their considerable and persuasive efforts, emergency medicine became an approved specialty by ABMS in an almost unanimous vote. It is difficult to capture in a brief paragraph the ex-tensive persuasive efforts required to effect this change. These leaders dissented from the overwhelming opinion of the ABMS, as expressed in 1977. They dissented so effectively that they changed minds and hearts and made emergency medicine an official ABMS-recognized specialty in 1979.

Further, we all have heard of Dr. Peter Rosen, a founder of our specialty. I will paraphrase an incident involving Dr. Rosen, as reported by Dr. Brian Zink in his book, Anyone, Anything, Anytime: A History of Emergency Medicine. Dr. Zink interviewed Dr. Rosen in Jackson, Wyoming, in 2003 as he collected the history of our specialty “from the horses’ mouths,” as it were.

In 1977, Dr. Rosen was leading the emergency department at the University of Chica-go, and he had the occasion to meet with his new dean. The dean, Daniel C. Tosteson, was an anatomist and not a physician. The dean opined in meeting with Dr. Rosen that he did not understand why emergency medicine should exist because there is no “biology” of emergency medicine. (We don’t claim an organ system in the manner of nephrologists with the renal system or cardiologists with the cardiovascular system.) The dean noted that if he were to have a heart attack, for example, he wanted to receive the care of a cardiologist. Dr. Rosen asked this dean how he might know he was having a heart attack. The dean replied that he’d expect to be having chest pain. Dr. Rosen replied by asking what the dean would expect to occur if the symptoms were mainly nausea. Dr. Rosen was quoted by Dr. Zink as saying, regarding the reaction of Dr. Tosteson, “It was the first time it had ever occurred to him that maybe you couldn’t run an emergency department with 47 different specialties. … I got so pissed at him that … I went out and wrote a paper.” Now, that’s effective dissent, when you look your dean in the eye and use his own words to explain why his opinion of our specialty is so wrong!