Physicians in social emergency medicine are examining how changes in social elements change patients’ experience in the emergency department—the emergency department is more frequently used as a primary provider as private health insurance coverage declines, for example.

To find out more, ACEP Now Medical Editor-in-Chief Kevin Klauer, DO, EJD, FACEP, recently spoke with Harrison Alter, MS, MD, emergency physician and associate chair of research at Highland Hospital, Oakland, California, and executive director of the Andrew Levitt Center for Social Emergency Medicine, about what social emergency medicine is, how it differs from public health issues, and how it can give emergency physicians a different perspective on what affects patients who come through the ED.

KK: So, what is social emergency medicine?
HA: We conceive of social emergency medicine as an exploration of the relationship between social forces and the emergency care system, and how together these two influence the lives of our patients and their communities. We are primarily a research institution because social emergency medicine is young, but we also do some direct services and a little bit of advocacy.

KK: What types of programs do you have in place that you think are most impactful to the EM community?
HA: We’re participating in several large-scale projects. Probably our biggest is Doug White’s HIV and Hepatitis C screening program [at Highland Hopsital]. He’s a co-investigator with three other sites in the HIV testing trial, which is exploring the most effective and efficient way to target screening of emergency department patients and HIV. He’s also spearheading a novel hepatitis C screening program. We’re a site for a large-scale study exploring the relationship between the context of alcohol consumption and intimate partner violence—does it matter whether you drink at home, or drink on the street, or drink at a bar? We have a lot of gun injury work going on. I’m a member of the advisory committee of the National Medical Council on Gun Violence, and we have, I think, at least three ongoing research projects exploring the phenomenon or epidemic of gun violence in this country.

KK: I’m amazed at the number of different projects you’re involved in. For those who don’t know—and I didn’t know—social emergency medicine seems like a public health focus for emergency medicine, including research and impactful societal programs. Would that be a fair statement?
HA: Actually, I wouldn’t say that. There are distinct differences between the way public health and social emergency medicine approaches problems. I think it can be summarized in the difference between emergency medicine and almost every other branch of medicine. If you’re an internist, you treat hypertension and diabetes and asthma. In the ED, we treat chest pain and difficulty breathing. We see the world from the patient’s side and from the experience the patient is having, and we then translate that into a diagnosis and care plan. I think that makes emergency medicine in many ways distinct from most every other branch of medicine.