As my shift is about to start, I look at the board to see what's new and what may be signed out. There's a drunk patient in bed 5, a psychotic patient in 19 in restraints, over in 9 is an elderly lady who lives alone, here for her 4th fall in 2 months. The code in bed 12 didn't make it. He was 45. Family is on their way in. The homeless guy in the hallway doesn't have anything really wrong, other than acute resource deficiency. I've seen the frequent flyer in 8 whose chronic belly pain is only cured by some drug that starts with a D. Fool me once, shame on you. Fool me twice, shame on me. In the background, I hear a medic unit calling in a baby being brought in for respiratory distress. Dare I take a quick look at the waiting room? There are 27 out there. Not too bad, it's a typical day.
“Accept the status quo, or take responsibility for implementing the change you want to see.”
Scenes like this are routine; are just part of the job. But what we do really isn't just a job. From time to time, perhaps on the drive home, or frequently when speaking to people outside of medicine, I recall the novelty of what we do. It's what drew me to the specialty in the first place. Each of these people has a story, and for a brief time, I get to play a supporting role, become entwined in their unique narrative. As providers in the ED, we share this remarkable privilege that provides us a perspective shared by few others in medicine or society in general. Day in and day out, indiscriminately and unceasingly, we bear witness to the extremes of the human condition. We are the gateway to the healthcare system and the safety net for those who fall through the cracks. More than any other specialty, we deal with the uninsured and underinsured, the homeless, and the victims of injustice or circumstance. Frequently on an individual basis we are able to do some good, to help people. But the ills of society and the shortcomings of our healthcare system are readily apparent every day. As such, it's all that much more important that we as emergency physicians make our voices heard and take the lead in shaping the healthcare landscape. ACEP's Principles of Ethics for Emergency Physicians states in article II, section D, paragraph 1:
“The emergency physician owes duties not only to his or her patients, but also to the society in which the physician an d patient dwell. . . Emergency physicians should be active in legislative, regulatory, institutional, and educational pursuits that promote patient safety and quality emergency care.”
The way I see it, we have two choices. Accept the status quo, or take responsibility for implementing the change you want to see.
EM originated as a specialty in 1961 when James Mills Jr., MD, along with a group of fellow internists, gave up private practice in Alexandria, VA, to solely focus on care in the ED.1 These pioneers were tasked with finding solutions to difficulties in coverage for an expanding patient population and providing better care for those who needed it most. Sound familiar? Our specialty is rooted in a legacy of advocacy spearheaded by a few diligent innovators. You can help to continue that tradition. But how, you may ask. Frequently, there is a desire to contribute but uncertainty as to how to go about it. Thus follow some basics for establishing yourself as an advocate for your patients, your profession, and for the public good.
- Get Educated
Visit the EMRA website, and specifically the health policy committee page for tons of Powerpoints, articles, and more. The EM Advocacy Handbook is available for free download. EMRA has a medical student rotation and a mini-fellowship in Washington, DC, available for residents. ACEP likewise has a great number of resources for advocacy, and you can look to the various other state and national professional societies as well. Join the 911 Network for important EM-relevant legislative updates. Social media can be an excellent resource for having important policy updates delivered to you daily. If you are interested in the nuts and bolts, you can go right to the source. All legislation is freely available via the Library of Congress THOMAS system. Using a tool called govtrack, you can get daily updates on important state and federal legislative issues pertaining to healthcare sent to your e-mail. This is also a great way to keep track of key committee meetings. Another fantastic resource is an app called Congress, which centralizes all the information about representatives into one place. You can see how your reps voted, see their contact info, bills they've sponsored, co-sponsored, etc. Clearly, technology has made it incredibly easy to gain knowledge if you just know where to look.
There are a great many political issues that have direct impact on medicine, and EM specifically. The Sustainable Growth Rate, GME funding, primary care shortages, ED crowding, and EMTALA are just a few. The easiest and quickest way to offer your support is by contributing financially to the professionals who represent our interests. Give a shift to NEMPAC – our own political action committee — or donate to the EM Action fund or other state EM PACs.
- Sign Up
Join the Health Policy Committee. Get involved in resident and hospital committees, local agencies, ACEP, EMRA, or other professional societies. Nearly every state ACEP chapter has resident opportunities. All these can be educational, great networking opportunities, and provide the chance to have a voice in the process of shaping how health care is delivered in the future.
Start locally – spread the word within your own program. Offer to do a policy or advocacy lecture during didactic time. Again, social media can be useful for reaching a wider audience, as can letters to the editor and articles for publications like this one.
- Step It Up
Make time to go to the Legislative Advocacy Conference and Leadership Summit. Write letters and make calls to your representatives. Lobbying is simply a matter of building relationships and sharing your unique insight to help those who shape policy do so in the most informed and effective way possible. This is what we do every day in the ED, just in a different context.
There are opportunities at every level, and we should see it as our duty to contribute as we are uniquely positioned and able to provide an important perspective to the debate. The fact is, change will continue to happen. It is up to us to ensure the right information gets to the right people so that change can be guided to the best interests of our specialty, our patients, and our communities. It is up to us ensure our representation. To borrow a quote from Gandhi:
“The future depends on what we do today.”
- Zink BJ: Anyone, Anything, Anytime – A History of Emergency Medicine, Mosby Elsevier, Philadlphia, 2006.