PublicHealthWelcome to my inaugural post on ALiEM! My goal for this new series of missives is to inspire discussion about aspects of our life in EM, beyond the day-to-day clinical work. I chose emergency medicine not only for the clinical challenge, but also for the potential public health impact. After all, we are the only specialty to consistently care for the poor, the disempowered, the mentally ill.

High risk patients

We serve as the sole source of care for many of the highest-risk patients.1–3 A disproportionate number of our patients, compared with the general population, suffer from alcoholism, substance abuse, and mental illness.4 These high-risk patients not surprisingly have higher recidivism, higher costs, and worse overall outcomes. Many therefore see the ED as the source of every problem in the healthcare system [Washington State Hospital Association, RAND Report]. But many of us prefer to think of ourselves in more positive terms: as the source for potential transformation of healthcare. [UCSD News, NY Times Blog]

Blog series: Public health + EM

So the goal of this new series is to talk about that how we can affect public health via EM (academic and otherwise). Administrators seem to believe that we, the pit-docs and ED nurses and EMTs, are really the key to reducing cost and improving outcomes [ACEP News]. So let’s do it, ourselves. Let’s have an honest and ongoing discussion about how to do this. Let’s talk about how “academics” isn’t just about education or research, but how it means influencing the trajectory of healthcare on a systemic (as well as personal) level. Let’s become active voices in restructuring the system in a way that benefits us and our patients.

What do you think?

Thoughts? Feedback? Do YOU believe that the ED has a public health role? Or do you think we’re at the mercy of the winds of change in healthcare?

Future topics

  1. What is physician advocacy, and why is it part of our job description?
  2. The role of research in EM
  3. mHealth, digital health, and Medicine 2.0: What does it meant for the ED?

Shameless Plug: Interested in discussing this in person? Attend our talk at the 2013 ACEP Scientific Assembly on “ED Superusers: Stop the Abuse, Stop the Violence, Breaking the Cycle” on Monday 10/14, 12:30-2:20pm.

Wilson K, Klein J. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154(4):361-365. [PubMed]
Weber E, Showstack J, Hunt K, Colby D, Callaham M. Does lack of a usual source of care or health insurance increase the likelihood of an emergency department visit? Results of a national population-based study. Ann Emerg Med. 2005;45(1):4-12. [PubMed]
Hunt K, Weber E, Showstack J, Colby D, Callaham M. Characteristics of frequent users of emergency departments. Ann Emerg Med. 2006;48(1):1-8. [PubMed]
Bernstein S, D’Onofrio G. Public health in the emergency department: Academic Emergency Medicine consensus conference executive summary. Acad Emerg Med. 2009;16(11):1037-1039. [PubMed]
Megan L. Ranney, MD MPH

Megan L. Ranney, MD MPH

ALiEM Featured Contributor
Assistant Professor of Emergency Medicine
Alpert Medical School, Brown University
Injury Prevention Center of Rhode Island Hospital
Megan L. Ranney, MD MPH

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