Looking at the Past, Stepping into the Future

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The St. Louis International Film Festival recently featured EMRA’s Emmy Award-winning documentary 24/7/365: The Evolution of Emergency Medicine. In this emotionally charged documentary, the tale of emergency medicine is brought to life by its original pioneers who, in their time, exemplified both the toughest resilience and the kindest compassion. I cannot help but think how privileged we are to be part of a specialty that was born in hospital basements by physician visionaries who cared more about their patients’ health than their ability to pay, and who put more weight in the quality of their care than of their own reputation. In boldly pursuing these ideas, they began to transform the landscape of the American health care system forever. Though these heroes faced a completely uncertain future, they were united by one common goal: to take care of patients in need.

Stepping into my new role as editor-in-chief of EM Resident has been a whirlwind. I have spent many gratifying hours reading your exceptional submissions. Additionally, I have been brainstorming how to make EM Resident even more interesting, more engaging, and more exciting than it already is. The ultimate goal is to maximize EMRA member involvement (there are more than 13,000 of us!) to the best of our ability. Transforming this vision into a reality will require a great deal of work by a very dedicated and talented staff, but we are all up for the challenge… Are you? Infused with the spirit of our pioneers, it is important to recognize where we have been before we can set our sights on where we would like to go. EMRA has remained a consistent part of the emergency medicine landscape for more than 40 years, and the mere existence of a publication such as this, developed and nurtured by members of the largest and oldest independent medical resident organization in the world, is extraordinary. The time and dedication required to excel, and to continue pushing the boundaries of our specialty, must be grounded in a desire to do what is best for our patients. The present-day demands placed on the emergency physician – of flawless documentation, excessive box-checking, ICD-10 coding, and a constant pressure to see more patients, more quickly, and more perfectly – may only move us further away from our founders’ vision, that is, further from the people. Our computers have become our lifelines, our fancy imaging modalities have become our physical exams. Our success at the end of a shift sometimes feels decided by how many patients we have seen, instead of how many we have helped.

My residency program recently participated in RightCare Action week, a movement that focuses on changing the culture of medicine from “more is better” to “right care for every patient.” The goal is to focus on restoring the doctor-patient relationship. With the ability to order virtually any test or treatment at the click of a button, we often test and treat based on what we think our patients are concerned about and will benefit from without ever asking them in the first place. We tell patients they need CT scans, expensive medications, or to be admitted to the ICU.

During the last week of October, all patients presenting to the emergency department were given the opportunity to fill out a card that simply asked, “What is your biggest worry?” The results were astounding. The middle-aged woman with chronic back pain asking for opioids? Her biggest worry was that she wouldn’t be able to lift her adult daughter with cerebral palsy into bed that night. The man with metastatic lung adenocarcinoma who presented with severe shortness of breath? His biggest worry was that he would die at home alone. By taking the time to understand our patients’ fears, motivations, and expectations, we can drastically alter the direction of their care. We must work to preserve the doctor-patient relationship and to uphold the values of our predecessors. No matter how tired or overworked we become, we must lift the veil of modern medicine to expose the heart of patient care.

It is my hope that you find this December/January edition of EM Resident to be not only a source of information, but also of inspiration – that you, too, will channel the spirit of our founders and become invested in seeing this organization continue to grow and transform. There are many ways to become involved, whether by submitting an article for publication, signing up for a committee or division, or volunteering as a program representative. It is only through your sustained effort and contributions that we can achieve our goals. Together, let us continue our humble quest to provide exceptional care to every patient, at any time, under any circumstance, and with unparalleled compassion.

Abby Cosgrove, MD

Abby Cosgrove, MD

Editor-in-Chief, EM Resident, Washington University in St. Louis, St. Louis, MO
Abby Cosgrove, MD

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