US emergency care today is a study in contradictions. Though emergency physicians are trained to have the expertise and technology to handle complex critical illness, an estimated one-third of emergency department (ED) visits are for primary care. Though EDs in many areas of the nation are already so crowded that they must regularly divert patients to other facilities, the number of EDs nationally declines every year. And though EDs are designed to handle a surge of victims following a catastrophe, patients and Presidents alike often view them primarily as a gateway to basic healthcare: in a Cleveland, Ohio address in July, 2007, President Bush was noted to observe,
“I mean, people have access to health care in America. After all, you just go to an emergency room.”
Many of these issues were recently reviewed in a series of reports on the crisis in US emergency care released by the Institute of Medicine.
These contradictions, along with other issues ranging from difficulty securing on-call specialists to the challenge of frequent ED use, from puzzling racial disparities in pain management to the scourge of hunger, have generated consternation and a search for solutions in the discipline of emergency medicine and among ED stakeholders. Past research has suggested that these issues arise from problems such as the implementation of managed care or the rising number of the uninsured.
We take another view. These contradictions may stem from and reflect emergency medicine’s unusual position on the frontier of the medical care system rather than any transitory current state of affairs. Further, we argue that in order to understand and address such paradoxes, ED researchers must expand their perspective on the nature of emergency care by acknowledging and analyzing the important social role of the ED in the US healthcare system and society. The dualistic role of emergency medicine can be, in part, reconciled by acknowledging the latent social functions of the ED embedded within its medical mandate. Here, we offer the notion of Social Emergency Medicine as a framework for this expanded perspective.
Welcome to the Andrew Levitt Center for Social Emergency Medicine, an independent non-profit research center operated by safety-net emergency physicians, social scientists and concerned citizens. As we expand our services, you will find relevant web resources, publications, ongoing projects and more here. We hope you will be inspired to participate.