Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why the name “emergency medicine” is no longer adequate: a call for change

Jordan Hughes, MD
Physician
February 9, 2023
41 Shares
Share
Tweet
Share

I am an emergency physician in training. It’s a thrilling and rewarding job learning to treat the severely ill and injured. But it is also a rare clinical shift when I don’t treat patients with life-limiting alcohol and drug addiction, people struggling with homelessness, those whose behavior does not allow them to safely be in a shelter with others, undocumented immigrants with nowhere else to turn for aid, uninsured patients who cannot receive outpatient care or children and adults with acute psychiatric emergencies. Treating these types of patients in the emergency department results from our current health care “system,” driven by for-profit insurance companies, reimbursement disincentives, and current state and federal legislation.

After many years of ever-widening clinical practice, the term “emergency medicine” has become inadequate to describe our specialty. I propose changing the name to one that better reflects the daily reality in American emergency departments: safety net care & emergency medicine. Though in some sense still lacking, this name better encompasses the care we provide–to both those who are socially most vulnerable and those who emergently seek care on their most vulnerable day.

But what’s in a name? A change in nomenclature would help force our specialty and the health care system around us to address the failings that have led to our current state.

Pointing the finger at ourselves first, we are woefully underprepared to care for the ever-rising number of psychiatric complaints we deal with daily, particularly in the wake of the COVID-19 pandemic. We need additional training and infrastructure to care competently for these psychiatric patients. Some we can send home, but they have no realistic chance of seeing a psychiatrist with any immediacy. Most of these patients, though, will linger in our departments for days on end, waiting for a bed in a psychiatric hospital. We need to treat them, too, not just warehouse them. Similarly, we need to better manage medical patients who we can send home but don’t have the ability to promptly follow up with a primary care doctor.

Moreover, I hope this name change allows our colleagues from other specialties to understand better our role in the system and the pressures we face in the emergency department.

“Yes, Dr. Hospitalist, I understand that we can’t say this homeless patient’s cellulitis has technically failed outpatient treatment. But he couldn’t afford the antibiotics I prescribed him a week ago when he first sought care, so I believe admission is the best way to practically treat his progressively worsening infection.”

Additionally, I want this change to exert pressure on state and federal officials to address the societal and legislative failings that have made emergency departments the last hope for some patients to seek non-urgent care, be it medical, psychiatric, nutritional, environmental, or otherwise.

“Yes, Dr. Hospitalist, I know you don’t have a billable indication for hospitalization for this physically disabled patient whose house is being condemned. But I’m not able to send them home tonight under these circumstances.”

This should also signal to hospital administrators and contract management groups, who measure emergency physicians’ performance in productivity and profit, that the care we provide does not neatly fit into the metrics we are professionally evaluated on and compensated for. True recognition of our role as a safety net would prompt a restructuring of our current productivity and compensation schemes to include patient-centered metrics as a core measure of our care.

Practicing safety net care is an honor, but I wish it were unnecessary. We need the language to identify and address the failings within and outside of health care that have led to safety net care being a substantial portion of the emergency physician’s practice.

Jordan Hughes is an emergency medicine resident.

Prev

Trauma motivated me to become a doctor

February 9, 2023 Kevin 0
…
Next

The unexpected gift of friendship in trying times

February 9, 2023 Kevin 1
…

Tagged as: Emergency Medicine

Post navigation

< Previous Post
Trauma motivated me to become a doctor
Next Post >
The unexpected gift of friendship in trying times

More by Jordan Hughes, MD

  • To the AAMC: Recommend an interview limit or else this year’s residency match may be a disaster

    Jordan Hughes, MD

Related Posts

  • A scribe’s haunting view of emergency medicine

    Nicole Russell
  • Antibiotic resistance is the climate change of medicine

    Eric Beam, MD
  • How social media can advance humanism in medicine

    Pooja Lakshmin, MD
  • The difference between learning medicine and doing medicine

    Steven Zhang, MD
  • Translating social justice into meaningful change for underrepresented minorities in academic medicine

    Keila Lopez, MD, MPH and Jean Raphael, MD, MPH
  • Medicine won’t keep you warm at night

    Anonymous

More in Physician

  • It’s time for C-suite to contract directly with physicians for part-time work

    Aaron Morgenstein, MD & Corinne Sundar Rao, MD
  • From rural communities to underserved populations: How telemedicine is bridging health care gaps

    Harvey Castro, MD, MBA
  • From solidarity to co-liberation: Understanding the journey towards ending oppression

    Maiysha Clairborne, MD
  • Finding peace through surrender: a personal exploration

    Dympna Weil, MD
  • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

    Katrina Gipson, MD, MPH
  • Beyond the disease: the power of empathy in health care

    Nana Dadzie Ghansah, MD
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
  • Recent Posts

    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
    • What I think it means to be a medical student in the wake of AI

      Jackson J. McCue | Tech
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Sam Neill's Rare Lymphoma
  • Day in the Life of a Doctor: Treating a Patient With Septic Shock
  • Paxlovid May Lower Long COVID Risk, VA Study Suggests
  • Digital Inhalers May Improve Uncontrolled Asthma Management
  • Another Win for Zolbetuximab in Advanced Gastric/GEJ Cancer

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
  • Recent Posts

    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
    • What I think it means to be a medical student in the wake of AI

      Jackson J. McCue | Tech
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...