Expanding the Emergency Room Model: ‘Central Care System’ Could Help Americans Gain Universal Health Care Access

By Dr. Sudip Bose, MD, FACEP, FAAEM

There are many reasons why emergency rooms are dangerously overcrowded. With millions of Americans lacking adequate access to primary care providers, emergency rooms have become the primary health care system and safety net for the uninsured, underinsured and those without access to other medical care. Overcrowded and with overworked staffs, ERs are perilously close to collapse in many places. (See my other article on ERs here: Our Nation’s Emergency Rooms). In fact, many already have closed their doors. There is an increased demand for emergency department care, as hospital emergency rooms have experienced a 32 percent increase in patient volume over the past decade.

There are many reasons why we are seeing an influx in the volume of people seeking care in the ER. For starters, the fastest-growing age group in the United States is those over age 65, according to the 2010 US Census, and emergency room visits by the elderly are rising at an alarming rate. We also have a shortage of primary care physicians, and a growing percentage of health care practitioners that do not accept Medicare and Medicaid because of low reimbursement rates. Confounding those issues is the EMTALA (Emergency Medical Treatment and Active Labor Act) of 1986, which requires emergency rooms to treat all comers, regardless of urgency or income. Two-thirds of emergency visits occur after business hours, when doctors’ offices are closed. For people who find themselves in distress without access to care for these various reasons, the emergency room is often the only place to turn, and the double doors will always be open for them.

Continue reading “Expanding the Emergency Room Model: ‘Central Care System’ Could Help Americans Gain Universal Health Care Access”

Five Universally Applicable Leadership Lessons Learned from Military Medicine

By Dr. Sudip Bose, MD, FACEP, FAAEM

In November 2004, I served in the Second Battle of Fallujah, which was the bloodiest battle of the Iraq War and the most violent since Vietnam. There is no substitute for, and no ingredient more important than, strong leadership — whether fighting in our military with fellow brothers in arms on foreign soil, working in a busy emergency room urgently trying to save lives, or just building your own successful business with a group of talented employees. During my time as a US Army emergency physician, I’ve noticed a handful of leadership “pearls” that have honed the performance of the medical and military teams I’ve served on, which consequently have saved the lives of countless patients and service members. These principles are essential for any person trying to start up a company, grow their business, or just get ahead in their lives.

1) Always Have a Forward-Looking Objective
Establishing both short and long-term objectives is essential to avoid being side-tracked and/or wasting valuable time doing things you really don’t need to accomplish. In the emergency room and on the battlefield, the principle of triage allows the team to constantly prioritize patients based on the severity of their individual illness or injury. The team should always know what the group as a whole is working towards. Additionally, the best objectives are never solely oriented toward solving immediate problems, but always work in the direction of accomplishing the bigger goal. Solving an immediate problem, but making no progress toward the endgame does not advance the team. As a military strategist would say, even when forced to go on the defensive, a commander should plan that defense with the intent to eventually convert to an offensive counterattack. When a complex patient comes into my emergency room with multiple problems, my overarching goal is not to solve any one individual problem, but to save his or her life. That means understanding which problems the patient has that should be solved, and which should be left alone for now. For example, when a patient arrives with an amputated hand, although that may be the injury that draws the most attention, it may not be the life-threatening emergency. In medicine we have to always remember to check our patient’s ABCs (airway, breathing, circulation) in a systematic manner first and foremost before we treat any other injuries.

Continue reading “Five Universally Applicable Leadership Lessons Learned from Military Medicine”

Leadership Under Pressure, a k a, Emergency Leadership

By Dr. Sudip Bose, MD, FACEP, FAAEM

How do you make decisions under pressure?

Leadership under pressure is not analysis paralysis. How do you move from analysis to action? In emergency leadership, you have to act, and you have to remain composed under pressure to ensure you have a positive outcome, or at least to find the path to the best outcome a situation affords.

How do you fight and win? Three key points:

  • Fill the vacuum
  • Say something
  • Divorce emotion

These are three principles that will help you lead and perform under pressure. They’re things I learned while serving in the U.S. Army as a front-line combat physician for 15 months while in Iraq. My service in war was one of the longest continuous tours of combat by a physician since World War II. I treated thousands of our troops during that conflict and also provided medical care for Iraq’s deposed dictator, Saddam Hussein, after his capture.

Continue reading “Leadership Under Pressure, a k a, Emergency Leadership”

The Emerging State of Medical Care In Our Nation’s Emergency Rooms

By Dr. Sudip Bose, MD, FACEP, FAAEM

People who go to a hospital emergency room cannot be turned away regardless of how sick or injured they actually are or whether or not they have insurance. They must be seen and treated.

Hospitals are sagging under the weight of the uninsured coming in to emergency rooms to get routine medical treatment. I often say, somewhat jokingly, but with a solid basis in reality, that after 5 PM I become a primary care doctor. E.R.s have become primary care clinics, especially in the evenings and on weekends, where doctors treat sniffles, coughs, colds and other relatively minor health issues — and at a very high cost.

We are seeing, in effect, medical refugees.

Being seen in an E.R., as opposed to a primary care physician’s (PCP) office costs much more. One of the main goals of the Affordable Care Act, also known by its slang name, “Obamacare,” was to reduce dependency on E.R.s by providing affordable care to a wider range of people who, since they had insurance, would then stop going into the E.R.s and see their PCP.

That hasn’t happened. In fact, just the opposite has, according to a survey conducted by the American College of Emergency Physicians. In a 2015 survey of E.R. docs the American College of Emergency Physicians conducted, 28% of respondents, who were emergency room doctors, said the volume of patients using the E.R. increased greatly while 47% said the volume has gone up slightly. That’s 75% of respondents who said the volume has gone up, either greatly or slightly.

Continue reading “The Emerging State of Medical Care In Our Nation’s Emergency Rooms”