Top Five Chief Complaints and what WACEP is Doing About Them

December 17, 2018 4:39 PM | Sally Winkelman (Administrator)

Lisa Maurer, MD
WACEP President's Message, December 2018

In keeping with essentially every organization providing a year-end countdown list, I would love to finish my last president’s message with a "Top-5 Chief Complaints" list and describe what WACEP is doing as an organization to improve each one of them for our physician members. Think of me as Casey Kasem reading off the chief complaints as they populate into your tracking board.

#5.  “Spider monkeys have moved into my living room.” Yes, you guessed it, there are no spider monkeys. Not to make light of the frequent psychiatric crises that we stabilize.  Frustrating part,? It takes us so long to connect these patients in crisis to the definitive and specialized care they need and deserve. WACEP has worked all year long with the Wisconsin Psychiatric Association to work towards a streamlined process of medical stabilization. A white paper reflecting best practices for our state will be released soon, and this task force between our two organizations will keep chipping away at the small problems that build up an amount to major delays. In the meantime, check out the SMART protocol, which included in this group’s conclusions for best practices.

#4.  “I took my blood pressure at Walgreens and it was high.”  Ahhhhhh, asymptomatic hypertension. Are you taking your medications? No. Why don't you have medications? I don't have a doctor. Why don't you have a doctor? I have Medicaid can't find anyone to take my insurance. Yes in the state of Wisconsin, our Medicaid program covers a notably large population without even doing the official “expansion” of the ACA. However, the financial burden then rests on the physicians backs with record low reimbursement rates, drowning any practice that sees a significant amount of Medicaid enrollees. When primary care doctors can limit these patients in their panel, they come for emergency departments further exacerbating the unfunded mandate of EMTALA.  WACEP has worked with legislative and regulatory state leaders to make sure they understand the logistics of our situation, and keep this as a high priority in mind as we move toward the next state budget. We have come farther than ever before in making our case heard, and are confident that we will be moving forward with progress. Please help us to continue to support friends of emergency medicine in Wisconsin through supporting our political action committee.

#3.  Wait - stop seeing patients.  This chief complaint is from your hospital president, who wants you to field a patient complaint.  Good thing WACEP has continued to develop our annual Spring Symposium, scheduled for April 3-4 at the Harley-Davidson Museum in Milwaukee. This year we are featuring a new leadership development content, targeting all of you emergency department leaders who manage staff, colleagues, patients, (hospital administrators, police officers….) everyday.  Come check this out as well as information on ED-initiated Medication-Assisted Treatment for substance abuse disorders, alternatives to opioids hands-on work sessions, presentations by the immediate-past president of ACEP, ultrasound workshop for emergency physicians, and definitely check out the reception the evening of April 3rd.  Invite your physician and non-physician colleagues to join us!

#2.  “N/V/D.”  Stomach flu going around? Guess again. This “flu” also comes with goosebumps, severe diffuse pain, and a patient who really just wants you to help them transition into medication-assisted treatment for opioid abuse rather than prescribe 12 more Oxycodone to get them by till their next ER visit two days from now. Patients who are started on buprenorphine from the emergency department for their active withdrawal from opioids have a much better chance of staying clean in the long run. But how can emergency physicians play this important role when we do not have clear outpatient ongoing treatment resources for our patients, and need to partake in additional training to have the necessary DEA waiver. The good news is WACEP will be working to gather and disseminate information around the state for what the medication assisted treatment resources are in your community. What's more, look for our partnership and promotion of the Wisconsin Society of Addiction Medicine's series of X-waiver training courses traveling around the state in the next year.

#1. Woohoo! Rough shift.  This chief complaint is from you.  Come to think of it, they've all been rough recently. And it's hard to schlep to each of my six shifts in a row when I'm not sleeping in between my 12s, I haven't seen fresh produce for weeks, and let's just say exercise is not how I get my release on my days off.  It's hard to prioritize our own mental health when we see patients in crisis every day, and the crutches to deal with this stress can lead to the slippery slope of substance abuse among our colleagues. WACEP has declared it a priority to decrease the stigma of substance abuse disorders and mental illness and work together to find ways to increase access to treatment for both.  More to come on this important project in 2019. 

A huge THANK YOU to the WACEP Board members and staff for all of your work to make progress on these and many other important programs that our chapter works on.  Happy Holidays!