WACEP President's Message, January 2020
Ryan Thompson, MD, FACEP
A recent tragic case which occurred in Milwaukee is garnering national media attention. You can read the full story here, but the broad strokes are that a young woman 9 months status post a stillbirth presented to an ED with chest pain, left after waiting 2 hours, and subsequently collapsed and died a short time later -presumably related to postpartum cardiomyopathy. (If you want to brush up on peripartum care, our friends at Wisconsin-ACOG have provided this great reference). Ultimately, this woman’s death was heartbreaking and very likely preventable.
The immediate and predictable media reaction was to blame the ED for the wait times she experienced. I do not know the physicians who were working at the time, but I’m confident that if the patient had stayed in the ED that she would have received the life-saving care that she needed. To lay the blame solely at the feet of these physicians and other ED staff is unfair and misses the whole host of failures that contributed to this woman’s death. Fortunately, ACEP’s Dr. Howie Mell was able to provide a small amount of context for the story, pushing back against the failed ED narrative.
As emergency physicians, we would like nothing better than to have EDs with enough staff, space, and resources to see every patient with little or no wait times at all. Unfortunately, this is far beyond our control. Innumerable forces contribute to ED crowding: a woefully overwhelmed mental health system that leaves patients boarding for days in the ED, inadequate Medicaid funding which leads to a lack of primary care availability and budget shortfalls in EDs, hospital system failures to decompress ED boarding through creative surgical scheduling and inpatient hallway beds, and many more.
I originally joined the WACEP board to head up the planning of the annual Spring Symposium (this year occurring April 15-16th in Madison, sign up here), but I have come to increasingly recognize the value WACEP offers in addressing the systemic issues we struggle with every day. National ACEP simply doesn’t have the resources or awareness of state-level problems to intervene effectively, but by working on the local level we can do so much. Dedicated members of our board monitor for state legislation relevant to EM so we can provide our perspective to legislators, sit on a multi-specialty task force dedicated to fixing ED psych boarding, have designed opiate-alternative guidelines to attenuate the opiate crisis, meet with state regulators to push for increased Medicaid reimbursement for EM so we can recruit more docs, and help craft position statements that EM physicians can use to advocate for change within their own institutions. I am constantly humbled by the passion and dedication displayed by our membership.
In the hustle and bustle of our lives it can become all too easy to lose sight of the challenges that face our specialty and our patients on a daily basis. WACEP has been working for years to give EM docs a voice so we can advocate for ourselves and our patients. As your new president, I will strive to continue that mission, but we need your help as well. Please reach out to us if you have an issue you are passionate about, tell an EM friend about the work we are doing on their behalf, and contribute to our PAC so we have the clout to push for legislative change in the state. WACEP is nothing without its members, so please help us help you!