Emergency Room has also become Primary Care

Joe Kernan
Posted 12/30/14

While we have heard a lot lately about the emergency room as the primary care provided for people who don’t have medical insurance, we have not heard how emergency medicine assumed that role …

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Emergency Room has also become Primary Care

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While we have heard a lot lately about the emergency room as the primary care provided for people who don’t have medical insurance, we have not heard how emergency medicine assumed that role relatively recently.

“When you dial 911 from any phone, someone picks up your call, an ambulance soon arrives, and you are speedily transported to an emergency room,” says a press release about a film on emergency medicine that aired on PBS.

“Once there, a team of specially-trained emergency medicine doctors and personnel with an enormous amount of resources at their fingertips care for you. No one asks if you can pay. No one refuses to treat you if you cannot.”

“24|7|365: The Evolution of Emergency Medicine,” which aired on Rhode Island PBS Monday night, chronicles the emergence of EMS and the specialty of Emergency Medicine, which became a medical specialty as recently as 1979.

“It’s our privilege to bring this story to the Rhode Island PBS community,” said David W. Piccerelli, president of WSBE Rhode Island PBS in the press release. “Access to 911 and emergency care is something we take for granted today. To realize just how recently this important system emerged is surprising and enlightening. We are thrilled to share this history, and to recognize the role local Rhode Island doctors play in the storytelling.”

The film features Brown University’s professor and chair of Emergency Medicine, Brian Zink, MD, as historical consultant. The documentary is the creation of one of Zink’s former students, Mark Brady, MD, a 2009 graduate of the Brown Alpert School of Medicine, a North Providence native.

“This is a story about mavericks in the medical field – mavericks who went against the medical establishment to meet the changing needs of patients in the ’50s and ’60s,” explained Brady, who is currently working as an emergency physician in Memphis as he fulfills his contract with the Navy Reserve.

“I have always had a strong interest in media,” said Brady on Monday, “but I also knew that I had to learn more about my medical craft as well.”

Brady says he was inspired by Dr. Zink’s book, “Anyone, Anything, Anytime: The History of Emergency Medicine.”

“At the time, there were huge changes in society, and the medical establishment was not prepared for the big jump in emergency visits to hospitals. Technology also became too big and too bulky to fit in the doctor's little black bag – so people increasingly went to the hospital for the latest in urgent diagnosis and treatment,” said Zink in the press release.

In a phone interview Monday, Brady said his study with Zink convinced him that there was a strong and important story to be told about emergency medicine and he set out to interview doctors from all around the country and in Canada and England.

“I read his [Zink’s] book, which I think is the only book on the history of emergency medicine, and it was an inspiration,” said Brady, “and I wanted to do the film while the founders of the specialty were still around to talk to. Sadly, since we finished the film, two of the people we talked to have passed away, so there is a certain urgency to the subject.”

Among the changes affecting emergency medicine was the increased mobility of Americans. As they moved around more, they no longer had family doctors, yet they needed somewhere to go when they got sick. Physicians, too, were also moving away from general practices and house calls, and seeking specialties instead. Specializing offers regular office hours and predictable schedules.

The changes combined to create a gap between the need for urgent treatment and the providers trained and on duty to respond. The pioneers of Emergency Medicine – among them, Dr. John Wiegenstein of Michigan – recognized the gap and filled it with persistent advocacy for better training and more resources, ultimately winning recognition as an important and unique branch of medicine.

“24|7|365: The Evolution of Emergency Medicine” explains the social, technological, and political forces that shaped the system as we know it now. As for Brady, he’s put a good deal of distance between himself and North Providence in his 35 years. A graduate of LaSalle Academy and Providence College, Dr. Mark Brady received early acceptance into Brown Alpert School of Medicine. He deferred admission to work at a children's hospital in Cambodia and then walked the Appalachian Trail for a year.

While in medical school at Brown, Brady concurrently earned a master’s in biomechanical engineering. He got a scholarship to do a master’s in public health at Harvard for a year. Then, he did an NIH fellowship in Peru and Bolivia for a year, studying emerging infectious diseases. He spent a few months doing an internship, writing at the Discovery Health Channel. He completed a four-year Emergency Medicine residency at Yale, where he was chief resident.

At Yale, he earned a diploma in tropical medicine from the London School of Hygiene and Tropical Medicine, went back to volunteer in Cambodia and spent some time working in Liberia as the only emergency doctor in the country.

“Back before the 1970s there was no 911, no ambulance systems as we know them, and if you arrived at a hospital the doctor there to care for you was probably the least qualified and most junior,” he said. Brady said there are over 130 million emergency room visits per year in the U.S. Qualified 911 and ambulance systems that are available anywhere, anytime to anyone. And the ER remains the only place that’s required by federal law to treat all patients regardless of their ability to pay. The effect of the Affordable Care Act is too new to assess, but most experts think it will relieve emergency room reliance as more people have access to primary care.

Dr. Zink lives in Coventry. He is the Frances Weeden Gibson - Edward A. Iannuccilli, MD, professor and chair of Emergency Medicine at the Alpert Medical School at Brown University. He is also Chief of Emergency Medicine at Rhode Island Hospital and The Miriam Hospital. He received the SAEM Hal Jayne Academic Excellence Award; the American College of Emergency Physicians Outstanding Contribution in Education Award; and the Medical School Dean’s Award for the Advancement of Women.

After its Dec. 29 premiere, “24|7|365: The Evolution of Emergency Medicine” will encore on WSBE Rhode Island PBS (36.1) on Dec. 31 at 1:30 a.m. and 2 p.m.; Jan. 1 at 4 a.m.; and Jan. 3 at 1 p.m.

The documentary also airs on WSBE Learn (36.2) on Jan. 6 at 10 p.m., Jan. 7 at 5 a.m. and Jan. 8 at 2 a.m.

WSBE Rhode Island PBS airs programming over the air on digital 36.1; on Rhode Island cable: Cox 08 / 1008HD, Verizon FiOS 08 / 508HD, and Full Channel 08; on MA cable: Comcast 819HD and Verizon FiOS 18 / 518HD; on satellite: DirecTV 36, Dish Network 36.

WSBE Learn transmits over the air on digital 36.2; in Rhode Island on Cox 808; Verizon FiOS 478; Full Channel 89; and in Massachusetts on Comcast 294 or 312.

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