Priya E. Mammen, MD, MPH Emergency Physicians can change the world. This is my fundamental belief.
We see on a daily basis what most could never fathom. While dramas on TV or in the movies show the frenetic pace and barrage of acute presentation, what many of us see and feel is the incessant waves of physical manifestations of systemic inequality, disparities, sexism, racism and a lack of social justice in the world around us. Emergency physicians are action-oriented problem solvers who can “find the line” amidst a deluge of stimuli, data, interruptions. As such, these waves can remind us of our greater responsibilities. They drive some of us to expand our efforts outside the four walls of the emergency department to better serve our patients.
I stumbled into the world of advocacy. The crux of my work and personal mission is to capitalize on the role and space of the ED to address the needs of those who otherwise fall out of the medical system. Through my programmatic work in HIV and HCV screening, systematic efforts to address the needs of people experiencing homelessness, and for the last 6 years, working to combat the opioid epidemic on multiple fronts, I have seen how biases and disparities create an unforgiving gauntlet for my patients. I started engaging with leaders across my region, city, and institution as it became more and more clear to me that few people had the perspective that emergency physicians take for granted. Being on the front lines reveals a clarity that few other vantages allow—the edges we see are crisper and sharper, and the solutions we recommend likely more practical.
Emergency physicians have emerged as strong and trusted voices in advocacy of the conditions and barriers our patients face. And whether the cause is #DocsForGunSense, #ThisIsOurLane, #GetWaivered, or #housingishealth, female voices have been the loudest and strongest. It’s often the women in our midst who are not only leading the charge to increase awareness and work toward improvements, but who have also committed both professionally and personally to positive impact and in changing some of the narratives.
What drives our advocacy efforts? What pushes us to take the step outside of the ED to tell the stories from within? We are, at our core, clinicians and scientists and our paradigm is evidence-based. Do we require aggregate data of a large cohort with p values for motivation? Do we approach our missions within academic terms of “low-hanging fruit,” “avenues to publication,” or “checkbox on the path to promotion?” I suspect for many it is more visceral.
One of my colleagues was spurred into action by a single event. One night, she was called to a room to evaluate a critical patient immediately upon arrival. As the team sprang into action, she worked to get a quick history and exam. The non-English speaking patient would only repeat “tengo pasaporte, tengo pasaporte.” It was several months into the new administration and ICE efforts to identify undocumented immigrants in any realm were rampant; the stark fear and deep vulnerability of some of our patients was palpable. Across the backdrop of a changing culture around us, she was determined to establish EDs, in particular, and hospitals, in general, as safe spaces for all. After drafting resolutions, collecting signatures, elevating the issues to greater awareness, she was asked by a departmental and institutional leader if her mission was worth putting her job at risk. Her answer was simple. “I’m sorry if this is making some people uncomfortable. But at some point my children will ask me what I did when all of this was happening, and I could not look them in the eyes if I sat by quietly. I’m an ER doc. I see this as part of my job. I’m pretty sure I could get another ER job. I can’t compromise on the world I try to create for my children.”
FemInEM and others have highlighted and brought attention to the disparities women in EM and women in medicine face. Here, too, aggregates and evidence have furthered the discussion. We are fortunate to have vocal and engaged experts in our midst who are willing to illustrate unconscious bias, able to deconstruct established practices to bring embedded flaws to the surface and force discussions through eloquent and pithy 280 character thoughts. But as the recently released NASEM report illustrates, the issues we face, the barriers we must overcome, and the disparities within the house of medicine and ivory towers of science can no longer be ignored and can no longer be championed by a strong few alone. It begets even more questions.
What would you do if you witness inequity or injustice in your midst? What if it is an individual and not a cohort? A colleague and not a patient? Would you speak up? Would you try to facilitate a discussion? Would you work to understand the issues? Or would you express your disbelief and confusion, but remain on the sidelines? Would you shake your head at the optics and stay silent? Would you point the way to others, but admit that you don’t want to get involved for fear of retaliation? Would you ignore it all together? Or would you instead capitalize on it for personal gain?
Emergency physicians can and will change the world. We must also be unwaveringly determined to change our world within along the way. This is my fundamental hope.
Thank you for your post. This is a question that has come up in a forum I attend, and we agree we would not know how we will respond until a situation presents itself. Coming from the belief that people are basically good, I, a former ER nurse, have seen humans in action to come to the assistance of others, sometimes in very heroic ways. All needs aren’t life threatening, but are often heart breaking. It often takes so little to ease another’s pain. Let’s do it.