Portal de Periódicos da CAPES

Foreword to Conference Proceedings, Inventing Social Emergency Medicine

2019; Elsevier BV; Volume: 74; Issue: 5 Linguagem: Inglês

10.1016/j.annemergmed.2019.06.016

1097-6760

Harrison Alter,

Health Sciences Research and Education

Before you are the proceedings of an invitational consensus conference called Inventing Social Emergency Medicine, including subsequent reflections and a supplemental riff off of the experience of being there. Invitees convened at the Dallas headquarters of the American College of Emergency Physicians (ACEP) for 2 days in September 2017 to do just as the title suggests: begin to provide some intellectual superstructure for what was a nascent field. Work had been done for many years to tease apart the complex interrelationship of social context and the emergency care system, but this work was just beginning to coalesce into a field. In fact, such a field had only relatively recently been dreamt of. In 2007, Dr. Barry Simon, my chair at Highland Hospital in the Department of Emergency Medicine, had an ongoing conversation with the family of Dr. Andy Levitt, our department’s long-standing and beloved research director. Andy had died just a few years before, and the family was interested in memorializing his commitment to Highland emergency medicine and its research enterprise. We thought about a lectureship, or a chair, or any number of the ways these gestures of generosity by the bereaved can go. But Andy was more than a pioneer in emergency medicine research, and more than a physician. He was, quite literally, a great humanitarian. This opportunity to think creatively about honoring Andy came at a very good time for me. In fact, my whole career to that point seemed to have built up to it. My first job out of college was at the Kaiser Family Foundation, where, as a special assistant to the legendary Dr. Alvin Tarlov, I spent 2 years designing and drafting a 10-year, $10 million program to increase the participation of underrepresented minority students in the health professions. Drinking in that atmosphere, full of highly optimistic intellectuals advancing an agenda of leveraging the social determinants of health, profoundly influenced me. Every next step built on that foundation—the Joint Medical Program, emergency medicine training at Highland, the Robert Wood Johnson Clinical Scholars program in Seattle, and 3 years with the Indian Health Service at Tuba City, AZ—to demonstrate to me the power of social forces to influence health, and the potential for emergency medicine to work within that system. So Barry and I put those 3 words together—social, emergency, and medicine—in a proposal to Andy’s family, and the Andrew Levitt Center for Social Emergency Medicine was born. The proposal was strongly influenced by my friend and Clinical Scholars colleague Dr. Jim Gordon’s thought piece in Annals of Emergency Medicine, “The Hospital Emergency Department as a Social Welfare Institution.” This essay spelled out the rationale, and some steps forward, for the emergency department (ED) as a leader in the clinical application of the social determinants, and serves really as a founding document for our field. I began to meet more frequently with Dr. Len Syme, who coined the term “social determinants of health,” in his offices. Despite 50 years of study, the bedside application of this pervasive concept was still elusive. Together we began to understand that the ED, because of its immediacy, because of its proximity to community stressors, and because of its reputation as a safe harbor, might be positioned to crack that code. We just needed a way to get people together to figure out how. He provided introductions at the Robert Wood Johnson Foundation, where Dr. John Lumpkin offered some simple yet profound ideas and his support, and the idea for a consensus conference took off. After a meeting in a Massachusetts gun shop with Dr. Steve Hargarten (that’s a whole different story), we brought the idea to Dr. Sandy Schneider at ACEP and Cynthia Singh from the Emergency Medicine Foundation (EMF). They “got it” immediately and recognized what ACEP and EMF could offer for the amplification of a conference, as well as to keep it grounded in physician practice. Sandy and Cynthia brought in Loren Rives from ACEP and Jana Nelson from EMF to operationalize an abstraction, and Dr. Lumpkin brought in Emmy Ganos and the Robert Wood Johnson Foundation to ensure that we stayed true to our vision. This team had a unique synergy that literally made something out of nothing. The editorial staff at Annals helped shape an unruly proceedings into a coherent and cohesive monograph. The structure of Inventing Social Emergency Medicine was patterned on the influential Conference on Socioeconomic Status and Health, convened by the Kaiser Family Foundation in 1987. We commissioned 5 background articles from 6 key thinkers in social emergency medicine: Drs. Jahan Fahimi and Lewis Goldfrank, Dennis Hsieh, Maria Raven, Thea James, and Joneigh Khaldun. These articles were to function as a table setting (Fahimi and Goldfrank), a general case (Hsieh), 2 examples of social emergency medicine thinking (Raven [housing] and James [violence]), and an exploration of translation to action (Khaldun and Michael Clery). We then gave each of these articles to 2 more thought leaders for prepared commentary: Drs. N. Ewen Wang and Suzanne Lippert, Jocelyn Freeman Garrick and Robert Rodriguez, Kelly Doran and Roberta Capp, Stephen Hargarten and Nathan Irvin, and Zach Meisel and Chris Barsotti. We built each segment of the meeting around one of the triptychs, an article and its commentaries. The proceedings before you, introduced by Drs. Jerome Hoffman and Hemal Kanzaria and woven together by Loren Rives at ACEP and Jennifer Sun at Highland, are structured the same way. The discussion among the 50 or so invited attendees ranged widely, but often came back to key points. For each segment’s discussion, we asked a few of the many trainees present—fellows and their mentors, and students and residents who competed to attend as Lynton Scholars—to team up and provide us with their reflections of the discussions: lessons learned, from the standpoint of people just on the threshold of a career in this work. For the key points and future directions, Dr. Erik Anderson (1 of 3 or 4 people to have done a fellowship in social emergency medicine at the time) and I tried to capture them in a summation. Dr. Breena Taira, herself a leader in social emergency medicine, submitted an article after the fact, inspired by the proceedings. Our hope in publishing this volume is to provide a reference point for those who will build on the foundation and structure of our field: some concrete recommendations, some abstractions to stimulate creative thought; all in the service of improving the health and the lives of our patients and their communities by incorporating social context into the structure and practice of emergency care. A list of participants can be found in Appendix E1, available online at http://www.annemergmed.com. Download .docx (.01 MB) Help with docx files AppendixList of participants, Inventing Social Emergency Medicine, Dallas, TX, September 14 to 15, 2017.