Commentary: Seeking consensus goals and broad support for social emergency medicine
Fahimi and Goldfrank eloquently delineate the ways in which social emergency medicine is integral to the foundation and practice of emergency medicine. Throughout their article, they emphasize the concurrent and, at times, symbiotic evolution of the skills that define emergency medicine practice, as well as the evolution of the political and legal constructs, such as EMTALA, that underlie our position as a societal safety net. They make a strong case for the moral imperative and legal basis to practice “fast medicine slowly,” addressing social determinants at the bedside, in the systems in which we work and in our research priorities.
There remain other, more mundane but equally powerful dimensions—namely, systems engineering and finances—required for broad support of the proposed social emergency medicine approach. Even if practitioners do not enter emergency medicine with a moral imperative to care for the most vulnerable populations, they join to practice the efficient, effective, exciting, and result-driven immediacy that is emergency medicine. To practice efficiently and effectively, providers cannot continue to conceptualize the social conditions preventing health adherence as externalities. Health nonadherence frequently arises because medicine draws its boundaries of responsibility too narrowly, and it is costing us.
Refining our current practice of social emergency medicine to improve the effectiveness of emergency care along metrics that matter to patients, physicians, hospital systems, and payers will gain social emergency medicine a central position within our specialty. Furthermore, rooting our framework in evidence-based effectiveness, documented outcomes improvement, and sophisticated cost-benefit financial proof is compelling and avoids political and ideologic battles while opening the possibility of unlikely or unexpected partnerships.
This article is part of a special supplement: Inventing Social Emergency Medicine: A Consensus Conference to Establish the Intellectual Underpinnings of Social Emergency Medicine.
Lippert S. Commentary: Seeking consensus goals and broad support for social emergency medicine. Ann Emerg Med. 2019;74(5):S14-S16. DOI: https://doi.org/10.1016/j.annemergmed.2019.08.434