Emergency physicians as community health advocates

The evening shift is as busy as yesterday, with new patients constantly appearing on the tracking board, assigned to hall beds that do not officially exist and require a bit of detective work to find. The next one up is a 20-year-old man with chest pain. He’s thin and black, and the chart lists no medical history. He smokes occasionally—sometimes cigarettes, sometimes marijuana—and rarely drinks alcohol. He looks comfortable leaning back in the stretcher, but in between his providers’ listening to normal heart and clear lung sounds, the rest of the story almost eagerly slips out: he has not been sleeping. His small apartment is full, with 2 toddlers, his wife, and his mother. It is located nearby in a low-income neighborhood in a city with a high incidence of violent crime. He paces the halls at night while his family sleeps to ward off possible home invasion, assault, or car theft. During the day, he hustles with odd jobs to bring in some money and watches his children but expresses fear of taking them to the park to play because of gun violence in the neighborhood. After review of a normal ECG result and chest radiograph, clinical guidelines are clear: he can be discharged home to follow up with a primary care physician.

Emergency physicians who understand the social context of medicine cannot accept this as the standard of care.

This article is part of a special supplement: Inventing Social Emergency Medicine: A Consensus Conference to Establish the Intellectual Underpinnings of Social Emergency Medicine.