WACEP President’s Message, June 2020
Ryan Thompson, MD, FACEP

Emergency Medicine is uniquely situated in the House of Medicine to bear witness to the failures of our society. We are there for people in their darkest hours and as a result we see the more overt societal problems – violence, child abuse, drug and alcohol addiction, sexual assault, and suicide. However, it is sometimes easy for us to overlook some of society’s more insidious ills.

Wisconsin has a long history of racial inequality. Our communities of color were confined to certain neighborhoods in our cities for large swaths of our state’s history – a practice known as redlining. The resultant deficiencies in housing, healthcare, education, and job opportunities remain even today. The education gap between black and white children in Wisconsin is the worst in the nation. Wisconsin has the highest rate of incarceration of black men in the nation. White people in Wisconsin make 37% more money than black people doing similar jobs. There is a 48% gap between black and white home ownership.

This housing, education, and income inequality has led to disparities in health, as well. Black infants in our state have a rate of mortality that is nearly 3 times that of other races. Rates of obesity, asthma, hypertension, lower extremity amputation from diabetes, arthritis, and hyperlipidemia are all significantly higher among African Americans. Shockingly, the rate of end-stage renal disease from diabetes is nearly 5 times that of white people.

As physicians, we are obligated to work toward better health for all of our patients. It can sometimes be difficult to see what we can do to be helpful- after all, we try to do our best for each and every patient in the ED. But there are things we can do, both big and small, to make a difference: Listen to your patients. Advocate for additional social work resources in your department. Help your patients get registered to vote. Support organizations that buoy underserved communities.  Make sure your department is attempting to hire people of color at all levels. Double check that your patient can afford their prescriptions. Mentor students of color. Recognize your own biases so that you can start to work against them.

We are at a unique moment both in Wisconsin and our nation as a whole. Emergency Physicians should take this opportunity to improve the lives of our patients and the health of our communities. The time for action is now.

Alister Martin, MD, MPP and Marin Darsie, MD

As the coronavirus pandemic has exacerbated longstanding healthcare inequalities that disproportionately affect communities of color and low socioeconomic status, many of us in the medical community are left wondering what we can do. Disparities in Wisconsin are especially sobering. Though Black Wisconsinites make up just 6% of the population, they account for 25% of COVID-19 deaths. The events of the past few months have shined a spotlight on health inequity, creating a pivotal moment for improving our healthcare system.

We want to provide those of you who are interested in a concrete action step: help your patients vote in a safe and healthy manner this November.

Dr. Alister Martin, an EM physician at Mass General Hospital and a faculty member at the Harvard Medical School, leads an organization called VotER that partners with healthcare providers to help patients register to vote. He started the project as a response to what we all see each and every day we care for patients – the healthcare inequities that stem from a democratic process where 51 million citizens aren’t registered to vote. VotER wants to ensure that patients, particularly those most left behind by the healthcare system, are empowered to fix it by inviting their voices into the democratic process.

VotER recently created Healthy Democracy Kits: badge-backers and lanyards with a QR code that patients can scan to register to vote or request an absentee ballot on their phones. It takes them 90 seconds or less while you go on to see the next patient. Voting from home is the safest way to participate in the November elections — this platform makes it easy for you to help your patients get ready to do so.

In the past few weeks, over 5,000 health care providers, including doctors, nurses, and social workers, have ordered their free kits. This effort will be featured in August during national Civic Health Month, a nonpartisan collaboration between healthcare organizations, voter registration organizations, and providers aimed at making the connection between civic engagement and healthcare. Join a rapidly growing number of health care providers across the country who are helping their patients vote safely by ordering your free kit today!

Potential actions:

• VotER’s Healthy Democracy Kit is free. Order yours here: http://vot-er.org/kit.
• Share this message with colleagues in your network or hospital/department who would be interested. Group orders are welcomed!
• Get involved in VotER’s work in other ways, like digitally engaging with patients about safe voting. Feel free to reach out to VotER directly at alister@vot-er.org.

Thank you.

Dr. Darsie is a WACEP member practicing emergency medicine and neurocritical care at the University of Wisconsin Hospitals and Clinics.

Christopher J Ford, MD
Infinity/Envision Healthcare-Ascension Columbia St. Marys Milwaukee
Advisory Board Member-Wisconsin Emergency Services for Children

Dear Fellow EM Providers of Wisconsin,

Last week I sent an email to my group, Infinity/Envision Healthcare, regarding the unrest and much-needed self-reflection our county is experiencing now given the Floyd tragedy. My goal was to advocate for our patients and provide an environment that was even more welcoming, given the circumstances. The email was well received and subsequently sent to my partners nationwide. I got many emails in response from throughout the country, often offering personal experiences of racial and social injustices experienced by the sender or their family members. I was genuinely appreciative of each story shared and respectful of the acceptance of the message I was trying to relay.

Similarly, I wanted to share my personal experiences in this forum, and offer the perspective of some of our patients as context. Despite growing up in an extremely politically active family, I will try to keep this as a-political as possible. In my experience, this has been the best approach to work interactions.

Growing up on the Southside of Chicago, I’ve had many interfaces with police as an African-American male. Some very positive, and some I will never forget, which tailor my interactions with law enforcement to this day. I share with some of my partners in a joking fashion, as is classically my coping mechanism, of how conscious I am of how I appear when driving through my (mostly white) neighborhood after a night shift as a black man. Or, more-so, how careful I am with my interactions with police even at work. Although jovially presented, there is much context, and more so, PTSD attributed. Unfortunately, these experiences are not held by myself alone but by many African-Americans and Latinos, many of whom are our patients.

I write this not to garner sympathy, but rather to invoke even more empathy into our interactions with our minority patient population over the coming days. Even if a member of this population has not had adverse run-ins with the police, the stressors of our current times remain triggers.  The Floyd funeral services, the protests, or witnessing of the eight minutes and forty-six seconds of unconscionable disregard for human life will likely re-open scars of the tragic loss of family or friends some have had subconsciously. Us of whom have grown up in inner-city environments probably will have a similar story of loss that rises again to surface with a tragedy such as the Floyd incident.

I ask that we all be incredibly mindful of our patient interactions, starting with our next shift. The entire nation is on edge at this time, and any form of confrontation will now be magnified. Although I am confident you all bring to your practice always an air of empathy and gentle touch, I will admit, I have had moments of frustration fueled by adverse patient interactions. Upon later reflection,  I wish I could have de-escalated some of these situations sooner. We are all human, and to deny our potential for mirroring anger is ignoring a huge blind spot in our practice. For all of our safety and the safety of our patients, we must take care to maintain an environment that is as least provocative as possible, even more so than usual.

I thank you all for taking the time to read this email, and I also thank you all for the work that you do. Years later, future providers will reflect on all we have been through as a discipline in the middle of a pandemic and social unrest; these are unprecedented times indeed. You all are truly heroes, never forget that!

~Christopher J. Ford, MD

These unprecedented times call for an unconventional ACEP20. After thoughtfully considering many different options and ideas, ACEP has made the decision to move ACEP20 to an online-only experience. More details will be released soon as the ACEP annual meeting evolves in exciting new ways. And while the delivery may be different, you can expect the same expert education and CME credit from the world-class faculty you respect. Read more from the ACEP President

ACEP launched the COVID-19 Wellness Hub to support EM physicians through the COVID-19 grind.

You'll find options for peer support and crisis counseling, plus the latest advocacy efforts related to removing barriers to care. You can address stress at its source, whether it's related to patient care, workplace, litigation, finances or personal stuff.

For those who want to do a deeper dive into specific issues, the Hub has topical libraries for burnout, PTSD, physician suicide and more. 

New COVID-19 Website, Plus Updates to COVID-19 Field Guide

Featuring more than 400 resources, the ACEP revamped COVID-19 website will help you find what you need, when you need it. Our most popular resource, the ACEP Field Guide for Managing COVID-19 in the ED (link), has grown to more than 230 pages and been translated to 5 additional languages. The following sections are newly updated: decontamination/cleaning, HCW checklist, HFNO, treatment and management. 

Capital Minute

Tune into our newly formatted Capital Minute webinar as we continue to bring you updates on our latest efforts to support and protect emergency physicians in the fight against COVID-19.  Click here to view the Capital Minute. Click here to register for the next live ACEP Capital Minute on Thursday, June 11.

Medicare Telehealth Flexibilities…Are They Here to Stay?

We are seeing an expansion of telehealth that we have never seen before, and it is hard to imagine ever going back to where we were before. However, for us to keep up the momentum and not return to the pre-pandemic telehealth world, a few things need to happen---read this Regs & Eggs blog.  

COVID-19 Financial Survival Guide: What You Need to Know

ACEP is standing up for our members who, despite serving on the frontlines of the COVID-19 pandemic, are having their livelihoods threatened. Cutting benefits, reducing shifts or canceling contracts in today’s environment is akin to signing a ‘Do Not Resuscitate’ order for many emergency departments and the physicians who care for patients, especially those in rural or underserved areas. Access the guide. 

Member Benefits: COVID-19 No Cost, Discount & Other Offers

You are risking your lives to care for patients from this unprecedented pandemic, and we all appreciate the additional stress on you and your families. We want to help. And, so do a lot of companies out there. So, thanks to you and thanks to the companies willing to support our healthcare heroes.  View the benefits. 

ACEP and other leading medical associations released a joint statement outlining steps to support the mental health of EM physicians and other clinicians during this pandemic. 

Developed by ACEP and the Coalition on Psychiatric Emergencies, the joint statement was signed by more than 40 groups. It emphasizes that a clinician's history of mental illness or SUD treatment shouldn't be used as an indicator of their current/future ability to competently practice medicine. 

"A physician's choice to address his or her mental health should be encouraged, not penalized," said ACEP President Bill Jaquis, MD, FACEP. 

The ACEP Ethics Committee is conducting a survey of Workplace Stress during the COVID-19 Pandemic.  The study is IRB approved and anonymous, and should take less than five minutes. ACEP members who have not yet participated are encouraged to take the survey here:
https://www.surveymonkey.com/r/LMRBFDT

New officers were recently elected by the Wisconsin Medical Examining Board (MEB). Tim Westlake, MD, an emergency physician, with ProHealth Care, was elected as Chair, Sheldon Wasserman, MD, FACOG, was elected Vice Chair and Alaa Abd-Elsayed, MD, was elected Secretary. 

Among discussion at the recent MEB meeting were the ramifications of the May 11 expiration of the Governor's Executive Order #72 and the impact on temporary licenses for physicians working across state lines to help with the COVID-19 pandemic response. 

WACEP President’s Message, May 2020
Ryan Thompson, MD, FACEP

Across the state, ED patient volumes remain significantly decreased, with some EDs seeing half or even a third of their usual volumes. While the initial decrease in volume was seen as something of a relief for some – who doesn’t love an easier overnight? – the persistent downturn has led to mounting concerns.

The first concern is, of course, for our patients. In the early days of the COVID outbreak, I was routinely having patients apologize to me for being in the ED for non-COVID related problems, even when they clearly needed to be seen for emergency care. They were worried that they were pulling me away from other people who might need my care, or that they would be “wasting” healthcare resources. While this concern for their neighbors is admirable, it is clearly ill-advised in the case of severe symptoms requiring ED evaluation, such as chest pain or abdominal pain.

Another cohort of patients avoiding the ED were people who were simply afraid that they would be exposed to COVID while in the hospital. I saw more than a few patients walk into the ED, look around at the isolation procedures in the waiting room and staff in their masks and face shields, and turn right around and walk back out. While this might seem like a reasonable fear, the fact is that we deal with highly infectious diseases in the ED all the time and are experts at preventing cross-contamination of patients.

This decrease in patients seeking ED care is doubly concerning when you consider the lack of outpatient care available right now. These patients aren’t seeking alternative care – they aren’t seeking care at all. This has led to a rash of delayed presentations and worse outcomes. Anecdotally, I’ve seen more ruptured appendices and perforated ulcers in the last 2 months than I normally would in a year.

Another major concern caused by low volumes is a significant drop-off in revenue for some groups. Small groups and rural hospitals run on thin margins as it is, and a sustained drop in volume could lead to corporate takeovers and hospital closings. While some government aid is available, it’s nowhere near enough to cover the losses. Compounding the problem is the significant amount of planning and sweat equity that went into preparing our EDs for COVID, often completely unfunded. Even for hospital employees and those employed by large groups, EPs across the state are seeing pay cuts and hours cut – an unneeded additional stressor in these already stressful times.

In order to try to reassure patients that Wisconsin’s EDs and hospitals are safe and have more than enough bandwidth to care for both COVID and non-COVID patients alike, WACEP has partnered with the Wisconsin Hospital Association. A new PSA will be hitting the airwaves soon across Wisconsin, reminding people that Wisconsin EDs are safe, well-equipped, and ready to care for them when they need us.