Old Dog Meets Best and Brightest

[I wrote the original version of this post ten years ago. I’ve rewritten it in past tense but kept the gist. The specialty of emergency medicine is now fifty-years-old. My thoughts in 2010 have more relevance today as the specialty continues to draw the best and brightest. Our patients win for that.]

At least a third of the people in the room were not born when I attended my first ever Scientific Assembly of the American College of Emergency Physicians (ACEP) in 1975. That meeting took place in Las Vegas, which makes it more remarkable that I remember any of it.  (Can you say “Palomino Club”?)

I had recently completed a surgical internship, and more recently left a promising neurosurgery residency to become one of those new “emergency room doctors” who limited their practice to the hospital ER. I was one of about 5,000 early members of ACEP, all of whom were “second-career” emergency physicians like me. The house of medicine (AMA) did not recognize emergency medicine as a specialty. The American Board of Emergency Medicine was just a dream in the heads of the hardy pioneers who founded ACEP to support the continuing medical education of second career docs like me. That was a daunting task with no formal body of knowledge or curriculum.

In those days, my breadth of medical knowledge contained Swiss-cheese-like holes that required rapid filling before I could safely treat emergency department patients while practicing (literally) this “newest specialty in medicine.” I felt comfortable diagnosing surgical or neurologic disease and managing victims of traumatic injury. But hand me an electrocardiogram and I had difficulty knowing which end was up, let alone recognizing subtle indications of what we now call “acute coronary syndrome.”

Over ensuing years, the College won recognition of the specialty of emergency medicine by defining a body of knowledge and core content. The American Board of Emergency Medicine became a reality, and I became not only a diplomate but an oral examiner.

Training of emergency physicians progressed from the pickup games of those early ACEP meetings to a formal curriculum taught by ACGME-accredited residencies in emergency medicine. The specialty soon became so popular that positions in EM residencies were among the most sought after in the entire house of medicine. In those days we boasted that emergency medicine attracted the “best and brightest” graduates of the US medical education system.

My US Navy career gradually drew me away from the emergency department as I became more involved in executive and operational medicine. As my navy retirement date approached, I decided that my former home-grown emergency medicine skills were long overdue for refreshment. I endured a trans-Pacific flight in the very back of a JAL 777 from Japan to San Francisco to attend a course entitled, “Essentials of Emergency Medicine 2010.”

Wow! Talk about the best and brightest! The quality of evidence-based knowledge and education in that course blew me away. We’re talking major leagues, folks. Looking back on my early days as a leader in the specialty, I feel as if I’d awakened from a long sleep to find a dream come true. In those early ACEP Scientific Assemblies we relied on educators from other specialties to teach us the various aspects of our “specialty in breadth.” Those presentations were often irrelevant to ED practice, reflecting the presenter’s own specialty perspective (or bias).

In the “Essentials” course, a cadre of emergency medicine superstars, many from one program at USC LA County, presented topic after topic, fully researched and developed to instill a depth of understanding and practical relevance to the emergency physician, and—more important—the ED patient; a depth we could not fathom in those early days of building the specialty. These were, in every sense of the term, the best and the brightest stars in the house of medicine. The audience, hailing from throughout the U.S., Canada, and abroad, contained many similar luminaries.

The experience moved me to extreme optimism about the quality of emergency care available to U.S. citizens and beyond, forty-plus years after those early visionaries of ACEP devoted their time and energies, sometimes against formidable opposition, to achieve that very end. Names like Wiegenstein, Mills, Rupke, Krome, Mangold, Rosen, Hannas, Haeck, Riggs, Podgorny and many others resonated in my mind. The best and brightest of today stand on the shoulders of those bold-thinking, dedicated giants from the early days of our specialty.

A highlight of my attendance at “Essentials” was the EKG session. Looking at the first of a series of practice EKGs, I recognized—within seconds—that I was holding the paper upside down. Now what was that cardiac rhythm…?