The "Bottom Line"

In the almost 10 years I have been writing monthly editorials for EM, I frequently find myself searching for a well-known quote I could adapt, or an analogy I could use to emphasize the main point of an editorial. This practice began with the second editorial “Victims of Our Own Success?” (Emerg Med. 2006;38[7]:9), about the June IOM report, “Hospital Based Emergency Care—At the Breaking Point,” describing overcrowded EDs, long lengths of stay, and subsequent ambulance diversions. To sum up the consequences for EDs, I adapted a quote from the late Yogi Berra about a popular restaurant: “Nobody goes there anymore—it’s too crowded.”

In “The Language of Emergency Medicine” (Emerg Med. 2006;38[12]:9) describing nonmedical terminology old and new, applied to medicine, I suggested a Bush administration motto for all of the non-“pay-for-performance” ED patients waiting to be evaluated, and all those the “gatekeeper” keeps waiting for an inpatient bed: “no patient left behind.”

A discussion of the need for appropriate and timely emergency care for the rapidly increasing numbers of elderly ED patients was entitled “It’s About Time” (Emerg Med. 2007;39[1]:7), and ended with “the golden hour” may not be what it used to be, and the “golden years” for most people never were, but there may nevertheless be a “golden opportunity” for emergency medicine to begin dealing with these increasingly important issues now....”

“The Least We Can Do” (Emerg Med. 2007;39[3]:8) compared working in an ED to performing in a theater in the round—for 8 to 12 hours at a time—and went on to bemoan the too-frequent times we walk past patients “like restaurant waiters who are oblivious to all [our] attempts to get their attention.”

In “Remembering Howard Mofenson” (Emerg Med. 2007;39[5]:7), I wrote about the famed Long Island pediatrician, toxicologist, and highly decorated World War II combat medic who was severely injured for the rest of his life. “I learned a great deal about toxicology and medicine from him. But I also learned something even more valuable to an emergency physician…and that was, to quote another World War II hero, Winston Churchill, “Never give in—never, never, never.”

In “The Razor’s Edge” (Emerg Med. 2007;39[6]:8 and Emerg Med. 2014;46[4]:149), I noted that Occam’s razor, aka the “law of parsimony,” is a paradigm often used to urge internists to seek a single diagnosis, such as tuberculosis or sub-acute bacterial endocarditis to account for a multitude of diverse signs and symptoms. But I noted that in emergency medicine, Gillette’s razor—beginning with its twin bladed Trac II and now including up to five separate blades—was a more apt model for ED patients who often have multiple causes for a single symptom, such loss of consciousness precipitated by syncope and followed by head trauma.

“Those Daily Disasters” (Emerg Med. 2008;40[10]:8 and Emerg Med. 2014;46[10]:436), contrasted the almost instant application of all available human and material medical resources to a declared disaster, with the sluggish response to severe ED overcrowding and surges, and asked why one type of disaster was more important than the other. “This seeming oversight is perhaps best expressed in the words of the late comedian George Carlin. “I’m not concerned about all hell breaking loose, but that part of hell will break loose. It will be much harder to detect.”

The “mixed messages” (Emerg Med. 2008;40[11]:8) given to ED patients who we treat in the middle of the night and then ask why they don’t come in the daytime or go to a primary care physician instead, seemed to be best illustrated by a Richard Tripping “art poem” that cleverly redesigned the familiar red and white reversible plastic shop sign to read “Come in, We’re closed” on one side, and “Sorry, We’re Open” on the other.

Finally, at this time of year, for all of those days in the ED when nothing seems to go right and we get yelled at by unhappy hospital colleagues, or by patients frustrated by an ED visit necessitated by an unresolved medical problem, or a long wait for an inpatient bed, I suggested a remake of Frank Capra’s classical film ‘It’s a Wonderful Life,’ (Emerg Med. 2007;39[12]:8) “demonstrating how much worse the world would be if emergency medicine had never been invented….[and calling] it ‘It’s a Wonderful Specialty.’” 

Once again, we wish everyone in emergency medicine a wonderful holiday season, and a very happy and healthy New Year. 

To start off the New Year next month, more “bottom lines” will be offered.

In the almost 10 years I have been writing monthly editorials for EM, I frequently find myself searching for a well-known quote I could adapt, or an analogy I could use to emphasize the main point of an editorial. This practice began with the second editorial “Victims of Our Own Success?” (Emerg Med. 2006;38[7]:9), about the June IOM report, “Hospital Based Emergency Care—At the Breaking Point,” describing overcrowded EDs, long lengths of stay, and subsequent ambulance diversions. To sum up the consequences for EDs, I adapted a quote from the late Yogi Berra about a popular restaurant: “Nobody goes there anymore—it’s too crowded.”

In “The Language of Emergency Medicine” (Emerg Med. 2006;38[12]:9) describing nonmedical terminology old and new, applied to medicine, I suggested a Bush administration motto for all of the non-“pay-for-performance” ED patients waiting to be evaluated, and all those the “gatekeeper” keeps waiting for an inpatient bed: “no patient left behind.”

A discussion of the need for appropriate and timely emergency care for the rapidly increasing numbers of elderly ED patients was entitled “It’s About Time” (Emerg Med. 2007;39[1]:7), and ended with “the golden hour” may not be what it used to be, and the “golden years” for most people never were, but there may nevertheless be a “golden opportunity” for emergency medicine to begin dealing with these increasingly important issues now....”

“The Least We Can Do” (Emerg Med. 2007;39[3]:8) compared working in an ED to performing in a theater in the round—for 8 to 12 hours at a time—and went on to bemoan the too-frequent times we walk past patients “like restaurant waiters who are oblivious to all [our] attempts to get their attention.”

In “Remembering Howard Mofenson” (Emerg Med. 2007;39[5]:7), I wrote about the famed Long Island pediatrician, toxicologist, and highly decorated World War II combat medic who was severely injured for the rest of his life. “I learned a great deal about toxicology and medicine from him. But I also learned something even more valuable to an emergency physician…and that was, to quote another World War II hero, Winston Churchill, “Never give in—never, never, never.”

In “The Razor’s Edge” (Emerg Med. 2007;39[6]:8 and Emerg Med. 2014;46[4]:149), I noted that Occam’s razor, aka the “law of parsimony,” is a paradigm often used to urge internists to seek a single diagnosis, such as tuberculosis or sub-acute bacterial endocarditis to account for a multitude of diverse signs and symptoms. But I noted that in emergency medicine, Gillette’s razor—beginning with its twin bladed Trac II and now including up to five separate blades—was a more apt model for ED patients who often have multiple causes for a single symptom, such loss of consciousness precipitated by syncope and followed by head trauma.

“Those Daily Disasters” (Emerg Med. 2008;40[10]:8 and Emerg Med. 2014;46[10]:436), contrasted the almost instant application of all available human and material medical resources to a declared disaster, with the sluggish response to severe ED overcrowding and surges, and asked why one type of disaster was more important than the other. “This seeming oversight is perhaps best expressed in the words of the late comedian George Carlin. “I’m not concerned about all hell breaking loose, but that part of hell will break loose. It will be much harder to detect.”

The “mixed messages” (Emerg Med. 2008;40[11]:8) given to ED patients who we treat in the middle of the night and then ask why they don’t come in the daytime or go to a primary care physician instead, seemed to be best illustrated by a Richard Tripping “art poem” that cleverly redesigned the familiar red and white reversible plastic shop sign to read “Come in, We’re closed” on one side, and “Sorry, We’re Open” on the other.

Finally, at this time of year, for all of those days in the ED when nothing seems to go right and we get yelled at by unhappy hospital colleagues, or by patients frustrated by an ED visit necessitated by an unresolved medical problem, or a long wait for an inpatient bed, I suggested a remake of Frank Capra’s classical film ‘It’s a Wonderful Life,’ (Emerg Med. 2007;39[12]:8) “demonstrating how much worse the world would be if emergency medicine had never been invented….[and calling] it ‘It’s a Wonderful Specialty.’” 

Once again, we wish everyone in emergency medicine a wonderful holiday season, and a very happy and healthy New Year. 

To start off the New Year next month, more “bottom lines” will be offered.

In the almost 10 years I have been writing monthly editorials for EM, I frequently find myself searching for a well-known quote I could adapt, or an analogy I could use to emphasize the main point of an editorial. This practice began with the second editorial “Victims of Our Own Success?” (Emerg Med. 2006;38[7]:9), about the June IOM report, “Hospital Based Emergency Care—At the Breaking Point,” describing overcrowded EDs, long lengths of stay, and subsequent ambulance diversions. To sum up the consequences for EDs, I adapted a quote from the late Yogi Berra about a popular restaurant: “Nobody goes there anymore—it’s too crowded.”

In “The Language of Emergency Medicine” (Emerg Med. 2006;38[12]:9) describing nonmedical terminology old and new, applied to medicine, I suggested a Bush administration motto for all of the non-“pay-for-performance” ED patients waiting to be evaluated, and all those the “gatekeeper” keeps waiting for an inpatient bed: “no patient left behind.”

A discussion of the need for appropriate and timely emergency care for the rapidly increasing numbers of elderly ED patients was entitled “It’s About Time” (Emerg Med. 2007;39[1]:7), and ended with “the golden hour” may not be what it used to be, and the “golden years” for most people never were, but there may nevertheless be a “golden opportunity” for emergency medicine to begin dealing with these increasingly important issues now....”

“The Least We Can Do” (Emerg Med. 2007;39[3]:8) compared working in an ED to performing in a theater in the round—for 8 to 12 hours at a time—and went on to bemoan the too-frequent times we walk past patients “like restaurant waiters who are oblivious to all [our] attempts to get their attention.”

In “Remembering Howard Mofenson” (Emerg Med. 2007;39[5]:7), I wrote about the famed Long Island pediatrician, toxicologist, and highly decorated World War II combat medic who was severely injured for the rest of his life. “I learned a great deal about toxicology and medicine from him. But I also learned something even more valuable to an emergency physician…and that was, to quote another World War II hero, Winston Churchill, “Never give in—never, never, never.”

In “The Razor’s Edge” (Emerg Med. 2007;39[6]:8 and Emerg Med. 2014;46[4]:149), I noted that Occam’s razor, aka the “law of parsimony,” is a paradigm often used to urge internists to seek a single diagnosis, such as tuberculosis or sub-acute bacterial endocarditis to account for a multitude of diverse signs and symptoms. But I noted that in emergency medicine, Gillette’s razor—beginning with its twin bladed Trac II and now including up to five separate blades—was a more apt model for ED patients who often have multiple causes for a single symptom, such loss of consciousness precipitated by syncope and followed by head trauma.

“Those Daily Disasters” (Emerg Med. 2008;40[10]:8 and Emerg Med. 2014;46[10]:436), contrasted the almost instant application of all available human and material medical resources to a declared disaster, with the sluggish response to severe ED overcrowding and surges, and asked why one type of disaster was more important than the other. “This seeming oversight is perhaps best expressed in the words of the late comedian George Carlin. “I’m not concerned about all hell breaking loose, but that part of hell will break loose. It will be much harder to detect.”

The “mixed messages” (Emerg Med. 2008;40[11]:8) given to ED patients who we treat in the middle of the night and then ask why they don’t come in the daytime or go to a primary care physician instead, seemed to be best illustrated by a Richard Tripping “art poem” that cleverly redesigned the familiar red and white reversible plastic shop sign to read “Come in, We’re closed” on one side, and “Sorry, We’re Open” on the other.

Finally, at this time of year, for all of those days in the ED when nothing seems to go right and we get yelled at by unhappy hospital colleagues, or by patients frustrated by an ED visit necessitated by an unresolved medical problem, or a long wait for an inpatient bed, I suggested a remake of Frank Capra’s classical film ‘It’s a Wonderful Life,’ (Emerg Med. 2007;39[12]:8) “demonstrating how much worse the world would be if emergency medicine had never been invented….[and calling] it ‘It’s a Wonderful Specialty.’” 

Once again, we wish everyone in emergency medicine a wonderful holiday season, and a very happy and healthy New Year. 

To start off the New Year next month, more “bottom lines” will be offered.