Posts Tagged public health

Doing Everything for Everyone Everyday Forever

So I get this little insert in my ACEP Newsletter, which looks like it’s under the editorial control of GlaxoSmithKline Vaccines (which is its own posts in and of itself), and the authors are arguing for replacement of the regular Td (tetanus-diphtheria) vaccine with the new Tdap (tetanus-diphtheria-and-pertussis, Boostrix! sounds more exciting) vaccine. They make the case that, wow, shock, awe: adults aren’t getting vaccinated for pertussis to prevent the 600,000 adult pertussis cases every year.

They then go on to talk about how the Emergency Department is “in a unique position” to immunize people and “overcome racial, ethnic, and socio-economic barriers.” (Skeptical me thinks it’s really all about GlaxoSmithKline wanting to enter the tetanus vaccine market and make a couple bucks a pop, but again, skeptical me.) So voila, yet another “Look what good you can do in the Emergency Department!” spiel.

And the argument is true: our referral bias is one of the anti-doctor crowd. One that prefers not to get regular checkups, or prefer homeopathy and The Vitamin Shoppe, or don’t see the need to see a physician when they feel just fine. We do see people that other doctors don’t. And part of what makes our jobs great is that our interventions do matter more than other physicians. I give aspirin to 42 people with STEMIs, I save one of their lives. Other doctors give a baby aspirin for primary prevention and need to treat 10 times as many people.

But I can’t help but feel like it’s yet another request for our already strained and closing Emergency Departments. We have to see more impatient patients, faster, with fewer resources available and more things asked of us. Domestic Violence Screening. Rapid HIV testing. Vaccinations. Smoking cessation counseling. And blood cultures within 6 hours, before antibiotics. (Kind of kidding on the last one. But only kind of.)

Please don’t misunderstand me: I’m a public health advocate. Public health and vaccinations and sewer systems and hand-washing have impacted and saved more lives than I will one thousand times over, but I gotta ask: Could we get a little help around here?

Yes, the less pertussis the better. Yes, as an emergency physician I’m proud to stamp out tetanus. Yes, there’s a large portion of HIV+ people out there who are infecting other people because they don’t even know they’re positive. Yes, I want to be able to offer victims of domestic violence information and options and safety. But who else is coming to the party? And are they bringing drinks?

I mean to say this: if public health wants emergency medicine to help its cause, then why not scratch our backs as well? Case in point: want us to offer rapid HIV testing? How about letting us offer rapid HIV testing and giving us bedside, point-of-care troponins? Something to recognize that we’re already stretched thin, and maybe we’ll break even if we get both.

(And to the public health folks out there, how about recruiting some other people in “unique positions?” How about pharmacies that sell cigarettes and alcohol? Get them in on the game to offer HIV tests and vaccines. And smoking cessation. Or why not have anesthesiologists screen for domestic violence? They’re often in a more private setting than we are. Or why not encourage those “lifestyle” specialties — looking at you, dermatology and radiation oncology — to start screening as well?)

I support these additional requests, because I think we really can have an impact that other specialties simply can’t — but if we as a medical community as a whole agree that these things are important to the health of our patients, it’d sure be nice to have the issues framed as “uniquely addressed in the Emergency Department” rather than “only addressed by the Emergency Department.”

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