Lynton Scholar Tehreem Rehman Reflects on the SEM Consensus Conference, September 2017

As someone just about to begin training in Emergency Medicine and who entered the profession of medicine invested in advancing health justice, it was an incredibly humbling experience to be included in a discussion with passionate and experienced leaders in the field of Social Emergency Medicine. From the very beginning, I was overwhelmed with the vast knowledge and perspectives being shared and debated, and eagerly reflected long after the sessions themselves ended. It was evident that in order to promote Social Emergency Medicine, physicians would need to look outside of the walls of the hospital in order to advocate for necessary institutional and structural change.

Within the institutions themselves, it would be imperative to garner support at the administrative level in order to create system changes that facilitated addressing structural determinants of health inequity. Additionally, institutions need to engage in curricular reform to ensure that future members of the profession are adequately trained to effectively address structural determinants. As someone who had to navigate numerous institutional barriers while establishing an interdisciplinary course on US Health Justice, the voiced need for greater mentorship and faculty support resonated with me. In order to truly promote cultural change within institutions that promotes the practice of Social Emergency Medicine, it would be particularly important, as one fellow participant noted, to include other members of the team such as nurses, physician assistants, and social workers in the design and implementation of relevant programs and innovation.

However, the work outside of the institutions themselves is arguably even more crucial. Even if system changes are made that facilitate identifying socioeconomic stressors in the clinical setting, the capacity to address them would be limited if adequate community-hospital partnerships are not established. Dr. Khaldun stressed that in the current health policy landscape, non-profit hospitals are mandated to devote a certain amount of resources to conduct a health needs assessment of the community and subsequently are incentivized to take action in order to meet metrics such as patient satisfaction and reduced hospital readmissions. However, the creation of community partnerships takes time and energy as you cannot easily undo the impact of historical institutionalized oppression and the intergenerational structural trauma that it consequently inflicted as Dr. James pointed out.

Outside of the sessions themselves, I benefited from the opportunities to get insight from different leaders in the field on their career trajectories and their different experiences with practicing Social Emergency Medicine. I intend to refer back to these acquired pearls of wisdom as I embark on my own journey of becoming an Emergency Medicine physician who effectively promotes health justice both within and outside of the walls of the hospital. Ultimately, I am grateful for the Lynton Scholarship that enabled me to participate in such an exciting and momentous milestone in the field of Social Emergency Medicine.

Lynton Scholar Rebecca Karb, MD, PhD, Reflects on the SEM Consensus Conference, September 2017

by Rebecca Karb, MD, PhD

It was an honor to attend the Social Emergency Medicine (SEM) Consensus Conference at the American College of Emergency Physician (ACEP) headquarters in Dallas, Texas. What an inspiring experience to get together with such a thoughtful, motivated, and justice-oriented group of EM physicians. The dialogue raised many important questions regarding the priorities for SEM as well as the strategies for pursing our mission. What is the most appropriate and effective strategy for addressing social determinants of health? And where is the most effective space to do so? Addressing SDOH in the ED is, by constraint of necessity, an individual-level intervention. As such, it should certainly be one of the tools that we research and develop as ED physicians; however, it cannot be the only space in which we intervene if we truly wish to address health inequalities.

We must be active and engaged at the community and policy level to change the underlying structures of inequality. For example, we may be able to develop an effective screen for homelessness or housing insecurity in the ED, and as a result provide an individual patient with the resources necessary to obtain secure housing. However, we have not altered the more upstream fundamental causes of disease but rather modified their effect on our individual patient. This is not unimportant and it is what we do as physicians—we treat individual patients. But our SEM mission must extend outside the walls of the ED and into our local communities and government. As ED physicians, we are on the frontlines of healthcare and have a unique window into the health of our communities. We should be systematically gathering information about our communities and using that knowledge in combination with our positions of privilege and power to advocate for fundamental changes at the policy level. I hope that we can continue to build a strong, cohesive movement and that EM can lead the way in the fight to eliminate health disparities.

This Is Not By Chance Alone

First Fridays in downtown Oakland is a monthly event that fills the streets with food and music and dance, brilliant colors, and enticing smells. Full of life. This past Friday, two groups of teenagers reportedly began an argument in the middle of the event.  Shortly, at least one person pulled out a gun and shot dead an 18-year-old boy in the middle of the street fair. His name was Kiante Campbell. Three other people were also shot and wounded: a teenaged friend of Kiante’s, and two young women in their twenties who were not involved in the argument and were simply out to enjoy the art and music. Hit by stray bullets, they were in the wrong place, at the wrong time. But the truth is with so many guns in our city and our country, any place could be the wrong place, any time could be the wrong time. The high prevalence of guns takes heated moments of dispute and turns them into lifetimes of irreversible loss and death.

Witness To Social Emergency Medicine

As we all know 20 children and 6 adults were shot and killed at Sandy Hook Elementary School on December 14th 2012. This horrific tragedy provoked a wide array of responses from leaders and citizens across the world. It prompted murmurs of a real response and dialogue about gun control and mental illness in our country by our elected leaders. Washington Post Associate Editor and presidential biographer David Maraniss called President Obama’s vigil to the victims his “Gettysburg Address”. His comparison is apt – the President’s speech was poetic, mournful, somber, and evoked the gravity and humanity of an evil day. 

Social Emergency Medicine Is A Two-way Street

Like most readers of this blog, I received a lot of calls and emails about Atul Gawande's recent New Yorker piece on high-cost patients (find it here).  The geospatial element, as well on the incorporation of the effects social pressures on ED use, were direct hits onto some of what Jahan Fahimi and I are working on with the Barometer Project, our effort to measure community stress and well-being from the ED. It was great to see these issues laid out so clearly in a very public forum.  

Belated Report From Phoenix: Still Walking On Air

Hard to believe that I never posted after our amazing panel in Phoenix. I was joined by several members of the Levitt Center’s Scientific Advisory Committee for a didactic session at the Society for Academic Emergency Medicine’s annual meeting. It was a bold move on the Program Committee’s part to select our unorthodox proposal.  I think we did not disappoint them.

An Embarrasment Of Riches: A New Fellow, And A Media Spotlight

We have a new Fellow, and a fine fellow he is indeed. The Levitt Center Board agreed to provide seed support for the first year of the first-ever Fellow in Social Emergency Medicine, Dr. Jahan Fahimi. Prior to his position as resident and then Chief Resident in our department, Jahan obtained a Master of Public Health from the Harvard School of Public Health and an MD from New York University, where he was elected into the Alpha Omega Alpha honor society.  Jahan is a Bay Area native, and a graduate of UCSD, summa cum laude.

Saem Faces Advocacy Role In Arizona

The most stimulating emergency medicine specialty meeting of the year, the Society for Academic Emergency Medicine, was greeted this year by many of us with less than the usual enthusiasm.  The same mind-expanding content, the same dear and deep people, but this year in Phoenix.  OK, it's hot.  OK, it's paved.  We can deal with that.  But the passage of the recent immigration law had many of us tied in knots.