Senator John Barrasso was “Doctor” Barrasso, an orthopedic surgeon from Casper, Wyoming, long before he came to Washington. So, after the passage of broadsweeping healthcare reform, it came very naturally for him to offer a physician’s perspective on the floor of the Senate. Since then, he’s given these “second opinions” about the unintended consequences of healthcare reform nearly every week.

I don’t often get calls from thoracic surgeons asking for my help. But this was a unique circumstance. His son, a first year student at the U.S. Naval Academy (a plebe as we call them) was going through his first baptism by fire. He was concerned that his son was hitting a breaking point, so he reached out for my help.

It’s a simple question. Given a specific set of facts concerning the presentation of a patient in the ED, what would the reasonably prudent physician do? Or stated more specifically, was an emergency physician’s actions in response to a given set of facts reasonable? This is the “standard of care” against which the physician’s actions will be judged in a case of alleged negligence.

A response to the backlash following last month’s op/ed “Life Cycle of a Parasitic Specialist” Normally, we would allow an opinion piece to stand as just what it is, an opinion. After all this is America and we still have free speech. However, in this case, the vitriol and vulgarity of the responses to an opinion piece demanded an explanation from the editors who published it.

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As I arrived to work I saw that the parking lot and the waiting room were packed. This is not supposed to happen at this place. “I’m getting too old for this,” I mumbled to myself as I dropped my 2am lunch in the frig and grabbed a handful of charts. I’d raced through an hour of charts before it dawned on me that they were filling the rack as fast as I could empty it.

The CDC reports that 123.8 million patients visited an emergency department last year. That’s 41.4 visits per 100 population. That number has risen every year despite numerous, concerted efforts by the government and the insurance industry to stem the rising tide. Could it be that patients see what the politicians and planners seem to be missing, that the model of emergency care by qualified specialists, when and only when you need it, is a good model for health care delivery?

With less access to primary care and multiple gatekeepers adding to the expense of health care, perhaps EPs should be the final stop for many ED patients.