EDITORIAL: Emergency: A View from Many Angles

Irina deFischer, MD

Scott and I recently saw the movie Sully, about airline Captain Ches ley Sullenberger’s successful landing of an Airbus A320 on the icy Hudson River in January 2009 after both engines were disabled when the plane ran into a flock of birds. Though the storyline focuses mainly on the NTSB investigation, I was fascinated by the response of the pilots and crew to the emergency, and how, with the help of ferry pilots, helicop ters and other emergency personnel, they were able to save all 155 souls on board with only minor injuries. Though they had never been in that situation before, they were very familiar with the equipment and had clearly rehearsed the procedures enough so as to be able to perform them almost without thinking, remaining calm throughout the process.

This issue of Marin Medicine focuses on emergency care from several angles. Retired Marin General emergency physi cian Dr. Miles Riner reviews the pivotal role of Emergency Rooms in our health care system and warns that many ERs are underfunded and may be unprepared to deal with potential disasters and epidemics. Dr. Veronica Jordan suggests we try to imagine “What if Primary Care Were as Easy to Access as the ED?” Neurologist Dr. Jon Artz, medi cal director of stroke services at Kaiser San Rafael, describes the Northern Cali fornia Stroke Express Program, which uses a team approach to evaluate and treat stroke patients as quickly as pos sible using local and regional resources simultaneously.

In a threearticle special section, “Emergency Care in Marin,” Dr. Jim Dietz, chair of emergency medicine at Marin General, outlines the plans for replacing that hospital’s 25yearold ER with a larger, more modern facility. He might do well to read the article by Dr. Tom Meyer, chief of emergency medi cine at Kaiser San Rafael, who describes the detailed planning that went into the design of his new Emergency Department, in order to be able to provide seamless patientcentered care for individuals with a multitude of conditions. Dr. Veronique Au tells us about Novato Community Hospital’s ED and its acute emergency stroke program.

At the other end of the stethoscope, otolaryngologist Dr. Sal Iaquinta reports on the care he experienced in the Emergency Room and hospital following a bicycle accident, including his discovery that humor and stoicism don’t always work to the patient’s advantage.

From the public health/prevention side, looking to keep people out of the ER, Marin County’s public health officer, Dr. Matt Willis, writes about the role of the medical society in supporting gun

violence research and evidencebased gun control laws, as well as in supporting phy sicians in their ability to screen families for guns in the home and counsel them about the safe handling and storage of firearms.

If all this sounds overwhelming, you might want to read the book A Fearless Heart, reviewed in this issue by Dr. Naveen Kumar, about cultivating compas sion, starting with compassion toward ourselves, to prevent and reverse burn out. And that’s a good thing to avoid since burnout—like the engine flameout that triggered Sully’s emergency—can have unpleasant consequences.

The issue concludes with four CMA related items. First, a report on the pre sentation to MMS president, Dr. Peter Bretan, of the Adarsh S. Mahal, MD Award at the annual CMA Gala. Then a 2016 House of Delegates Report, fol lowed by a listing of CMA’s Solo and Small Group Practice Resources. Finally, Dr. Bretan reports on CMA’s advocacy efforts on behalf of physicians on the issue of inadequate insurance networks and the tension between outofnetwork physicians being paid equitably for their work and patients being protected from “surprise bills.”

All in all, this issue of Marin Medicine is just what the doctor ordered for physi cians who’d like to think about a range of challenges outside the office.

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Dr. deFischer, a family physician at Kaiser Peta- luma, is chair of the Marin Medicine editorial board.
Email: irina.defischer@kp.org