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New Decade, New Challenges

January 11, 2010

As we welcome a new decade, I’ve been thinking a lot about perspective. This past decade has been marked by terrorism (at home and abroad), economic collapse, home foreclosures, H1N1 and regime changes. Not a very upbeat decade, as decades go. Ronald Reagan spoke of that bright shining city on a hill and challenged us all to work to have the future we all desire. Is that still possible and what will that future look like?

In 2000, little did anyone realize that there was something called Facebook, Twitter or the iPhone. Today many can’t imagine our lives without them. In emergency medicine, we have seen amazing developments including drug eluting stents, advances in trauma care, explosion (not all good) in the use of CT scans and bedside ultrasound impacting our practice in ways we never thought possible.

What will this decade bring for us who practice in the ED and healthcare in general? Will it bring access to primary care for our patients? Will we be paid less for what we do? How much more “hassle factor” can we take while still providing high quality care? Will the overall cost of care be lowered? Depending on where you stand in the political spectrum, your answer will be very different.

What I do know is that no one will be able to predict what this world will look like in 2020 (with any certainty). I am also sure that while some say the days are bad now we are certainly not engaged in a Civil or World War. Our economic crisis does not compare to 1929 with 25% unemployment. H1N1 is not the Great Influenza pandemic of 1918 where 20-40 million died worldwide.

Which leaves us looking at that city on the hill. There will be a thousand reasons why we can’t reach it. Too far, too much regulations, bad weather, people working against us, not enough water on the journey just to name a few. Does that mean we shall just give up because it’s too hard? Of course not.

In the last 200 odd years, there have been thousands of reasons why our ancestors shouldn’t have traveled to America. For some insane reason, they thought the risk of travel to a far and distant shore (one they never saw on a google search) with the hope of providing a better future for their family was worth it. Does that mean that we should abandon our personal ancestry that has delivered us to today? Since that is our source of strength why wouldn’t we want to take the best of our past to forge a new collective future?

In emergency medicine, there is also a shining city on the hill. That future involves our patients being seen immediately by an exceptional provider who has immediate access to past medical information. The patient is treated compassionately and efficiently using the latest advances in technology while results are explained in ways they can understand. Once our patients are treated, rapid follow-up is scheduled when necessary to avoid a revisit to the ER and allow other non-urgent conditions to be fully evaluated.

Crazy talk! That’ll never happen! I submit it already does. Look up, over there, up higher. All it takes is for us all to be persistent enough to find the path that gets us there.

May it be a great decade for all of us.

Angelo Falcone, MD

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