Each year, ACEP’s Council elects new leaders for the College at its meeting. The Council, which represents all 53 chapters, 39 sections of membership, the Association of Academic Chairs of Emergency Medicine (AACEM), the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents’ Association (EMRA), and the Society for Academic Emergency Medicine, will elect the College’s President-Elect, Council Speaker and Vice Speaker, and four members to the ACEP Board of Directors when it meets in October. This month, we’ll meet the Council officer candidates.

The Council officer candidates responded to this prompt: Give an example of an issue where you had to sideline your personal viewpoints to represent the opinion of a group.

Council Speaker

The following member is a candidate for ACEP Council Speaker.

Gary R. Katz, MD, MBA, FACEP (Ohio)

Current Professional Positions: chief medical officer and emergency physician at Community EM Partners, Ohio; assistant professor, department of emergency medicine, The Ohio State University, Columbus

Internships and Residency: emergency medicine residency, Summa Health System, Akron, Ohio; emergency medicine internship, Summa Health System

Medical Degree: MD, Medical College of Ohio (1998)

Response

One of my guiding principles is that when I represent an organization, I do so in a manner that speaks for that collective opinion without distancing myself from or otherwise undermining the decision authority of that organization. For this reason, I will focus on my process for when I assert my personal opinion and when I would set that aside in the duty of the organization to which I serve.

The first step is making sure I’ve asserted my personal opinion at the appropriate time. To do this, I must assure I have actively participated in the deliberative process to the extent allowable. During discussion if I find that a recommended action is errant or shows poor judgment, then it is appropriate to raise those concerns to the appropriate body, be that subcommittee, chair, Council floor, or other administrative component of the organization.

However, if the organization has been thorough, fair, and fulfilled its duty as a deliberative body, once the final decision is made, my duty is to then represent that point of view. This must be completed without acting defiantly or undermining the decision. This goes so far as to avoid distancing myself through statements such as, “While I don’t agree, the organization has decided to take [specified] action.” In a similar vein, I view it as inappropriate to recruit others to object to the decision on my personal behalf via backroom conversations, which is just another way to skirt one’s duty to properly represent a body’s position.

While a specific position may be at odds with my personal stance, it is important to remember that our organization has redundant processes to properly consider positions and share where we might individually disagree or agree. Through proper channels, it is always possible to reconsider, modify, or resolve decisions, but to do so, one must use the formal deliberative process to amend or rescind prior action. A highly functioning organization can employ these tasks for greater agility than blindly implementing past decisions under a changed or new construct.

Council Vice Speaker

The following members are candidates for ACEP Council Vice Speaker.

Kelly Gray-Eurom, MD, MMM, FACEP (Florida)

Current Professional Positions: chief quality officer and assistant dean for quality and safety; associate chair, director of clinical and business operations, and director of PA services department; and professor, department of emergency medicine at the University of Florida/UF Health Science Center, Jacksonville

Internships and Residency: emergency medicine residency and internship, University of Florida Health Science Center

Medical Degree: MD, University of Vermont College of Medicine (1992)

Response

Emergency physicians sideline their personal views all the time. We are 24-7-365. Anyone. Anything. Anytime. At any given moment, we are called upon to provide care and compassion to people we don’t agree with and sometimes don’t like very much. We deal with administrators and consultants who have vastly different viewpoints. Yet usually, we find a way to put aside our personal views and simply do our jobs to the best of our ability. I am no different. I take deep breaths. I walk away. I face-palm at my desk. I try to ignore the unimportant differences that cause needless turmoil during the shift. Most of the time in the ED, I can just keep moving.

Outside of the ED, it is harder. Social media and political advocacy in 2019 create entirely new levels of difficulty in the challenge of collaboratively finding common ground. Rapidly typing the first thing that pops into my inflamed brain when I see one of those posts is so tempting. The power is right there—a thumb click away. My view will be online for all to see. It is hard to step back from that adrenaline rush. When I start thinking, “Well, I will just tell them,” delete and scroll down has become my favorite self-centering trick. Wait, pause, and think it through. It doesn’t have the same immediate gratification, but it also doesn’t have the inevitable, “Ugh! What did I just do?”

Advocacy has a very different challenge because unlike social media, the people in the room can see me. Working across differences is critical to achieving our goals for ACEP and our EM physicians. I don’t agree with some of the people who are important to our advocacy efforts. I don’t always like their actions or their voting records. Mastering the poker face and reading the room have become key skill sets. A sense of humor doesn’t hurt either.

One of my DC representatives would take perverse delight in bad-mouthing my emergency department and my partners every time we entered their office. “You didn’t treat my constituent’s diabetes correctly. He had a blood sugar of 117, and you did nothing!” It was always a 15-minute browbeating from Dr. Google. They had no wish to be educated; they just wanted to start our conversations feeling their authority. I had to learn to hold my medical teaching moments for ACEP issues. If I deviated too far from Dr. Google, I became the enemy and the conversation was over. I wouldn’t let them get too far down the path of bad-bad doctor. Some things are just too important, and our clinical reputation is one of them. But allowing a small personal annoyance to slide for the good of the group was necessary in that particular office, at that particular time, to achieve advocacy success.

Finding humor, having patience, picking the right moments, and learning to set aside personal agendas are tools that will help me serve and facilitate discussions as Council Vice Speaker.

Andrea L. Green, MD, FACEP (Texas)

Current Professional Positions: emergency physician, American Physician Partners and Marshfield Clinic Eau Claire Center, Eau Claire, Wisconsin

Internships and Residency: emergency medicine residency, Howard University Hospital, Washington, DC; emergency medicine residency, Sparrow Hospital/University of Michigan, Lansing

Medical Degree: MD, University of Iowa College of Medicine (1979)

Response

In the state of Texas, we breed big ideas and big points of view. When President of the Texas College of Emergency Physicians, of course I had to tackle big issues. I fought against the repeal of Texas tort reform statutes, shut down an effort by a teaching hospital that was trying to create an alternative board emergency medicine fellowship, was involved with efforts to address the issue of Medicaid expansion in our state, and started our chapter residency visit program. I do not shy away from jumping into issues with both feet. I am skilled at recognizing when and how to intervene, putting things in proper perspective, and the importance of creating win-win situations in a variety of settings. I have integrity and selflessness, and I unquestionably understand suspending your personal viewpoints on behalf of others.

A personal example was a situation that occurred when I was a member of a single-hospital, independent, democratic emergency physician group. Our group was requested to provide staffing for a new facility being developed by our hospital. The group initially indicated to the CEO a willingness to accept the additional contract. However, as time grew closer to opening the new facility, the group began to reconsider the financial risk and the work. Our group hired a consultant who did an extensive financial and risk assessment and provided data indicating that the risk was not as substantial as the group predicted. I was comfortable with the data presented and the assessment of the consultant. I felt that our group could be successful and was concerned about the potential negative impact on our group of changing our position so late in the process. I encouraged our group to move forward with the project. After multiple meetings with the consultant, the group took a vote deciding not to move forward and requested that I present their decision to the CEO. This decision was made about 90 days prior to the opening of the new facility. I met with the hospital CEO concerning the decision of our group. I discussed with him the financial, staffing, and risk concerns of our group. He was extremely displeased with being advised of this decision at 90 days prior to his grand opening. To prevent our group from losing their contract, I knew I had to problem-solve. I agreed to help him with an alternative plan to keep his opening on track, ultimately creating a win for our group, who continued enjoying their single contract for over 20 years.

Howard “Howie” K. Mell, MD, MPH, CPE, FACEP (Illinois)

Current Professional Positions: national reservist emergency physician, Vituity, Emeryville, California

Internships and Residency: emergency medicine residency, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota

Medical Degree: MD, University of Illinois at Chicago College of Medicine at Rockford (2004)

Response

I have served as a member of the Public Relations Committee and as a spokesperson for ACEP for the last nine years. In that time, I don’t think I’ve seen a single clinical issue as contentious as the use of tPA for acute ischemic stroke. There are strong opinions on both sides of the debate, and I’ve been known to make my opinion very clear—to say I’m skeptical is perhaps a bit of an understatement. At one point, I had an opportunity to take that skepticism public, perhaps even to reinvigorate the debate nationally. But instead, I put the College first and faithfully represented ACEP as a spokesperson.

In February 2013, ACEP published a controversial guideline entitled “Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department.” This set off a firestorm. Almost immediately, a Council resolution was introduced asking that the policy be revisited and that a 60-day open comment period be included. Needless to say, the Council debate was spirited, lengthy, and at times downright heated. Many Councilors had significant questions about the data used to drive the conclusions, and we strongly disagreed with the determination that there was Level A (by ACEP’s rating scheme) evidence supporting the use of tPA. We stridently argued to rework the policy. That resolution was eventually passed by 75 percent of the Councilors. The policy would be revisited. The ACEP Board had a lengthy discussion regarding clinical policies in November 2013, and in January 2014, the Board approved specific direction and comments to the Clinical Policies Committee regarding implementation of the resolution.

When this occurred, many in the media (including some national news outlets) asked, “What happened [with ACEP’s policy]?” As an ACEP spokesperson, I was asked to handle some of these interview requests and to help come up with talking points regarding the controversy. This was an incredible opportunity to express my opinion to reporters, to explain the limitations of the data, and to describe the concerns shared by so many of our colleagues regarding the use of tPA in acute stroke. It might’ve been possible to drive the tPA question into the national health care discussion, especially considering the cost of the drug. However, it wouldn’t benefit ACEP to revisit the Council debate in the press. Putting the use of tPA to treat acute stroke into question in the public’s eye would only serve to confuse and even frighten patients, and ACEP didn’t have a recent clinical policy (at that point) to fall back on. So I helped craft a message that the debate on the resolution was a debate of methodology, about the rigor required for a Level A recommendation, and whether the meta-analyses used by the Clinical Policies Committee provided sufficient evidence. With this type of dry description and simple, but truthful, summation, most media outlets quickly lost interest. While I usually would wish to reenergize a debate about which I am passionate, that wasn’t my role.