RS: Well, that’s not easy to answer, Kevin. It was certainly fly by the seat of your pants for sure. That part was exciting. I had no idea of what I didn’t know; none of us did. Going back to that perspective of the ’70s, we would do things that would be unthinkable today. If someone was really nasty, we paralyzed them and talked to them, “You know, when I bag you, you breathe. When I don’t bag you,” you’d stop bagging for a while, “you notice you don’t breathe. So I’m going to wake you up in a little while, and I want you to be really nice. Got it?” When they woke up, they were always nice.
Explore This Issue
ACEP Now: Vol 35 – No 12 – December 2016Today, the rules are entirely different. The expertise we bring to the bedside today is much more exciting. Back then, we didn’t have ultrasound, CT, or MRI. We had an IV, some blood, and that was about it.
KK: Zach, which world would you like to work in? In yesterday’s emergency medicine or today’s?
ZJ: Great question. I think it’s comforting to hear people who’ve been around for a while saying that they’re just as happy to practice today as they were initially. The entrepreneurial side of me thinks that it would have been advantageous to have been around 40 years ago. I think that starting your own group is challenging in today’s environment. At the same time, I think a lot of the major battles have been fought, so it’s certainly easier for folks to walk into emergency medicine today and be a respected member of the hospital and be respected as a specialist. I certainly thank everyone that came before us in terms of fighting all of those battles. In terms of where emergency medicine is headed in the future, I think that we’ve heard a lot more talk about being part of this acute care continuum and looking at how emergency medicine can get more involved in the prehospital environment, doing more things in terms of community paramedicine, keeping people out of emergency departments, how emergency physicians are more well-positioned to deal with unplanned episodic care, and looking at how new technologies are going to enable telemedicine to allow remote evaluation of patients.
JS: In the early ’70s, a resident we helped train in the community told me that a leader, Don Thomas, told him that there were three things you needed to know in emergency medicine: Was the patient alive or dead? Are they going to live or die in the next 30 minutes? And did they need to be admitted, or could they go home? Like Richard was saying, there were times I did things I was never trained to do as a rotating intern, but it saved people’s lives. Instead of having somebody to show you how to do something, you did it first, then you showed somebody else.
The entrepreneurial side of me thinks that it would have been advantageous to have been around 40 years ago. I think that starting your own group is challenging in today’s environment. — Zachary Jarou, MD
5 Responses to “Emergency Medicine Founders Discuss Origins of the Specialty, How It’s Changed, and What the Future Holds”
December 18, 2016
Cindy Pearsall Sussman MD FCEPI was sorry to not see a credit given to Dr David Wagner, the real “grandfather of Emergency Medicine” in your article. Dr Wagner was a general surgeon at the Medical College of Pennsylvania in Philadelphia and noted the immense need for an Emergency Medicine residency program. His was the first, and paved the way for many more to come. As a graduate of that program, I am proud to say that we were well prepared for just about anything that came our way. Dr Wagner deserves credit for having the foresight and energy to get the field on its feet.
December 18, 2016
Cindy Pearsall Sussman MD FCEPCorrection- Dr Wagner was a pediatric surgeon
December 18, 2016
MarianKevin,
Thank you for an insightful article regrading the history of emergency medicine and where we are headed.
I find it ironic that there are two articles in this edition of ACEP eNow discussing diversity in emergency medicine, however, your interview panel lacked diversity. I am certain that this was not intentional, but it certainly highlights the unawareness at times of this particular issue.
December 19, 2016
Kevin Waninger MD FACEPEven more important, Dr. David Wagner was a great role model and a really nice man. I am a better doctor, and even more important, a better colleague, friend and father, because of my interaction with Dr. Wagner.
November 22, 2018
Kathleen Nakfoor, Ed.D, MBA, MSIS, RNI had the privilege of working with Dr. John Wiegenstein, MD and Dr. Eugene Nakfoor, MD from 1970 to 1975. I was told “history is being made in this emergency room” and know this to be a fact. I recall working with Dr. Wiegenstein the nights before he head off, yet, to another meeting to battle for EM as a speciality. He entertained us with stories of his less than impressive luggage when checked into the presidential suite. I was well aquatinted with stories of progress being made in EM.
What has been overshadowed by the enormity of ACEP formation and EM becoming a specialty, are the historical changes that were made in emergency department management. I recall Eugene Nakfoor, MD, also a founding ACEP member, telling me stories of the fact no one knew how to bill for services, such a practice was unprecedented. He garnered “departmental status” in which he controlled all hiring and firing of the entire staff.. He and the nurses developed the original scribe system, not the one in existence today. There has never been such a well managed emergency department using the scribe; actually a pivotal individual with whom the department was organized.