“Is everybody having fun?” shouted Dean Wilkerson, ACEP Executive Director. Some hoots and hollers and applause emanated from the group.

No, we weren’t at the EMRA party or that totally awesome NEMPAC cocktail party that serves red and blue cocktails during election years.

It was at ACEP Council meeting.

Now, this was my fifth Council meeting, the first was in 2008 in Chicago when I was a member of the EMRA Board of Directors. I thought it would be kinda boring at first. You know, a bunch of old fogies talking about better times and nitpicking semantics in the bylaws. I thought it would be a lot of hot air from people who like to hear the sound of their own voices.

But, alas, it was not. Well, there is plenty of hot air from people who like to hear the sound of their voices. But, it was actually pretty interesting, seeing the “business of emergency medicine” get done.

Live update: 0842: Oohhh, yes! ACEP now takes American Express again! Hoorah! They were pretty much the only ones who would give this in-debt-new-attending a business card.

Back to the business of emergency medicine. OK, so yes, this is how it all gets done. Well, most of it.

For those of you who have never been to a Council meeting, Council is held over 2 days. The first day is a little more relaxed, and everyone breaks up into groups to review and debate the resolutions. That can get pretty fun, actually. I love watching people get all riled up about that which they are so passionate. Even if it’s a bylaw. Although this year, the marijuana resolution wasn’t on the agenda. I’ve missed it and all the “discussion” around it.

The reference committees consider all of the testimony and either amend, recommend to adopt, refer or reject resolutions. Without reference committees, the Council would probably be in session for days trying to change and argue about the resolutions.

Day Two is more formal and governed precisely by parliamentary procedure. The entire Council gets together and begins to vote on the individual resolutions. Now, this is the part that can get interesting. Each resolution is not only discussed, but picked apart, sometimes line by line. If it wasn’t for parliamentary procedure, all of this would just end in a food fight or a rumble out back. I shoulda brought my piece.

Live update: 0859. Dr. Bob Suter, ACEP Past President, makes his first recommendation for change. I need to remind myself to keep count of his trips to the mic.

I grant that this can be tedious. But having served as a member of the EMRA BOD, little commas, articles and conjunctions can change the meaning of the resolution, and can change the responsibilities of the Board members, the individual members and the ACEP Council. So they are very important.

Live update: 0938. Dr. Suter just did 20 push-ups as punishment for using a cliche! I am so not joking.

One of the biggest debates of this year’s Council was if ACEP should oppose or support a single-payer system. Should we, as a college, come out one way or another? ACEP is a pretty big organization and includes more than 30,000 emergency physicians, likely with 30,000 opinions. This year there were two contradicting resolutions presented. One stated that ACEP supports a single-payer system, and another that stated ACEP opposes. Obviously both can’t pass.

Live update: 1123. Dr. Kevin Klauer, Vice Speaker of the Council, just admonished a councillor for using a mythical creature in an argument.

Another hot issue was the Choosing Wisely campaign. Basically, there is a huge list of tests (blood, urine, x-ray, CT, MRI) determined to be useless by other specialties that we are now being asked to use as a guideline. The goal is cost-effective care (See page 16).

Live update: 1359. Dr. Linda Lawrence just said “ass” in response to Dr. Klauer’s question, “To what part of the anatomy were you referring when you said ‘bite us in the you-know-what’?”

On one side of the issue is that, of course, we are all for cost-effective care and reducing needless tests. I hate that all these tests not only cost money, but many times they make no difference in my disposition. Some of these make sense, but, personally, I’m not sure us jumping on that bandwagon is such a good idea. I mean, I’m the one taking the risk usually, not the family doc or the pediatrician. If I feel a test is necessary, I’m going to order it. Ultimately, the Council voted not to join the Choosing Wisely campaign.

Live update: 1519. Well, I thought the medical marijuana issue wasn’t going to come up this year! But, alas, it was snuck in on the TBI/PTSD resolution as an amendment. It has been struck down as not being germane to the resolution. At least the rest of the Council isn’t smoking it. But, wait, where are his push-ups?

Another Live update: 1546. The councilor who put forth the medical marijuana amendment just called the pain medicine/patient satisfaction score resolution “half-baked.” Seriously. Push-ups, anyone?

Wow, there was a ton of debate about pain medication prescribing and the relation to patient satisfaction scores. That is certainly a hot topic, as more people die from prescription medication overdose than in car accidents nowadays.

I’ve had plenty of people who have said I am not compassionate because I don’t judiciously write for narcotics. I resent that insinuation. Being compassionate has nothing to do with giving people whatever they want. If someone is in pain, I will treat them. If this is your third visit to the ED that day, and I can see that you got narcs from the other ED, then, NO, I’m not going to write you a script so you can end up as an overdose 12 hours later.

Live update: 1624. Since people wanted to keep going and keep us ahead of schedule, Council Speaker Dr. Marco Coppola has asked for a leg bag instead of a bathroom break.

Once discussion and voting of the resolutions are complete, the Council moves onto the election process. The Council will elect a President-Elect and members of the Board of Directors.

I know, I know. Despite my commentary, all this STILL might sound a little boring. But members of the Council are discussing real issues that we deal with every single day in the ED. Council discussed everything from narcotic prescriptions to the ramifications of the Affordable Care Act to psychiatric patient boarding in the ED to EMR conversion.

Each time I attend Council, I discover that many of the frustrations I have on shift in my little corner of the world, other people have in their little corners. I learn how they deal with their issues, and, I don’t feel so alone in my fight. I can see that others are fighting the good fight with me.

Change is afoot, my dear EPs, and if you just show up for work and go home, you will be left behind. Now is the time to get involved, whether it’s with ACEP or a committee at your hospital, you need to ensure your seat at the table. If you don’t show up, they’ll just serve you up something that you didn’t order and certainly didn’t want.

Dr. Lisa Bundy wrote this column while sitting in the Council meeting. She is an attending physician at ERMed, LLC, in Montgomery, Ala., and a former photojournalist, who not only sings in the car, but talks to herself, is addicted to diet drinks and shoes, and thinks emergency medicine is the greatest specialty.