Tuesday, May 8, 2007

Tribal Thinking & The Ultimate Confounder

Today, I exchanged some interesting communication with the leader of an organization that has been affectionately dubbed "EM's crazy uncle". I asked him to state very simply, "yes or no", that there was no place in the House of Emergency Medicine, for prejudice and discrimination.

Unfortunately, I did not receive a simple yes or no, as one might expect from most well-meaning and well-intentioned folk of good conscience. Nope. Instead I got an answer that was extremely conditional upon another condition that was itself conditional upon something to do with whether ABEM agreed that prejudice and discrimination were ok - or something like that......I think.

His answer was a touch confusing. Honestly, I did ask him to use small words, because my intellect was not as vast as his, but alas, I was still unsure what he was going on about.

Let me share with you some words from a quantum physicist, Fred Alan Wolf. I think they speak very well to the current debate on who should practice emergency medicine:

If I am a member of a tribe, my concept of self is different than if I am, say, a member of a closed family unit. My behavior, in turn, depends on how I see myself. For example, soldiers fighting in a war view themselves as part of a larger unit; and they behave quite differently toward those outside of their unit, particularly enemies, than they would if they were village people greeting strangers.

Thus, how we become aware of the world around us is to a large extent dependent on how we think about our individuality in relation to our environment.

Think about what group or "tribe" you most identify with and how this identification determines your thoughts, beliefs and behavior. What happens when you change your tribal affinity? A new "you" emerges.

Dr Wolf's words are rather enlightening, to say the least. They teach me not to be so passionately against any group or organization. I shouldn't even mock them, like calling them "crazy uncle" etc. In fact, I should warmly embrace them.

Jesus said we should love our enemies. I agree.

This month's Annals of Emergency Medicine, contains a very comprehensive and balanced article (pp. 614-617) by Maryn McKenna, on the state of play in EM today, and about how the IOM has somehow rekindled the debate on who should practice EM. It's an awesome read, and discussed every group's position. I'll leave it to you to decide who might be short of a full deck, and who might be in such a political quagmire, that 'doing the right thing' would require far too much red tape.

The article also touches on the key to the whole problem: money. Ms. McKenna calls it 'the ultimate confounder'.

Certain groups hide behind unproven arguments that quality will fall if we allow "just anybody" to practice EM, when the real truth of the matter is that they might not be able to upgrade from a $500K house to a $1.3m house. They might not be able to buy a vacation condo in Miami or Vegas. They might not be able to take another vacation to the Mediterranean - perhaps on the west coast of Italy in the shadow of Vesuvius!

Who will pay the price for these attempts at artificially reducing the number of emergency physicians in the USA? The patients. Such disgracefully bigoted policies will limit access to emergency care for so many people. There are already over 60 million people in America with no health insurance. Some kids can't even get a bloody vaccine!

And yet, some groups feel so strongly that ERs should only be manned by those physicians who have completed an EM Residency. What utter nonsense.

Even the pro-EM-residency organization, Society for Academic Emergency Medicine, declared in a 2004 study that "residency training will not supply enough specialists to meet the demand for emergency physicians for 30 years". I guess the left hand doesn't really know what the right hand is doing.

I work for the United States Alliance of Emergency Medicine. We comprise, emergency physicians (of all cloths, colors, nationalities, training and board certification), emergency nurses and paramedics. We embrace and welcome everybody. There should not be any tribal insurgencies. The whole world has witnessed what that kind of thinking results in.

I invite all members of other organizations that are clearly prejudicial and discriminatory, to join USAEM, and connect with like-minded, good people, of good conscience. People who can give you a straight answer, and are intellectually honest. People who do not think with their bank accounts.

I dream that one day, the various tribes will put their differences aside, and come together under one big tent - as big as we want it to be. It's not the 17th century any more. There is no room for restraints of trade or the creation of monopolies. Let's all be friends.

In the words of Rodney King, "why can't we all just get along?"
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Dr. de Asis said...

Congratulations on the blog and Keep up the good work! I have blogrolled you on my blog. Is there any way to link to the Annals of Emergency Med article you mentioned? Thanks.

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