He has received numerous awards for his role in advancing emergency medicine and has served in many leadership positions for the American College of Emergency Physicians and the American Board of Emergency Medicine. He was the editor-in-chief of the Journal of Emergency Medicine and was an author and the original editor of the most highly regarded textbook in the field, Emergency Medicine: Concepts and Clinical Practice, now in its eighth edition.
Dr. Rosen has also co-edited numerous other textbooks, including: The Five Minute Emergency Medicine Consult; Protocols for Pre-hospital Emergency Care; An Atlas of Emergency Medicine Procedures; Emergency Pediatrics, Essentials of Emergency Medicine and; Diagnostic Radiology in Emergency Medicine
[[{"fid":"883","view_mode":"media_adaptive","type":"media","attributes":{"height":201,"width":144,"style":"float: left; width: 144px; height: 201px;","class":"adaptive media-element file-media-adaptive"}}]]Dr. Rosen, who is board certified in both emergency medicine and general surgery, is currently working on a new book that will address geriatric problems in emergency medicine. The book is part of a series of books he has published on the following topics in emergency medicine: Ethical Problems in Emergency Medicine and Cardiovascular Problems in Emergency Medicine.
Dr. Rosen said that a field without literature isn’t much of a field, and that he is most proud of two accomplishments: the literature he has created and the physicians he has trained. At the DEM, the Rosen legacy will continue not only through his scholarly contributions, but in the legacy of his great niece, Sophie Galson. Sophie will begin her residency at the DEM and represents the third generation of emergency physicians in his family.
In May, he received an honorary PhD from Washington University in St. Louis and provided a lecture to the emergency department while there.
Dr. Rosen took a moment to share his views on a number of issues affecting emergency medicine and to discuss his legacy.
On Healthcare Reform
Key components of the Affordable Care Act will take effect in 2014 and affect all aspects of healthcare delivery. Dr. Rosen believes that emergency departments will continue to be the only convenient way to get care within the health care system and that initially, there will be an increase in payment for services that were not being paid for before.
“The myth of primary care alleviating the workload of the emergency department is a persistent myth that won’t go away,” said Dr. Rosen. “Primary care offices will never be open 24-hours a day and even if they were; and there is no sign of this happening, primary care physicians cannot care for true emergencies.”
The initial increase in payment for services will only be temporary, as Dr. Rosen foresees government regulation on patient care being initiated to keep government costs down.
“The three pillars of the Obama healthcare plan are increased access, improved quality and lower costs. You can do one of those three, but you can’t do all three. The government has already undertaken various stratagems to decide; retrospective to the patient’s care, whether or not the treatment will get paid.”
For instance, Dr. Rosen says, the government and health planners will begin to more intensely question retrospective data after a patient’s work-up has been done to assess if payment is justified. “But there is no way, you can look at a 55-year old man with chest pain and say that it isn’t ischemic heart disease until you’ve looked into it and just because you have demonstrated that it wasn’t, it doesn’t make it an inappropriate visit to the emergency department, even though the chances are great that we will stop getting paid for just such a retrospective analysis.”
On Maintaining Quality of Care
‘My biggest fear of government bureaucracy is that in the name of quality, they will in fact force us to deliver only the medical care that has a high probability of success. That means that some of the patients who had a low probability of success and that we have been able to salvage, will not be eligible for that same level of care in the future.”
The solution, Dr. Rosen says, is to have doctors who are willing to creatively fight for the opportunity to save patients.
“One of the things I have seen in government controlled medical systems is the absence of creativity and the refusal to accept the use of new methods of diagnosis and treatments. We somehow have to fight to keep that kind of creativity in our practice and not just in emergency medicine, but in all of medicine.
On the Future of Emergency Medicine
Dr. Rosen believes that medicine is evolving more and more toward two species: acute care and elective and chronic care and sees emergency physicians taking on more of the acute care needs of patients.
“We are seeing things that I never thought would come to an emergency department like the post-op care of same day surgery. We are taking on more and more patients acutely and probably doing as good a job as we used to do when we admitted them into the hospital.”
He predicts that emergency medicine will become more specialized and says emergency physicians are already doing the bulk of the acute diagnostic care for every specialty.
“Does this mean that we will be doing the surgery and organ transplantation and skeletal fixations? No, I don’t mean that at all, but I think we are the ones who will deliver the acute septic care.” He also predicts that the emergency department will have to expand. “We have to be proactive. Not to the point of making individual house calls but perhaps institutional calls.”
“You don’t want to try to do too much out in the field and yet, there are things that make a big difference if you do them out in the field and that can be done well. We must continue to have very strong relationship with those agencies providing pre-hospital care.”
On the Role of Emergency Medicine Physicians and Earning the Respect of Peers
“It requires a certain personality to do emergency medicine. It is solving puzzles within the constraints of the pressure of time. It is managing multiple problems simultaneously and it is the chance to be the one to solve the patient’s problem acutely. Not everyone likes that. Not everyone is good at it and not everyone should try to do it, but if you do, to me it is the definition of what a physician is.”
He credits the leadership within the UA Department of Emergency Medicine for the respect the field of emergency medicine has gained and urges new residents to fight for that respect.
“I think that there is a good deal more respect for our specialty than when we started and I think it’s in large measure to do with the respectability and accomplishments of people like Harvey Meislin, MD, Sam Keim, MD, Frank Walter, MD, Terry Valenzuela, MD and Ken Iserson, MD, and other members of this faculty who have put in a lot of time and energy into the development of the field,” said Dr. Rosen.
“We have got to keep fighting for that respect and the only way you are going to attain it, is by being respectable.” He urges emergency medicine physicians who become disenchanted to remember why they became a doctor and what they hoped to accomplish in emergency medicine.
“As I look back at my life in emergency medicine, I don’t feel like I wasted it. I can’t think of a single shift where I worked in the emergency department where I didn’t see at least one patient who I felt I had helped. That was one of my goals as a physician, I wanted to do something that was worth doing that would help people and that’s emergency medicine. You have to remember the price tag for doing something worth doing is high, but it’s worth paying.”
On the Challenges in Emergency Medicine
Dr. Rosen said there are two big challenges facing emergency medicine: Geriatric care and the change in the bacteria and viruses that cause disease.
“We see very few diseases in the elderly that are a onetime event.” In treating geriatric patients, Dr. Rosen said, the norm is to expect re-admittance to the emergency department for age-related care and the treatment of chronic diseases that worsen over time. He anticipates that with the healthcare reform act, emergency departments will face bureaucratic obstacles in the payment for those re-admitted.
He also said bacterial resistance will continue to be a challenge for those practicing medicine, including those in the emergency department. He recalled a statement made by the late Nobel laureate, geneticist and microbiologist, Joshua Lederberg, who said, we are at a war with bacteria and we have weapons that only work for a while. “That doesn’t mean that we shouldn’t use antibiotics, but it does mean that we have to understand that they won’t continue to work and we have to use them wisely,” Dr. Rosen said.