I grew up in the home of doctors amidst
a closed community of scientists of
various types physicians engineers
chemists computer scientists with
phenomenal role models like my 95 year
old grandma who was a PhD zoology
professor in post-independence India it
would seem a foregone conclusion that I
too would become a scientist I chose to
become an emergency physician but I
also grew up in the home of a
self-taught artist whose images and
perspectives pervaded our physical space
in his mid life my father sought out his
first formal art education by taking
lessons with Edward looper an acclaimed
local african-american artist whose was
widely known for his bold use of color
ed loper was an anomaly himself born in
1916 his paintings hung in some
institutions before African Americans
themselves were allowed in he and his
art taught me how to see layers to
understand meaning IDI loper taught me
how to view a painting Korea he said let
the image fill your view take it all in
let your eyes wander across the canvas
in any way they’re driven and then take
and a step closer still until you’re as
close to the canvas as you can possibly
get take in all the textures and lines
that come together to form the parts of
the painting to understand how a complex
play of color can bring together the
depth and meaning to convey a story and
then take a giant step back and see how
the painting fits in its space how does
it add or detract from the world around
it does the message or meaning change
this has become a sentinel paradigm of
how I view the world let me tell you a
story about a woman I’ll call miss Mae I
met miss Mae on a busy Thursday
afternoon in the emergency department
when her primary care physician sent her
in for evaluation of a headache and high
blood pressure on arrival miss Mae’s
blood pressure was 223 over 114
exceptionally high she lay on a
stretcher uncomfortable but not in agony
and was easily answering all my
questions she had had a headache
it was ongoing for days and familiar to
her as one that reminded her that told
her that she her blood pressure was
elevated she had not taken her blood
pressure medicines that day she had not
taken anything for heavy as an emergency
physician I know she’s at risk for a
head bleed a heart attack heart failure
or kidney failure
but overall clinically she looked pretty
good and her tests confirmed this she
just hadn’t taken her meds she thought
going to her doctor would make it better
her doctor felt like she needed a higher
level of care and so sent her to me as
an emergency physician
I have the skills and resources to
immediately determine if she’s an
imminent threat to life or limb but what
if we take some steps closer miss may
hadn’t taken her blood pressure
medicines because she ran up
she ran out because the mail delivery
service her insurance company made her
use didn’t send her supply in time she
called her doctor’s office and was told
she needed to make an appointment but
the earliest appointment was still two
weeks away she went to an urgent care
center to address her headache and was
given a dose of Tylenol and a two-week
prescription for her medications she
took this prescription to the pharmacy I
was told that her insurance company
denied it because she was supposed to
get everything through mail order the
time finally came for miss May to go to
her regular doctor and she was sent to
me instead
she smiled weekly at me and said I was
trying to stay out of the ER but it
seems you guys are the only ones who can
miss May is a middle aged after American
woman she emigrated from Liberia as a
refugee during a time of civil war and
genocide in her country she lives in
South Philly has a primary care
physician meets criteria for obesity and
has chronic disease her story baguettes
more questions how many people are just
like Miss May who come to the emergency
department because someone sends them in
who have doctors and resources but have
a question or a need that can’t be
addressed in a timely manner how about
people who don’t have a doctor don’t
have insurance where are they supposed
to go in times of need how about other
people like hourly wage workers those
who are caregivers to others those who
can’t easily make an appointment during
emergency departments exist at the
interface of the hospital system and the
communities they serve by their very
nature emergency departments are
universally accessible to anyone who
needs us or wants us further we’re the
only part of the health system that’s
purely user triggered we will see
anybody regardless of ability to pay or
regardless of nature of emergency for
everybody else you must prove yourself
before you walk through the door do you
have insurance can you pay can you call
when the office is open can you wait for
an appointment emergency departments
have a unique perspective on the needs
of the communities they serve
when I look at the emergency department
much like I do a painting I see a
cross-section of society and a broad
range of need all of my sense is taking
the stimuli around me to create a
picture of the population I serve as I
take steps closer the individuals come
into focus their their complaints and
presentations their diagnostic needs
their questions and the fear and
uncertainty they can’t articulate closer
still and I see all the reasons that
brought them to my doors none of which
are disease specific but all of which
will have an impact on the plan I put in
place how they eat sleep work and play
these are the social determinants of
health but what if I take a step back my
emergency departments did sits in a
specific part of Philadelphia a city of
neighborhoods what about the other
emergency departments in the city each
are a reflection of the neighborhoods in
which they reside and the communities
they serve together this mosaic of
emergency departments creates a picture
of the populace that may be missing from
the medical system at large
people like miss may thousands
over my career have made me wonder does
anyone see what I see I and my
colleagues in the emergency department
work to be accessible to those most in
need and during times of greatest stress
we are driven to fill in the gaps and
create the safety net to foster survival
and a second chance we see on a daily
basis what most could never fathom but
honestly what has affected me the most
are example after example of systemic
inequality of disparities of gender race
income status on my patients and their
world I am an impatient doer it is a
character trait or flaw of most of my
brethren in the emergency department
when it became clear that the stories of
miss May were not being heard on higher
levels I became acutely aware of my
greater responsibility this has driven
me to expand my efforts outside of the
walls of the emergency department how
could I use the lessons that I’ve
learned in the emergency department to
increase health equity how could I show
others the phenomenal potential of
capitalizing on the reach and access of
the emergency department to help impact
the health of a community how could I
make the emergency department a tool of
the opioid epidemic is the public health
crisis of our time the numbers are
staggering
I live in work in Philadelphia that has
the highest overdose rate of any large
city in the country with more than 1,200
deaths in 2017 alone but behind the
graphs and the numbers and the
statistics are people husbands and wives
someone’s child my neighbors I have
pulled that blue and lifeless from cars
I have watched their suffering from the
chronic disease that is addiction I have
tried to engage them when their fear has
prevented them from even being able to
look me in the eye and I have watched
the anguish of those who love them not
in 2012 I was part of a group of
emergency physicians that recognized the
important role of emergency departments
in the face of the epidemic we led the
charge and made a concerted effort to
not only limit our role in the problem
but to work to save lives beyond the
emergency department this grassroots
effort started initially with safe
opioid prescribing which in effect
decreased the number of prescriptions
from the emergency departments in my
system
by nearly 70% I and other physician
champions across the city became leaders
in overdose prevention in increased
access to ongoing care far ahead of most
emergency physicians are pragmatic
problem solvers and here was another
example of each of us working to address
a problem we saw in our midst
we adapted to the needs of our community
far quicker than the systems around us
and work to make our interventions
we illustrated a lesson emergency
departments in Philadelphia and any
urban center have the power to impact
the health of a city my dear friend and
mentor
Jeremy Nowak helped me understand as a
giant in urban civic engagement and
Urban Development
he saw it another way in the era of
Amazon uber Airbnb those who adapt to
meet the needs of the populace gain
power emergency departments are
accessible 24 hours a day seven days a
emergency physicians are practical
fixers many of us looking beyond the
immediate needs of acute care to the
world around us I try to meet my
patients where they are and work to make
my interventions relevant not only to
the way they access care but live slow
changing institutions continue to force
people into paradigms that may not meet
their needs in taking giant steps back
and considering emergency departments in
the context of our world we see they are
uniquely positioned to address public
health issues to impact population
health to work towards health equity and
to ultimately become tools of social
justice among disparate populations in
any urban center I interpret the world
through the lens of an emergency
physician but also as a public health
advocate as a member of the Philadelphia
community
as the daughter of immigrants as a wife
and a mother as a supporter of the equal
of the fundamental rights to equal
access to care I am a believer in the
power of urban resilience and social
justice to increase and improve the
future for all of us this journey began
with a simple paradigm of seeing a
painting understanding the world and
looking beyond it continues with a deep
sense of responsibility and a growing
sense of empowerment many of us realized
the cavalry may not be coming and even
if they do they will not see what we see
from the frontlines of our world it
starts with us we have the power to
disrupt for greater good we can change
our world power belongs to the problem
[Music]
you [Music]
a closed community of scientists of
various types physicians engineers
chemists computer scientists with
phenomenal role models like my 95 year
old grandma who was a PhD zoology
professor in post-independence India it
would seem a foregone conclusion that I
too would become a scientist I chose to
become an emergency physician but I
also grew up in the home of a
self-taught artist whose images and
perspectives pervaded our physical space
in his mid life my father sought out his
first formal art education by taking
lessons with Edward looper an acclaimed
local african-american artist whose was
widely known for his bold use of color
ed loper was an anomaly himself born in
1916 his paintings hung in some
institutions before African Americans
themselves were allowed in he and his
art taught me how to see layers to
understand meaning IDI loper taught me
how to view a painting Korea he said let
the image fill your view take it all in
let your eyes wander across the canvas
in any way they’re driven and then take
and a step closer still until you’re as
close to the canvas as you can possibly
get take in all the textures and lines
that come together to form the parts of
the painting to understand how a complex
play of color can bring together the
depth and meaning to convey a story and
then take a giant step back and see how
the painting fits in its space how does
it add or detract from the world around
it does the message or meaning change
this has become a sentinel paradigm of
how I view the world let me tell you a
story about a woman I’ll call miss Mae I
met miss Mae on a busy Thursday
afternoon in the emergency department
when her primary care physician sent her
in for evaluation of a headache and high
blood pressure on arrival miss Mae’s
blood pressure was 223 over 114
exceptionally high she lay on a
stretcher uncomfortable but not in agony
and was easily answering all my
questions she had had a headache
it was ongoing for days and familiar to
her as one that reminded her that told
her that she her blood pressure was
elevated she had not taken her blood
pressure medicines that day she had not
taken anything for heavy as an emergency
physician I know she’s at risk for a
head bleed a heart attack heart failure
or kidney failure
but overall clinically she looked pretty
good and her tests confirmed this she
just hadn’t taken her meds she thought
going to her doctor would make it better
her doctor felt like she needed a higher
level of care and so sent her to me as
an emergency physician
I have the skills and resources to
immediately determine if she’s an
imminent threat to life or limb but what
if we take some steps closer miss may
hadn’t taken her blood pressure
medicines because she ran up
she ran out because the mail delivery
service her insurance company made her
use didn’t send her supply in time she
called her doctor’s office and was told
she needed to make an appointment but
the earliest appointment was still two
weeks away she went to an urgent care
center to address her headache and was
given a dose of Tylenol and a two-week
prescription for her medications she
took this prescription to the pharmacy I
was told that her insurance company
denied it because she was supposed to
get everything through mail order the
time finally came for miss May to go to
her regular doctor and she was sent to
me instead
she smiled weekly at me and said I was
trying to stay out of the ER but it
seems you guys are the only ones who can
miss May is a middle aged after American
woman she emigrated from Liberia as a
refugee during a time of civil war and
genocide in her country she lives in
South Philly has a primary care
physician meets criteria for obesity and
has chronic disease her story baguettes
more questions how many people are just
like Miss May who come to the emergency
department because someone sends them in
who have doctors and resources but have
a question or a need that can’t be
addressed in a timely manner how about
people who don’t have a doctor don’t
have insurance where are they supposed
to go in times of need how about other
people like hourly wage workers those
who are caregivers to others those who
can’t easily make an appointment during
emergency departments exist at the
interface of the hospital system and the
communities they serve by their very
nature emergency departments are
universally accessible to anyone who
needs us or wants us further we’re the
only part of the health system that’s
purely user triggered we will see
anybody regardless of ability to pay or
regardless of nature of emergency for
everybody else you must prove yourself
before you walk through the door do you
have insurance can you pay can you call
when the office is open can you wait for
an appointment emergency departments
have a unique perspective on the needs
of the communities they serve
when I look at the emergency department
much like I do a painting I see a
cross-section of society and a broad
range of need all of my sense is taking
the stimuli around me to create a
picture of the population I serve as I
take steps closer the individuals come
into focus their their complaints and
presentations their diagnostic needs
their questions and the fear and
uncertainty they can’t articulate closer
still and I see all the reasons that
brought them to my doors none of which
are disease specific but all of which
will have an impact on the plan I put in
place how they eat sleep work and play
these are the social determinants of
health but what if I take a step back my
emergency departments did sits in a
specific part of Philadelphia a city of
neighborhoods what about the other
emergency departments in the city each
are a reflection of the neighborhoods in
which they reside and the communities
they serve together this mosaic of
emergency departments creates a picture
of the populace that may be missing from
the medical system at large
people like miss may thousands
over my career have made me wonder does
anyone see what I see I and my
colleagues in the emergency department
work to be accessible to those most in
need and during times of greatest stress
we are driven to fill in the gaps and
create the safety net to foster survival
and a second chance we see on a daily
basis what most could never fathom but
honestly what has affected me the most
are example after example of systemic
inequality of disparities of gender race
income status on my patients and their
world I am an impatient doer it is a
character trait or flaw of most of my
brethren in the emergency department
when it became clear that the stories of
miss May were not being heard on higher
levels I became acutely aware of my
greater responsibility this has driven
me to expand my efforts outside of the
walls of the emergency department how
could I use the lessons that I’ve
learned in the emergency department to
increase health equity how could I show
others the phenomenal potential of
capitalizing on the reach and access of
the emergency department to help impact
the health of a community how could I
make the emergency department a tool of
the opioid epidemic is the public health
crisis of our time the numbers are
staggering
I live in work in Philadelphia that has
the highest overdose rate of any large
city in the country with more than 1,200
deaths in 2017 alone but behind the
graphs and the numbers and the
statistics are people husbands and wives
someone’s child my neighbors I have
pulled that blue and lifeless from cars
I have watched their suffering from the
chronic disease that is addiction I have
tried to engage them when their fear has
prevented them from even being able to
look me in the eye and I have watched
the anguish of those who love them not
in 2012 I was part of a group of
emergency physicians that recognized the
important role of emergency departments
in the face of the epidemic we led the
charge and made a concerted effort to
not only limit our role in the problem
but to work to save lives beyond the
emergency department this grassroots
effort started initially with safe
opioid prescribing which in effect
decreased the number of prescriptions
from the emergency departments in my
system
by nearly 70% I and other physician
champions across the city became leaders
in overdose prevention in increased
access to ongoing care far ahead of most
emergency physicians are pragmatic
problem solvers and here was another
example of each of us working to address
a problem we saw in our midst
we adapted to the needs of our community
far quicker than the systems around us
and work to make our interventions
we illustrated a lesson emergency
departments in Philadelphia and any
urban center have the power to impact
the health of a city my dear friend and
mentor
Jeremy Nowak helped me understand as a
giant in urban civic engagement and
Urban Development
he saw it another way in the era of
Amazon uber Airbnb those who adapt to
meet the needs of the populace gain
power emergency departments are
accessible 24 hours a day seven days a
emergency physicians are practical
fixers many of us looking beyond the
immediate needs of acute care to the
world around us I try to meet my
patients where they are and work to make
my interventions relevant not only to
the way they access care but live slow
changing institutions continue to force
people into paradigms that may not meet
their needs in taking giant steps back
and considering emergency departments in
the context of our world we see they are
uniquely positioned to address public
health issues to impact population
health to work towards health equity and
to ultimately become tools of social
justice among disparate populations in
any urban center I interpret the world
through the lens of an emergency
physician but also as a public health
advocate as a member of the Philadelphia
community
as the daughter of immigrants as a wife
and a mother as a supporter of the equal
of the fundamental rights to equal
access to care I am a believer in the
power of urban resilience and social
justice to increase and improve the
future for all of us this journey began
with a simple paradigm of seeing a
painting understanding the world and
looking beyond it continues with a deep
sense of responsibility and a growing
sense of empowerment many of us realized
the cavalry may not be coming and even
if they do they will not see what we see
from the frontlines of our world it
starts with us we have the power to
disrupt for greater good we can change
our world power belongs to the problem
[Music]
you [Music]
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