Emergency MedicineMedical EducationSMACCIs Emergency Medicine a Failed Paradigm

Is Emergency Medicine a Failed Paradigm by Scott Weingart and Simon Carley

Scott presents the argument that whilst Emergency Physicians are amazing, as it stands, Emergency Medicine is failing.

Scott presents the system as it should be.

This involves stabilising the critically ill before admission to the ICU, seeing sick patients in appropriate time and seeing the less sick patients as you can.

The issue as it stands, is when this system breaks down. He talks about the ‘boxes’ which now includes the ‘not sick at all’ patient. This leads to Emergency Physician’s not doing what they are trained to do.

Scott discusses the issues with the outcome measurements of Emergency Departments. Hospitals measure patient satisfaction and wait times.

Moreover, Scott argues that a trip to the ED should be the worst day in a patient’s life and measuring their satisfaction is misleading.

A good medical outcome should be the indication of success.

Scott also discusses the issue of Emergency Physicians not dealing with emergencies for most of their practice. This, in Scott’s eyes, leads to cognitive dissonance, where ED doctors are not doing what they are trained to do.

Simon argues that Emergency Medicine is not a failed paradigm. Emergency Physicians are trained to help people, when people feel that they need to be treated.

He claims that doctors in this speciality want to treat a wide variety of people across a wide spectrum of disease.

Evidently, Simon discusses a ‘revolution’ in Emergency Medicine. An increasing number of people are attending Emergency Departments across the world. The generalist approach of Emergency Medicine is critical in triaging, treating, and helping these people in their moment of need.

The skills, breadth of knowledge and wisdom and ability to work across a range of specialties and in uncertainty is what makes Emergency Medicine and the physicians who work in it special.

Join in the debate as Scott and Simon argue for and against the place of Emergency Medicine.

Finally, for more like this head to our podcast page. #CodaPodcast

Simon Carley

Professor Simon Carley MB ChB, PGDip, DipIMC (RCS Ed), FRCS (Ed)(1998), FHEA, FAcadMed, FRCEM, MPhil, MD, PhD is Creator, Webmaster, owner and Editor in Chief of the St Emlyn’s blog and podcast. He is visiting Professor at Manchester Metropolitan University and a Consultant in adult and paediatric Emergency Medicine at Manchester Foundation Trust. He is co-founder of the BestBets website, St.Emlyn’s social media learning platforms and the MSc in emergency medicine at Manchester Metropolitan University. He is an Education Associate with the General Medical Council and is an Associate Editor for the Emergency Medicine Journal. He is the lead for CPD at the Royal College of Emergency Medicine. His research interests include diagnostics, Medical Education, Major incident management & Evidence based Emergency Medicine. He is verified on twitter as @EMManchester



Scott Weingart

Scott is an ED Intensivist from New York. He did fellowships in Trauma, Surgical Critical Care, and ECMO. He is best known for talking to himself about Resuscitation and Critical Care on a podcast called EMCrit, which has been downloaded > 30 million times.