The essay of all essays: "The biology of emergency medicine" (2 of 2)

Dr. Peter Rosen

This is part 2 of my review of Dr. Rosen's 1979 article on "The Biology of Emergency Medicine" (see part 1).

According to Dr. Rosen, there are 3 broad categories of ED patients:

• The emergent
• The urgent
• The non-urgent 

We must know how to identify and prioritize these. Medical students and residents are poorly taught the differences. “There are two shocks to residents: not every patient is sick, and many patients are sicker than they first appear”, he writes.

There are 3 critical ingredients which define a valid residency experience, according to Dr. Rosen who trained in surgery:

• Pathology
• Adequate faculty
• Adequate number of residents

Uniquely, the specialty of EM is not defined by diseases, but rather by the level of acuity. Per Dr. Rosen our most important responsibility in the ED is proper assessment and stabilization. As emergency physicians (EP), the proof of the diagnosis is not as important as the assessment and stabilization. He states, “The quality, appropriateness and timeliness of the initial care is the biology and responsibility of our specialty.” Thus, EM training cannot be learned under someone else’s service.

The article has many other important points that every EP should keep in mind. This article is at the top of my list of reading whenever I encounter a medical student interested in EM. Even though it was written many years ago, many elements still hold true in our profession.

Dr. Rosen ends the essay by quoting Oliver Wendell Holmes:

“I find the great thing in this world is not so much where we stand, as in what direction we are moving: to reach the port of heaven, we must sail sometimes with the wind and sometimes against it - but we must sail, and not drift, or lie at anchor.”

Javier Benitez, M.D.

References:

1. Rosen P. The biology of emergency medicine. JACEP. 1979 Jul;8(7):280-3. Pubmed.
2. Peter Rosen’s lecture at UCLA. All L.A. Conference May 5, 2011: Reflections on 40 Years of Emergency Medicine. (Need to download actual video)
3. Zink BJ. The Biology of Emergency Medicine: what have 30 years meant for Rosen's original concepts? Acad Emerg Med. 2011 Mar;18(3):301-4.  Pubmed .