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Life in Emergistan: A Model for Unity and Greatness

Leap, Edwin MD

doi: 10.1097/01.EEM.0000515681.37424.2f
Life in Emergistan

Dr. Leap is the president of LeapMedicine, PC, a member of the board of directors for the South Carolina College of Emergency Physicians, and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available at, and Working Knights, Cats Don't Hike, and The Practice Test, all available at, and of a blog, Follow him on Twitter @edwinleap, and read his past columns at

diversity, tolerance

diversity, tolerance



How do you define yourself? Or describe yourself? I have tried to avoid immediately categorizing myself by my profession. I have always agreed with The Little Prince: “When you tell [grownups] you've made a new friend, they never ask you any questions about essential matters. They never say to you, ‘What does his voice sound like? What games does he love best? Does he collect butterflies?’ Instead they demand, ‘How old is he? How much does he weigh? How much money does his father make?’ Only from these figures do they think they have learned anything about him.”

Physicians especially love to divide themselves into groups. Each group has its own characteristics. Most of those reading this (but not all) are emergency physicians, also known sometimes as pit docs. There are internists, or fleas. Surgeons, or cutters. Anesthesiologists, or gas passers. Pediatricians, or pediatrons. Radiologists, or shadow doctors. Orthopedists, or carpenters. (I kid!) Our specialties are our nerdy fraternities and sororities, the places we learn to make our living, establish habits of thought and behavior, and create world views and life-long friendships.

Unfortunately, the division goes much further than specialty. We are divided between rural and urban, and there are significant problems in that chasm. Physicians in urban teaching centers sometimes have little knowledge of the stark limitations of the rural setting when we call for help or transfers. “You don't have a surgeon? You don't have an ICU?” And rural physicians often forget that even the big house eventually reaches capacity and can't take transfers; the presence of a large center (or a helicopter) is no excuse for sloppy care on the outside.

We are also segregated into community and academic, and I have found that this is a point of contention with many community physicians. Research, treatment pathways, algorithms, checklists, and new imperatives seem to emanate constantly from academic centers and flow to the community hospital and its citizens. Community physicians, many of whom have lived through countless swings of the medical pendulum and associated policy changes, are often reasonably skeptical of the latest study, the latest rule about pain medications, or the most recent sepsis protocol. They feel cut off from what they perceive is a connection between academics and policy-makers, and they feel particularly excluded if they have an interest in entering academia, which seems like a closed club.

Physicians are also increasingly divided by gender and sexuality, as we see various physician advocacy groups pop up. That's fine, I suppose, as long as it doesn't split us further apart but serves as a source of encouragement and connection for the members of those groups. (It becomes toxic when it is used as an exclusionary tool. I was told once that my opinion in a debate was less relevant because I was a straight white man.)

Our divisions seem to be at their worst when it comes to politics. And it's a pity because we have such potential to be models for the rest of the world. I have seen physicians argue politics in person and online. I have been part of some of those debates, and it can be ugly. I have recently withdrawn from most political dialogue because it wastes time, causes anger, and accomplishes nothing.

But I will give this opinion and stand by it. I've worked with physicians who were Christian like me, Muslim, Hindu, and atheist. I have worked beside ardent progressives and hardcore conservatives who make me look like a socialist (and that's tough to do). I have worked with physicians who were gay and straight, rural and urban, academic and purely clinical. I've laughed and cried with them, eaten with them, encouraged and been encouraged by them. And I'd do it all over again. Because when it comes to our job, our real job of treating the sick, easing suffering and saving the dying, all of our differences evaporate into vapor.

Identify yourself by whatever category you wish, but never forget that we can serve as a model for unity, a model for the greatness of all free people, when we do our jobs well and do them together for the good of others. Now, what's your favorite food? What's your hobby? Tell me about your spouse and children. Those categories interest me more than all the rest.

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