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Words Matter

The Case against ERs and ER Docs

Hawkins, Seth Collings MD

doi: 10.1097/01.EEM.0000532180.93606.86
Words Matter

Dr. Hawkinsis a charter member of the American College of Emergency Physicians Medical Humanities Section, a writer of prose and poetry, an anthropologist, and a full-time clinical EMS and emergency physician in the Carolina mountains. Follow him on Twitter at @hawkvox, where you can also follow #wordsmatter conversations.

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Nobody feels stronger than I do that the growth of emergency medicine as a legitimate practice of medicine is one of the indisputable success stories of the past half-century. I'm sure it seems counterintuitive that I feel equally strongly about a contention that is sure to be more controversial.

We must do away, once and for all, with ERs and ER docs.

The emergency unit in the hospital is often described as the “ER.” The physicians who practice there are often called “ER docs.” This is wrong in so many ways.

The concept of an “emergency room” dates back to an era when emergency care was delivered in a small number of rooms (or even a single room) within a hospital. It was often staffed by a nurse or just a greeter, and primary care providers or specialists were called in when patients needed emergency care or would provide shift service without special training.

This is still practiced in some rural parts of the country. Modern hospital-based emergency medicine is practiced in a full-fledged department, with a wide range of resources, and ideally staffed by physicians who are board certified in emergency medicine or have chosen to specialize primarily in this type of care. The emergency department is usually a division of a department or a department in its own right, not just a “room.” If we want to represent the modern environment in which we work, we need to promote modern terminology referring to that environment.

When forced to make the distinction, we have established that “ER” is a popular culture term and “ED” is the preferred professional term. Primack, et al., wrote a fascinating comparison of televised and real-life emergency medicine. (J Emerg Med 2012;43[6]:1160.) They established that we say “ED” when we discuss the real world and “ER” when talking about media portrayals of what we do.

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Not an ER Doc

Then there's the ER doc. Calling those of us who practice emergency medicine “ER docs” is equally problematic, maybe even more so. If it is correct to define physicians by the location in which they work, then surgeons and anesthesiologists should be called “OR docs.” Nephrologists should be called “dialysis center docs.” Despite being one of the newest specialties, emergency medicine is one of the richest and most diverse specialties now practiced. Emergency physicians respond to cardiac arrests on the floors of the hospital. We sometimes provide other emergency services throughout the hospital, especially in rural hospitals where we may be the only physician in the hospital. Are we comfortable being called “hospitalists” in those circumstances?

Many emergency physicians take their practice out of the hospital altogether. Emergency Medical Services (EMS) is now a board-certified subspecialty of emergency medicine. It is nonsensical to say that EMS can be a subspecialty for an “ER doc” because by definition the scope of practice and operational environment of an EMS physician is prehospital or out-of-hospital. Other emergency physicians have now entered politics, public health, and academic roles. Others still work as toxicologists, wilderness medicine specialists, global health experts, and sports medicine specialists. They carry their practice as emergency physicians into these environments despite the fact that these practices have nothing to do exclusively with EDs and they may spend the majority of their practice outside of modern emergency departments.

The reality that we practice emergency medicine, not emergency room medicine, and we are emergency providers, not ER providers, seems obvious. What we need now is a commitment to be truthful in our language and convey an accurate message about our identity.

Others have adopted terms that more closely follow nomenclatural standards in medicine. In this model, we would be “emergentologists” who practice “emergentology” in an “emergency department,” just as we have gastroenterologists and anesthesiologists practicing gastroenterology and anesthesiology. This seems equally viable, and avoids the need to define the provider type more precisely with a terminal label (emergency PA, emergency physician, etc.). It does risk sounding somewhat pompous in a field that is known for, if nothing else, its practicality, orientation toward action, and operational capability versus fancy terminology.

Invoking the ancient Greek roots of an “ology” specialty may further establish our equal seat in the house of medicine. As long ago as 1978, the case was being made for this term, along with a discussion of why this terminology critically matters. (JACEP 1978;7[1]:29.) These were not widely accepted in the years that followed, but are in use on the internet (www.theemergentologist.com) and in professional dialogue (Dr. Graham Walker's outstanding “Emergentology” column in this magazine).

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