SOCIAL EM & POPULATION HEALTH
Addressing Housing Insecurity in the ED: A Resident’s Perspective Written by Jasmine Y. Gale, MD, and edited by Jacqueline Furbacher, MD, and Payal Modi, MD, MPH, on behalf of the SAEM Social Emergency Medicine and Population Health Interest Group
SAEM PULSE | MARCH-APRIL 2023
A Case
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A disheveled 68-year-old male in no acute distress presented with chest pain. The EKG was nonischemic. The history was inconsistent. He interjected to ask for a sandwich because he hadn’t eaten in three days, and my concern for a medical emergency instantly decreased. I asked where he lived, and after asking three different ways, I finally learned he was sleeping on “the streets.” I reviewed his chart and, as expected, found no recent emergency department (ED) visits. Instead, I discovered that he had an extensive cardiac history. The
concern for a true medical emergency now rose back up on my differential, and he was appropriately worked up for his chest pain. The workup was negative, and he was medically cleared to be discharged home. Now what?
Transitions
As I make the transition from medical student to emergency medicine (EM) resident physician, competing demands have felt like they have skyrocketed, and with them, so have feelings of defeat, overwhelm, and helplessness. As a medical student, I would have easily spent an hour with this patient, hearing his story, discussing why he
wasn’t taking his medications, and offering resources. While fourth year of medical school is about learning the medicine and maximizing patient care, intern year is about learning the medicine, balancing multiple active patients, and become efficient at doing so, without sacrificing patient care. Priorities shift to learning to think about disposition and department flow. The reality is that there is a waiting room of 30 patients, the orthopedic consult is finally on the phone for your patient next door, you still haven’t gotten around to repairing that facial laceration, and yet another patient is attempting to leave against medical advice. We are trained