Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Nov 2006
ReviewThe role of the emergency department in the care of homeless and disadvantaged populations.
This article provides an overview of the role of the emergency department (ED) in the care of homeless and disadvantaged populations. It suggests that organized emergency medicine can have a significant impact on total community health by maintaining a universal "safety net" for the delivery of integrated health and human services. The epidemiology of social deprivation among ED patients is examined, with a particular focus on homelessness. Current research on the value of socio-medical integration in the ED setting is discussed, with emphasis on selected initiatives that have demonstrated feasibility, cost-effectiveness, and impact.
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Emerg. Med. Clin. North Am. · Nov 2006
Emergency medicine and the health of the public: the critical role of emergency departments in US public health.
This issue of the Emergency Medicine Clinics of North America focuses on the spectrum of public health issues that significantly impact the practice of emergency medicine and which are faced by practicing emergency physicians on daily basis. Topics include public health research in the emergency department; respiratory threats; emerging infectious diseases; emergency department overcrowding; end-of-life care; racial and ethnic disparities; issues of health promotion and disease prevention encompassing substance abuse, alcohol, and injury and violence; and public health surveillance; and the problems of homeless and disadvantaged patients. This article gives a brief introduction to the important relationship between emergency medicine and public health.
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Emerg. Med. Clin. North Am. · Aug 2006
ReviewEMTALA and the ethical delivery of hospital emergency services.
This article examines the role and impact of EMTALA on the ethical delivery of hospital-based emergency services, primarily through close inspection of three of the core EMTALA mandates: the medical screening examination, the duty to accept patients in transfer from less capable facilities, and the requirement that the hospital provide on-call physician services to the emergency department to help stabilize patients with emergencies or help accept patients in transfer. Hospital and physician responses to these mandates, such as triaging/screening patients away from the emergency department, avoiding the application of EMTALA, refusing to accept inpatients with emergencies in transfer, and devising ways to avoid on-call duties, are analyzed in some detail.
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Emerg. Med. Clin. North Am. · Aug 2006
ReviewExpert witness testimony: the ethics of being a medical expert witness.
Giving testimony as an expert witness in court carries numerous ethical obligations, which are rarely delineated by the individuals who seek such testimony or even known to those who provide it. Because most expert medical witness testimony about the performance of physicians requires that a witness be medically licensed, and because verdicts based on expert testimony directly influence the standard of care that will be applied in the future, providing medical testimony legitimately can be considered to come within the realm of the practice of medicine. Testifying as an expert in legal matters should be undertaken with the same degree of integrity as the practice of medicine and is rightfully subject to the same degree of scrutiny and regulation.
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Emerg. Med. Clin. North Am. · Aug 2006
ReviewVulnerable populations: cultural and spiritual direction.
Cultural, spiritual, and religious diversity of emergency department patients is increasing while that of emergency physicians in particular remains predominantly homogeneous. With a discordance of cultural, race, and ethnicity exist, in the case of ethical conflict -resolution becomes that much more difficult. Patients may feel vulnerable when their emergency care provider does not understand his or her cultural, spiritual, and religious uniqueness as it relates to the patient-doctor interaction and health care decision making. This review will examine (1) language differences; (2) cultural, religious, and spiritual differences between patient and provider; (3) differing explanatory models of disease between patient and provider; and (4) diverse bioethical models of decision making of differing cultures in an effort to reduce vulnerabilities.