By George Terwilliger, MD

Not too many years ago, Emergency Departments (ED) were staffed by part-time doctors. These providers might have been physicians-in-training or established local doctors with regular practices in general surgery or primary care. However, as the complexity of patients in the Emergency Department has grown, Emergency Medicine has become a medical specialty in and of itself. These medical practitioners are trained with a skill set that ensures patients receive the care they need in the safest, quickest and most efficient manner possible.

George Pierce Terwilliger, MD
George Pierce Terwilliger, MD

In the old model, developing the skills needed to provide quality emergency medicine took many years of formal practice. Today, Emergency Medicine residencies provide that ad hoc learning in formal, intensive programs of training. The first formal Emergency Medicine residency program was introduced by the University of Cincinnati in 1970. Currently, there are 160 accredited Emergency Medicine residencies with one of the newest being at Dartmouth Hitchcock (DHMC) in Lebanon, NH. Emergency Medicine residency training is similar to Family Medicine residencies. Practitioners are exposed to many medical specialties including internal medicine, pediatrics, obstetrics and gynecology, cardiology, neurology and orthopedics. However, due to the often-urgent nature of Emergency Department patient, emergency medical training also focuses on treating trauma, heart attacks, strokes and other emergency medical conditions.

In rural communities like ours, a challenge in practicing Emergency Medicine is managing the expectations of the patient. Sometimes, the problems that bring an individual to the ED are related to a condition that isn’t going to get solved during that one visit. The patient might need to be hospitalized and seen by a surgeon or specialist. At other times, once the emergency has passed they might be cleared to go home. When this occurs and a patient is discharged to go home, follow up with their primary care provider is recommended. Helping the patient arrange this follow-up is increasingly a priority of the ED. The Emergency medical provider becomes an important part in the continuum of patient care.

Here in Brattleboro, BMH and the local community has benefited enormously from its affiliation with Dartmouth Hitchcock Medical Center. Not only is it the tertiary hospital for medical emergencies but the BMH Oncology Department is staffed by DHMC physicians. This affiliation has recently been enhanced to include a partnership with Cheshire Medical Center/Dartmouth Hitchcock Keene Emergency Department. Harneet Sethi, MD, a professor with the DHMC residency program, oversees both the BMH and Cheshire emergency departments. This arrangement benefits BMH by providing Emergency Medicine residency-trained physicians. One key to success for BMH’s new Emergency Department will be EM trained physicians who know the community and are part of it. Additionally, starting this July Cheshire will become a training site for DHMC Emergency Medicine residents.

The affiliation with Cheshire and DHMC also provides BMH the opportunity for collaboration in crafting policies for cutting-edge patient care and adapting them to the needs of our community. From the moment a person enters an ED, there are numerous decisions to be made. The more we can create systems and keep things consistent and up-to-date the more effective we will be in serving our patients. Electronic health records, standardized systems and policies are integral to achieving this goal. The ability to review and appropriately share medical history with a patient’s other doctors and members of the healthcare team can optimize diagnosis and treatment.

There’s no better time to engage in these efforts than during our reconstruction of the Emergency Department at BMH. When the renovation and expansion project is completed, we’ll be better able to provide the services people in the community need, continuing to improve the already high standard of care.

George Terwilliger, MD, is the Site Director for the Emergency Department at Brattleboro Memorial Hospital.

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