The Rape of Emergency medicine

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Feb 7, 2009
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Hey EM gurus and fellow students like myself.
I am a foreign medical student and an EM fanatic. Recently I got an opportunity to finish a clerkship in the US at the St. Mary's Hospital Longbeach. A mentor there suggested I read this book, "The Rape of Emergency medicine" by James Keaney to know more about the histroy of EM. And believe you me, I was shocked to say the least about its gory beginnings.

I am posting this topic here to ask for an opinion from some of the old guns as to the accuracy of the representation in the book. Were the AAEM and pyramid inc as bad (an understatement) as they are made out to be in this book?

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Well the AAEM (American Academy of Emergency Medicine) is the groups that uses the book as an illustrative tale of why it takes the stances it takes. I believe you meant "Was ACEP (American College of Emergency Physicians) as bad as they said it was?"

I'm not old enough to have lived through the actual times but I know many of the players. Here are a few disclaimers: I have read the book cover to cover twice. I work for one of the evil corporate staffing groups. I am a fellow in ACEP.

I think the book made a lot of great points about the things that were wrong in EM in the early days. I think that the rise of AAEM was a justified phenomena given the problems and the feeling that ACEP was carrying water for the corporate groups. I think that things really were as bad as they sounded although there were probably some other ways to go about fighting the good fight.

I really believe that the leadership of AAEM felt they were fighting that good fight for the soul of the specialty. Bob McNamara is one of the greatest teachers I have ever met and I personally owe him a great debt of gratitude for everything he has done. Another giant who I respect greatly, Ed Panacek, called Bob "the conscience of Emergency Medicine" and pointed out that by choosing the hard fight that he did he gave up a lot personally and professionally.

I see that corporate groups seem to be slowly edging out all the independent groups. This is not a good thing but it is reality. Indie groups are not perfect. There are indie groups that are way more dishonest, manipulative and ruthless than the corps ever were. But a well and fairly run indie group is a great asset to its docs and hospital.

The corp groups are run much more fairly now than in the past. I do think that is because of AAEM and the book.
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Thank you very much docB for clarifying that for me. You're right, I meant to say ACEP=the bad guys

I was initially so taken aback by th commercialism of the whole scheme that I believed the author might have been exaggerrating for the sake of making the book more interesting.

I had the pleasure of meeting Dr Jon Hughes (I was told one of the founding fathers of EM in California) during my clerkship at St.Mary's Longbeach and I personally said thank you for introducing the concept of organised emergency care to not just the US but the world. Several countries have formed their EM services using USA as the role model.

In my country, Pakistan a formal EM training has been started this year. Thanks to a US trained EM grad and its based on the training he received in the US. Hence I feel the pioneers of EM did a great service not just to the US but the world by providing much better level of care during the 'Golden Hour'. The concept of offering the most intense and life saving measures in the critical hour of life for a patient sounds common sense today. But so do all great ideas.Anyway I digress from the point.

Thank you again DocB for the clarification. AAEM indeed fought a very just and tough fight.
I highly recommend this book to any EM hopeful. You'd love it.
And thank you cerberus for the link. Students who haven't read it, start reading.
Any other recommendations from my peers are welcome :)
House of god.. great book.. not directly about EM.
The EM primer was a good read for me at the end of 3rd year/beginning of 4th year


  • em primer.pdf
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Thanks OccupytheED. this book should help a great deal for the clerkship.

Ectopic fetus, book added to the list of books to read. Thank you!

Does anyone happen to have The pdf of the checklist manifesto by Dr Atul Gawande ?
Haha OccupytheED, I just have to say I love your name. When all the Occupiers got booted (excuse for homeless to pitch tents), where did they go? Straight to the ED for detox/SI/food. We had to kick them all out. It totally was Occupy ED
Haha thanks, I appreciate it. During my audition rotations about 20-30% of my patients were of the intoxicated/malingering variety and it seemed like their sole purpose in life was to literally occupy the ED. Pretty funny when as a 4th year on an away you wind up taking care of the same people 2-3 times.
Does anyone have a pdf of this book that they can email me?
which book do you want? The rape of EM or the house of god?
If anyone hasn't hasn't read the book, the full pdf is available here

There is a 404 error for that link. It worked before, I read about half of that book when you first posted the link, now it is not there for me to finish.

Do you have a copy of the rape of Emergency medicine one? I'm interested in reading it.
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which book do you want? The rape of EM or the house of god?

I'm looking for the rape of EM pdf, I can provide an email address to anyone if they have it, just PM me. thanks!
Hello blackavar, Please pm me your email ad. I will email it to you.