Introduction: Supporting the Delivery of Connection and Compassion

Joshua Walterscheid, MD

Patients in crisis present a unique set of challenges for the medical professional, as well as for the entire health-care system. These patients can be quite complex medically, but even in those cases that are relatively straightforward, the amount of time and resources required to deliver the best possible care is substantial. 

These patients need not only delivery of quality medical care, but also referrals to and consultations with appropriate social workers, case managers, addiction programs, and mentalhealth services. One final thing they need is compassion and a human connection with their health-care provider.

This month’s edition of The Physicians Report highlights the various important facets of care required for these challenging patients. This includes a detailed analysis of the opioid crisis facing our country, a review and recommendations on conversations with victims of domestic violence, a report on the integration of behavioral and physical health services, and discussions on treating addiction in inmates, the health benefits of housing for the homeless, and the positive impact that case workers have for patients in crisis in the ED.

As an emergency-department physician, I can speak from firsthand experience about the value of having case workers available to assist with the non-medical aspects of care that these patients require. The health system I work in has embedded care managers in the ED, and they are a vital member of my health-care team. While it costs the health system money to provide these services and have care managers present in our ED, they actually create a net cost savings by helping to reduce bounce-backs and unnecessary admissions. They do that by getting patients the resources and referrals they need in a timely fashion.

We are currently expanding our caremanagement program to include some fulltime care managers, who are doing outreach in the community with high ED utilizers to help ensure that these patients are getting access to the services and treatments they need. It has become increasingly apparent that in order to provide the best possible care, a team-oriented health system–integrated approach is needed.

As health-care providers, we are in a profound position, regardless of whether or not our specialty is focused on treating patients in health emergencies. We all see people at their best, their worst, and everything in between. While it’s not always immediately obvious, we often see people who are in situations of crisis. It is an honor to support patients during these times. Having the right systems in place is what allows us to remain focused on showing up at our best for them.


Joshua Walterscheid, MD
Salem Emergency Physicians
Salem, Oregon