11 November 2008

A Time for Change, Finally

Dr. Michael Copass, "legendary" director of the ER at Seattle's Harborview Medical Center, is finally being put out to pasture.

A little background: Copass, trained in neurology, has been running the ER for thirty-some years. He has run his fiefdom with an iron fist and a cult of personality striking in large part for his antipathy towards the field of Emergency Medicine as a specialty. The University of Washington has become something of a local embarrassment, being the last of the top ten medical schools in the US (actually, the last of the top fifty!) not to have a training program in Emergency Medicine. Copass has sworn, apocraphally, that it will be over his dead body that there will be an EM program in "his" ER.

The consequence is that over the last twenty years, with regard to emergency care and training, UW has slowly slipped further and further behind other mainstream university medical centers. The political environment has been toxic, with even UW faculty members decrying the insitutional hostility towards EM. Matters came to a head a few years back when the ACGME decertified Harborview's EM training program, a move which resulted in the EM residency at Madigan pulling its residents from Harborview, citing "inadequate supervision," specifically a lack of supervision from trained Emergency Physicians. (Others have alleged that supervision at all in Harborview's ER is "nominal.") Madigan now sends its residents to Emanuel in Portland for their trauma training. Seattle, the 15th largest metro area in the US, does not have a dedicated training program in EM; most cities this size have two or three.

The University was, I think, highly embarrassed by the fiasco. Since that time, they have recruited for and hired a number of trained and certified Emergency Physicians. (Some of whom are good friends of mine.) The word on the street is that the UW is finally intent on starting a training program in EM, which would be a welcome and long overdue development. If Copass was encouraged to retire in order to remove one of the last remaining obstacles, it would be an ironic capstone on a career which has in some respects been dedicated to opposing the development of EM as a specialty.

Still, there's going to be yeoman's work to be done at Harborview. The insitutional bias against EM may run deep, and the faculty who take over the reins of the department will have their work cut out to establish control over the department and autonomy of their operations. I admire and respect those colleagues who have signed up to bring about the needed change. It's thankless work, fighting these turf battles. Most of the work to establish EM as an independent specialty was done in the '80s and '90s: it seems very weird and anachronistic to have to go back and revisit those battles. I will be cheering them on, and I look forward to a time not too far in the future when I may have the opportunity to work with UW residents, or to hire graduates from a local program.

I should stipulate here, that I have never worked at UW, did not train there, and have never met Copass. I do not doubt that he has been a dedicated physician and educator. If I have misstated his positions here, I will be only too happy to publicly apologize. However, his reputation is that of a divisive persona who has persisted in fighting one of the last bitter turf battles in the house of medicine. To the degree that is true, he will not be missed.

22 comments:

  1. While I don't like to celebrate people's retirement in a negative way, this made me smile a little, being a med student who grew up in the area and wants to return home for an EM residency. I'd be interested to hear what you think about Dr. Copass's legacy with Medic One, though.

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  2. I trained at UW, knew Copass, and hated my time at Harboview like I have never hated another few months of my life. Copass is/was a bitter, cruel, nasty, vindictive short man and I for one will not miss having him in this community.
    Cheers~your kids' trusty pediatrician

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  3. I've known Dr. Copass for almost 20 years. He routinely came up to Alaska and was intimately involved in EMS up there, as well in Washington State.
    While I acknowledge and understand his negative aspects, for me he was a mentor and inspiration to do better.

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  4. While I respect your opinion as an Emergency Physician, Harborview is the best ER in this country for a surgeon to train in, for exactly the reason that it is run by surgery and medicine personnel, rather than EPs. I will be sad to see that change.

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  5. Jill,

    I trained at a variety of ERs and we co-existed very well with the surgeons -- both those working the ED and those serving as consultants. There were times when we humble ER types were able to teach the surgeons some things, believe it or not.

    Revmedic,
    Copass is a polarizing figure for sure. People either love or hate him -- there's no in between.

    It's interesting -- Copass could have gotten ABEM certified and been a huge force for good. With a reputation like his, he would have vaulted into the ACEP leadership and contributed so much to the development to the specialty. It's not interesting; it's sad.

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  6. Before getting into medical school I worked for AMR in Seattle for a couple of years. During that time I'd often see Dr. Copass while dropping off patients at the Harborview ER. My first impression of him was a grouchy, short, vested man with a big personality, and when I noticed everyone seemed to tread softly when word spread that Copass was wandering the halls, I figured my first impression was accurate. He was somewhat infamous amongst my AMR colleagues, as well: our favorite Copass story was of the poor EMT who gave a lackluster SOAP report in earshot of Copass, who then stormed over and demanded to see his EMT certification. Upon handing him his certificate, Copass tore it to shreds in front of him and told him to get the hell out of his ER. I don't know of any EMTs that actually carry their certificate on them, so the validity of this story is iffy, but I think it reflects Dr. Copass's management style fairly well.

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  7. I used to be a medical assistant at Harborview ED, and Dr. Copass will always be a role model to me for his work ethic, his devotion to Harborview and Medic One, and his constant demand for the best out of everybody.

    Today I am a medical student, planning to go into EM, and I have a feeling that a little bit of flexibility goes a long way as an EM doc. Flexibility is not one of Copass' strengths, unfortunately, and it's too bad that that will be what people remember about him. He did a hell of a good job in that ER.

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  8. Go for the job, Shadowfizzle.

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  9. I can't help but wonder if the absence of EM docs running the show at Harborview is the very reason that Medic One has done so well. Would EM docs have allowed paramedic students to participate in the same clinical rotations? Probably not.

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  10. Having completed worked EMS in Seattle and completed med school at UW, I spent much time in the HMC ED. Copass was a very compassionate physician who cared deeply for his patients and I respect him for this. As an Emergency Medicine resident, I feel the HMC ED is run very pooly and provides very poor patient care at times, largely because of the lack of appropriately trained (EM) docs. I have seen patient's wait hours for routine shoulder dislocations, I have seen HMC attendings consult gyn for vaginal discharge making them wait hours for a simple pelvic, I have seen trauma patients lay supine and aspirate their blood while someone frantically pages "anesthesia STAT to the ER" overhead multiple times while the IM attending sits there and waits helplessly, I could go on forever, but I think we all realize the deficiencies an IM attending has in a busy level I trauma center.

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  11. I spent many months in the HMC ED as a surgical intern. I'm now an emergency physician.

    Copass was dedicated to the ED and Medic One, but is/was a practicing neurologist without any EM training and entirely outdated and misguided in his concept of how to run the ED. That ED could be great, but his stubborn personality and bizarre perceptions of EM have kept it in the 1960s-70s model of ED practice. He thought it was brilliant though. I'm personally a little angry with him for squandering the EDs potential for quality patient care and training/education. The practices that he enforced were nothing short of ridiculous. Q5 min hematocrits on every trauma patient personally drawn and spun by the intern, podiatry interns running traumas, renouncing FAST for DPL- all overseen by a second year surgery resident with no attendings in site. I could go on, but this was several years ago, so it sounds like things have changed some for the better.

    Despite all that, I genuinely respect Dr. Copass for his years of dedication to running a very difficult ED and his development of the superb Medic One, and wish him the best personally.

    So, are they looking for future faculty? Anyone know anything? Projected time of residency startup?

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  12. I would suggest that an ER where patients are turfed to appropriate services that deal with a patient's issues is safer than an ER where "certified ER physicians" don't listen, mis-manage patients, and operate at snail pace. Harborview has a can-do attitude and is by far the most efficient ER I've worked in to date. Copass ain't perfect, but the ship is run tightly. Quit crying ER sissies.

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  13. Neurologist,

    Um, yeah. How many ER's have you worked in? How many were staffed by non-ER docs? I'm willing to bet not too many. See, Harborview is the very last of a dead and dying breed. ER docs now run something like 90% of the ERs in the country. I've worked in, lemme count, nine, big and small, and all were run by EM.

    And you show your ignorance as well by criticising ER docs as "slow." Seriously? Slower than internal medicine? C'mon man, there's nothing in life slower than an internist. Except maybe a neurologist.

    Tell ya what, don't bother coming down to consult. I'll just call you with the MRI results.

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  14. Any updates on UW EM Residency? It'd be awesome to help start up a program at HMC. I remember volunteering at Harborview ER as a college student and thinking, "I will never do EM," because of the sheer craziness. Now, I love it.

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  15. Haven't heard anything lately. Sound like an EM residency is going to happen, but the groundwork will probably take a couple of years to lay.

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  16. Dr. Susan Stern is the new Division Head of Emergency Medicine at the UW. She is actively recruiting experienced academic emergency medicine physicians to start an EM residency training program based at HMC and UWMC.

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  17. I've heard good things about Dr Stern, and I look forward to meeting her (and maybe working with her, within the region).

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  18. As a paramedic from another state, and having attempted to obtain certification in Washington, I came across the same brick wall over and over. I have been told repeatedly that "we have higher standards here" and that the training of all the other states in our great country are "inadequate". This is a direct teaching of Copass, and his dedication to himself and his pet drones.
    My wife is a Nurse at Harborview, and has repeatedly told me of the outrageously dangerous attitudes and treatments of Medic One Paramedics, and the disdain felt by nurses and doctors alike.
    I for one say good riddance in regard to his leaving Harborview. I just wonder when we can celebrate the same for his leaving EMS. His ways of teaching for Paramedics in antiquated and unacceptable for modern medicine, and we will never come under ONE standard as long as he is around.

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  19. donovan13@hotmail.com11/21/2011 6:06 AM

    obviously NONE of the people that have posted on this really have had any omg can i say it "TREATMENT" from Dr. Copass...here's a little taste of the reality of how much he does care for his patients.

    I was assualted in 1999 by 5 (yes 5) UW frat guys. I sustained horrible blows to the back of the head, neck. and spine (yes, I said back, they were cowards).

    after a couple weeks I had my first grand mal ...I don't know if that many people really understand how horrible , embarassing , awkward , socially debilitating , and depressing rhis would be for someone that worked 6 nights a week in seattles largest nightclub, had a regular dj night on the 7th night and even guest dj'd at least 3 times a month after work..as well as had 2 live bands that played fairly often..I really just wanted to disappear or worse yet die..

    please really take all that in
    ....
    when I met Dr. Copass after my first seizure I was 6'3" , wearing bondage pants and a painted leather jacket, while sporting bright blue hair...
    his first words to me (while smiling ) "I'm a grumpy old man and i don't take any BS"..

    I loked at him and just said "cool, ok."

    he shook my hand and we've been friends ever since....

    if anybody out there has a single bad word to say about him I doubt that they have ever REALLY had a conversation with him...his first questions to me every time I see him are not to do with my illness , it's about me , how I'm doing and what I've done to make myself better..it's not always medicine that helps , I feel it's more often the actual caring for the patient that makes a difference...

    I have to say that if he is ever not my Dr. anymore .....well I really can't even express the sadness that would be felt...

    at least try to understand him his methods his approach and his history....he's a slightly shorter man but he is without a doubt a giant in this current world..it disgusts me that little apathetic weasels can undermine such a wise and caring ICON of medicine and actual humanity..shame on you !! open your eyes..we all fail without people like him!!!

    Donovan13@hotmail.com

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  20. having worked in Harbourview ED in the early 90's and then trained fully as a board certified ER doc and then worked in a number of large and small ER's I now agree with Copass's methods of running ER


    Morbity and Mortality is less when run by medical and surgical personal rather than the current ACEP crop of ER physicians-these are big on commentary, self-promotion but lack the skills and depth of internists and surgeons.

    Copass's model should be the bench mark of all ER's and current ER docs should only be involved in sutures, minor injuries and plasters.

    Long Live Copass's model

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  21. Any evidence that backs up your opinion?

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  22. The model at Harborview is the traditional model of medical intake. The emergency medicine folks created a field for themselves and typically are not much more than triage nurses who order dilauded or supplemental oxygen. I applaud Harborview for their stance on this change, hopefully other hospitals will follow their lead.

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