Speaking a board-certified emergency physician, Dr. Levine\'s commentary is well-advised as regards patients keeping an accurate list of their meds, doses, and allergies. It is my belief that in its rush to have doctors adopt that most imperfect tool called the electronic health record (EHR), the Obama administration has over-sold its current capabilities and misled the public about the current abilities of the EHR. As an emergency physician, I wish ALL patients listed not only their current meds and allergies, but also where they obtain their meds, so if we have questions about meds that come up, we could call the pharmacy to verify. However, as a whole, his comments do not represent our department or my specialty. He might have well said that he wants to write a rant and that emergency medicine does not deserve to be classified as a specialty, even though it has been a member specialty of the American Board of Medical Specialties for over 35 years. There is too much ignorance and inaccuracy contained within his comments to rebut every point, but let\'s examine a few of his assertions: 1) \"the triage nurse will decide how acute your illness is, and how quickly you should be seen, and even in what part of the Emergency Department.\" This is only partly true. Indeed, a triage nurse will use a structured triage instrument that triages all patients to one of five levels, the top two based on acuity of illness and the next three based on acuity plus anticipated resource utilization. Dr. Levine is apparently unaware of, or does not care to cite, data regarding the derivation and validation of triage scales, as published in peer-reviewed manuscripts. Plus, what alternative to triage does he propose for an environment where patients don\'t arrive based on a schedule, like his nice controlled office environment where patients have appointments, but rather where they arrive by when they believe they need services? 2) \"Emergency Room\". We are not the \"Emergency Room\", our DEPARTMENTS have lots of rooms and we are usually a clinical department in the hospital. Such is the case where I work. At my hospital, our emergency physicians are part of the medical community. I am the President of our hospital foundation\'s Board of Trustees. Three of my fellow emergency physicians are Trustees, and two of my partners are members of our hospital\'s Board of Directors. The show \"ER\" was based on 1970s medicine. If Dr. Levine were looking around, he would learn that the TV show is like a dead ancient insect stuck in amber....it is a time capsule of the past. Further, \"ER\" was a drama, not a documentary. 3) Mid-levels: Our practice is among hundreds of emergency medical practices that does not use mid-levels in our fully staffed and equipped emergency departments, so it is clear his assertion about the pervasiveness of their use is inaccurate. Even where mid-levels are appropriately used, they are generally not allowed to see the sickest patients. They are limited by their scope of practice and trained to do what they know. Dr. Levine\'s example that he cites is exceptional, not typical. To use another example, if an airplane crashes (an exceptional event) and the news papers report that crash, does that mean that all airplanes crash, and that flying is unsafe? Of course not. One is similarly ill advised to use exceptional events in hospitals to guide their world view. In fact, I\'d bet Dr. Levine\'s office could benefit from mid-levels. Many of his patients\' office visits surely require his expertise. However, if a patient comes in for a checkup and has no new problems and a well- controlled blood pressure, then for a mid-level to evaluate the patient may be fully appropriate. Dr. Levine would be freed to concentrate his attention and talents upon patients who truly need his expertise. Dr. Levine would be correct to assert that some emergency departments are run by publicly traded corporate entities that hire physicians to work in the hospitals with which they have contracts. These may be places where there are greater pressures to deploy mid-levels less appropriately, above their level of training and skill. In emergency medicine, we refer to these publicly-traded entities as \"Contract Management Groups\" or CMGs. I am proud to have been a member of the American Academy of Emergency Medicine (AAEM) since its founding in 1994. AAEM was founded, to a great degree, to stand up for physicians and patients who were being harmed by the practices of CMGs. Inappropriate use of mid-levels is certainly one practice that would tempt CMG management, to maximize profits. However, in fairness, CMGs have the same motivations as I do when they offer physician services. Both seek to provide a service that pleases the patient and which does not result in untoward events. 4) \"For non-emergency conditions, when your physician’s office is closed, I would consider seeking care at an urgent care center that your physician knows of and recommends\". This is problematic on two levels: First of all, mid-level practitoners are more likely to work without on-site supervision at an urgent care center than in an emergency department. If he is so against mid-levels, his suggestion is illogical. Second, and more importantly, patients may not know when they have an emergency! For example, consider a 60 year old man who has fatigue and nausea, feels a bit feverish and has been sweating, but who has not had chest pain. They go to an urgent care center, believing they don\'t have an emergency, wanting to obtain a prescription for their nausea, when they in fact are having a non-STEMI. In other words, patients often don\'t know if they have an emergency, or not. It is NOT their job to be their own doctor and determine if an emergency exists. Believe me, I like nothing better than to tell a worried patient, \"This time, the news is good. All of the evidence today points away from you having anything serious causing your symptoms.\" However, patients are not as good as well-trained doctors at determining when an emergency condition exists. 5) Calling the office-based doctor: Dr. Levine\'s assertions are intellectual dishonesty, unless Dr Levine\'s pager is on and unless he is available 24 x 7 x 365. At our hospital, when I call the cardiologist to facilitate outpatient follow-up, I usually am connected to the on-call cardiologist, not the doctor who regularly sees the patient. In summary, although I don\'t work in a perfect environment and I don\'t claim to achieve perfection, there is little in life more frustrating to emergency physicians than the assertions made by doctors who have not actually worked in a modern ED for years if not decades, whose view of the ED is frozen in a past model, and who is so arrogant as to think that he alone knows how it could be run better. Dr. Levine uses atypical events to cast aspersions on the thousands of emergency physicians in the world who provide proper care in difficult circumstances. Does Dr. Levine check the credentials of every pilot of the plane onto which he steps, before he flies in a commercial airliner? Or does he trust that systems of training have taught the pilots? And does he trust airlines based on their track record and his personal experiences with them? It\'s the same with emergency physicians. We have training, our practices have oversight, and we are part of a system, the hospital. Every year, millions of safe take-offs and landings are accomplished around the world. Only when rare accidents occur does an airplane make the news. Similarly, in 2013, over 110 million emergency department visits occurred. Most of these visits were successes and did not result in Sentinel Event reports or lawsuits. Our training and our systems of care that are used in modern emergency departments are usually successful. Dr. Levine’s selective citation of events does not provide a representative view of the quality and accuracy of care provided every day in emergency departments not only in the United States, but indeed, in the more than thirty nations in which emergency medicine is a primary specialty.