Summary Pro Side: Dr Graff What we are dealing with is not a physical unit but in reality a concept. We are not emergency room doctors — we are emergency physician specialists. We deal with emergency medicine in all its aspects; we don't deal with a room. Whether you have an observation unit or an observation policy, what is important is the concept of how to deal with a certain type of patient. The overcrowding issue may actually help us. Rather than us putting our head into a hole saying we can't deal with this type of patient — ie, we don't deal with continuing care — we should provide ongoing care for a certain type of patient, a patient who is appropriate for an observation unit. We shouldn't deal with a patient who is appropriate for admission to the hospital, who has 20 or 30 medicines, and who needs intensive services. We are going to manage patients who have a limited intensity of service that we define as manageable for our nurses, a level of service similar to that on the medicine floors. This saves the bed upstairs for patients who are “train wrecks” with very high service needs that would consume our staff's energies. At the same time, we are offering to society a way of dealing with the health care crisis. The latest Health Care Financing Administration statistics show that more than 12.4% of our nation's gross national product is for health care. This is up from 11.6% of the gross national product from last year despite cost-containment studies and efforts. Our specialty should have input into solutions being developed for these problems. With observation units we are part of the safety net for the population, managing many common emergencies that otherwise would have needed hospital admission. We are part of the solution trying to deal with health care policy.