Emergency physicians, nurses, and paramedics are a superstitious lot. I thought it might be interesting for those not in the business to read about some of our superstitions. In no particular order, here are my favorites.
1. The “Q” word. “Quiet.” it’s truly the kiss of death. The “S” word, “slow,” carries the same jinx. Usually some newbie nurse or clerk who is …
I got the call from the ER because I was the “no-doc” surgeon, meaning I was the guy to call when a patient showed up needing a surgeon, and who had no primary care doc to direct the referral. Usually it meant trouble. A drunk who smashed his car and himself, possibly others. Stab-wound, gun-shot. People who don’t have their own doctors include more than those down on their luck; …
Stercoral perforation as a deadly cause of colon rupture
In 1905 William Osler gave his farewell address as he prepared to leave Johns Hopkins for Oxford and England. After speaking to the assembled medical students about the tragic side of medicine he said:
The comedy, too, of life will be spread before you, and nobody laughs more often than the doctor at the pranks Puck plays upon the Titanias and the Bottoms among his patients. The humorous side is really …
William Osler’s humor, and finding fun in medicine
It had been a high-speed motor-vehicle accident. One car. A twenty-something male driver without passengers. No seat belt. And now, this same driver had no movement from his waist down and no sensations below his mid-abdomen.
According to bystanders, he had been driving his sedan dangerously fast, some estimates of nearly 100 m.p.h., before losing control. The car veered off the roadway to the right, flipping mid-air before smacking head-on into …
Priapism is indicative of spinal cord injury in trauma
Medical students today consider lifestyle an essential criteria when choosing a specialty.
It’s become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.
There’s been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands.
Claudia Golden, a Harvard economics professor, recently noted that,
high-paying careers that offer more help in balancing work …
Lifestyle matters for specialties that want to survive
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 70-year-old woman with hypothyroidism fell and fractured her hip. During preoperative evaluation for hip fracture repair, she mentions recent mild fatigue, which has not significantly limited performance of her daily activities, and ongoing right upper-quadrant abdominal pain after eating. She takes levothyroxine, 0.075 …
MKSAP: 70-year-old woman with hypothyroidism and a fractured hip
I’ve made some fairly outrageous claims about the workload of a neurosurgical resident recently. Seems like a reasonable time to lay out exactly what a day on call can be like for me and my fellow residents.
To be fair an average experience may be hard to articulate. Different rotations and different days yield different … adventures. Right now I’m on a service that could hardly be called grueling, but I …
A neurosurgical resident’s typical day
So there was a neurosurgeon who called a plumber for a house visit.
The plumber arrived and after spending an hour bestowed the neurosurgeon a bill of $500. The surgeon was stunned; he said, “Even I don’t charge this much after a surgery.” The plumber stood up, gave him a sly look and said, “well that is why I am a plumber now; I used to be a neurosurgeon.”
I mention this …
How a plumber charges more than a neurosurgeon
Antibiotics for viral infections are a big pet peeve of mine. No. Make that a huge pet peeve.
Some doctors prescribe antibiotics for coughs and stuffy noses because the patients want them. If you’re one of those patients who think that antibiotics make your coughs go away, or clear up your stuffy noses, or somehow make your sinus headaches vanish, or if you’re a doctor who prescribes antibiotics for these symptoms, …
Antibiotics need to become controlled substances and regulated
I’m not sure about the validity of this study: Free Access to U.S. Research Papers Could Yield $1 Billion in Benefits.
Quantifying how much money will be saved by increased efficiency due to open access seems like fuzzy math at best. However, we do need better access to medical journal articles. As a researcher, I’ve constantly fought the battle against firewalled journals. I am fortunate to be part of a university …
Paying for access to medical journals
Everyone one knows ER docs work shifts. Many places though have each doc doing a set schedule. Such as 1 day, 1 evening, 1 overnight or one week with days, one with evenings, and one with nights.
Others, like my hospital, it is a mass jumble. We work all sorts of random shifts at random times, so long as it evens out at the end of the 6 week block that …
Shifts and making switches in the ER
There’s a new bunch of bloodsuckers running rampant in cities all over the country.
No, they’re not on a new vampire TV show or in a Twilight sequel. They’re bedbugs, and they’ve been showing up in droves in more and more cities across America. And despite what is commonly thought about them, bedbugs do not exist only in the poorest sections of town, they are showing up at 5-star hotels.
That means …
Bedbug rashes, and how to prevent and get rid of bedbugs
The Disease Management Care Blog received this posting from an experienced nurse with a background in clinical and administrative medicine.
We’ve all seen them. Those vacuous workplace posters exhorting teamwork, creativity and other forms of inspiration and accomplishment. A version has begun to creep into our nation’s health care facilities. reminding everyone of the need for privacy, how infections can be spread and the importance of patient service. And if my …
Do posters in the hospital really help patients?
by Lyle Denniston
Hospitals know that medical care decisions often have legal consequences, which makes it all the more important to know what the law requires. But when judges can’t agree, and there also is some ambiguity in the way government officials see a legal issue affecting care decisions, hospitals may need to go to the ultimate authority – the U.S. Supreme Court – for an …
When does the duty to provide emergency medical care end?
A reader informed me that Dr. Oz did a TV show recently on nosebleeds.
I took a look at the video clip and it is my opinion that some information Dr. Oz conveyed is not entirely correct. Again, I should stress that this is just my opinion and I’m sure there will be many who may feel differently.
Error #1:
Contrary to what was said on the show, ice packs do …
Teaching Dr. Oz about nosebleeds
There is very little doubt that if we eat the diet we were designed to eat and spend adequate time in the sun that we will get most if not all the nutrients we need.
That’s the ideal, but not the reality for a lot of us. I was recently advised by a group of physicians who are experts in the area that it is reasonable, and probably preferable, for adults …
Taking a multivitamin, vitamin D and fish oil every day
The holidays are a great opportunity to ask family members about their health history.
Learning about your family’s health history can help you answer your doctor’s medical history questions. It can even help your doctor determine if you may be at risk for an inherited cancer like breast, colorectal, ovarian, prostate or endometrial cancer, which sometimes run in the family.
Keep in mind that just a small portion of cancers – about 5 …
How to create your medical family tree
First, this piece is not a how-to guide for getting into medical school.
But I use this ploy for good, and not for evil. Through conversations with a number of non-medical colleagues, I’ve been forced to think a bit more about premedical and medical education. A letter from a reader (which is presented in a highly altered version below) made me decide to more thoroughly and …
Making the decision to go to medical school
Here’s the scenario: on the 2nd of the month, a patient with diabetes on metformin and high blood pressure on benazepril sees her family physician for a routine follow up.
The patient’s blood pressure is elevated and the decision is made to add carvedilol to help get the blood pressure to goal. The patient’s metformin and benazepril “drop” (are renewed) at the pharmacy on the 18th of every month, a date …
Help patients synchronize their prescription drugs
She was like … Superwoman. A strapping medical visionary probably in her forties. Gray long coat falling below the knees. She strode confidently down the hallway towards the elevator, a father hurrying beside her with his young lanky daughter cradled in his arms. The girl’s head nuzzled into her father’s shoulder. She was old enough to walk by herself…but clearly she was sick. Unable.
Undoubtedly they were headed from the medical …
Why patients are leaving our practices
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