I sit here today, in this small, windowless call room with its low twin bed that is covered in untouched hospital blankets and sheets. Tonight is one of my last nights on a 30-hour call shift in the medical intensive care unit. Yet another mile-marker on this long journey of residency. My day began at the break of dawn, when I and another resident passed each other in the parking …
Reduce sedation in critically ill patients
An article written by Dr. Sally Satel in The Wall Street Journal, Physician, Humanize Thyself, discusses the origins of the white coat ceremony. In the 1980s, as insurance companies placed increasing pressure on physicians to minimize visit time and maximize patient volume, the medical profession at large became increasingly cynical and disgruntled. A direct result of this was the White Coat Ceremony, whereby each medical student goes up on stage …
Does the White Coat Ceremony encourage compassion?
A recent survey in the American Journal of Bioethics, indicates that 80 percent of patients expect to see a physician when they come to the emergency department.
Parents were more insistent about their child see a physician or resident for even a minor condition such as a sprained ankle.
Patients indicated a preference for seeing a resident alone for non-urgent conditions (60%) and compared to a physician …
How PAs and NPs impact emergency room care
It is hard to imagine that someone can emerge from intern year – 12 months of chaos, little sleep, and hours upon hours spent responding to pages and putting orders in a computer – and know something, anything, about medicine. I did not believe in this training system until now, after my first night as a supervising resident. The knowledge I have absorbed over the …
Gratitude from patients and their families
I recently completed a long stretch of night shifts in the emergency department. I have done a myriad of things – spent over twenty minutes trying to convince a patient to take a pill that she needed to treat her psychosis, sutured a facial laceration for a young gentleman who kept insisting that he wanted to leave AMA (against medical advice) and just place a …
How much we should try to help patients who do not want our help?
An article in the Wall Street Journal, Taking Medical Jargon Out of Doctor Visits, emphasizes that the use of medical jargon leads to poor communication between physicians and patients, and consequently leads to ineffective medical care. Federal and state officials are now pushing healthcare professionals to use simpler language to communicate medical advice to patients.
I could not agree more with this mission. The gap …
Medical jargon leads to poor communication between physicians and patients
Physicians used to take care of patients at their homes.
Through the 1960s, patients would make a phone call and the doctor would arrive at the doorstep, black bag in hand, eager to serve. This changed in the mid to late-1960s as doctors developed group practices and as medical care expanded to include technology-based studies and specialty referrals, and thus became more hospital-centered. Prior to World War II, 40 percent of …
How house calls benefit patients and physicians
According to an article published in the Journal of General Internal Medicine, counties with teaching medical hospitals experienced a 10% increase in fatal medication errors as compared to counties without teaching medical hospitals.
First, what is the July Effect? It represents an entire transition in the hospital, during which medical students become interns, interns become senior residents, and second or third-year residents become chief residents. …
Fix the July Effect for incoming interns and residents
A recent article in US News and World Report, Most U.S. Physicians Practicing Defensive Medicine, claims that physicians are ordering more tests and escalating the work-up of sick patients, all in the name of defensive medicine.
Is it true? Absolutely.
It is especially true in the emergency department, where we have one shot to get things right, or else. Ironically, by practicing defensive medicine we are not practicing …
Defensive medicine forces residents to use test oriented care
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