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Physician voices
Last night when I came to work most of the beds in our 31-bed emergency department (ED) were full. There were more than 20 patients either in the waiting room proper or in the chairs that serve as "rooms" behind…
Last night when I came to work most of the beds in our 31-bed emergency department (ED) were full. There were more than 20 patients either in the waiting room proper or in the chairs that serve as “rooms” behind the triage area.
Much of the problem was the fact that we were boarding patients who were waiting on inpatient beds, psychiatric admissions, or transfer to higher levels of care elsewhere. …
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The emergency department crisis: Why patient boarding is dangerous
Physician voices
I recently worked an evening shift in the emergency department the day before New Year's Eve. Patients arrived in waves, by car and by ambulance. They seemed to check into the triage area every few minutes. When I left at…
I recently worked an evening shift in the emergency department the day before New Year’s Eve. Patients arrived in waves, by car and by ambulance. They seemed to check into the triage area every few minutes. When I left at midnight, there were 23 patients awaiting admission in the ER waiting for four, six, 12 or more hours — some for a full day.
Simultaneously, there were about 20 waiting to …
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Hospitals at a breaking point: Lack of staff and resources leave ERs in chaos
Physician voices
Sometimes I really look forward to something new. An alien race arriving on earth would be a nice start. I think we could all use a change in the news cycle. Because I am very tired of thinking about, talking…
Sometimes I really look forward to something new. An alien race arriving on earth would be a nice start. I think we could all use a change in the news cycle. Because I am very tired of thinking about, talking about, and especially treating COVID-19.
In all of my years of medical practice, I have never seen anything that taxed the system and caused so much mayhem, while simultaneously producing such …
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Trapped in a cauldron of suffering, medical staff are weary
Physician voices
Given the devastation wrought by the COVID-19 pandemic, many are asking why people would be hesitant to be vaccinated against it. That's the question that bounces around the skulls of countless physicians, public health experts, journalists, politicians, and others. But…
Given the devastation wrought by the COVID-19 pandemic, many are asking why people would be hesitant to be vaccinated against it. That’s the question that bounces around the skulls of countless physicians, public health experts, journalists, politicians, and others. But before trying to answer the question, it might be reasonable to ask why people do, or fail to do, other things that negatively affect their health.
Why does a patient with …
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Vaccine hesitancy is complex
Physician voices
Physicians in general are a pretty intelligent group of professionals. However, we sometimes make the mistake of thinking that we must also know a lot about almost everything because we know a lot about one particular thing. However, given the…
Physicians in general are a pretty intelligent group of professionals. However, we sometimes make the mistake of thinking that we must also know a lot about almost everything because we know a lot about one particular thing. However, given the exploding pace of advancing knowledge, that idea is hubristic. But it isn’t just science and technology where we fall short.
During the COVID pandemic, one of the things most contentious has …
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Why do people keep going to church?
Physician voices
I have a lot of energy. I have been going and going and going for so long. And today, it hit me. I’m tired. I began this pursuit of medicine in 1983 when I decided to be a zoology major.…
I have a lot of energy. I have been going and going and going for so long.
And today, it hit me.
I’m tired.
I began this pursuit of medicine in 1983 when I decided to be a zoology major. I worked and went to medical school. And I went to medical school and worked. Then I worked and went to three years of emergency medicine residency and worked hard for those three …
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This physician is tired, and he’s not alone
Conditions and diseases
Everyone seems to be walking about in disbelief. College educators and administrators are shocked. Public health officials are incredulous. Politicians are confused, and news reporters are busily shaking their heads at the numbers. Physicians, my colleagues across the country, are…
Everyone seems to be walking about in disbelief. College educators and administrators are shocked. Public health officials are incredulous. Politicians are confused, and news reporters are busily shaking their heads at the numbers. Physicians, my colleagues across the country, are beside themselves. And all of this head-scratching and hand-wringing is because students went back to their colleges and universities and behaved like, you know, students at college and universities.
And then …
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COVID-19 and the college experience
Physician voices
Despite the fact that many people have difficulty finding a family physician, there remain many options for medical care. From emergency departments to urgent care clinics to clinics based in retail stores and pharmacies, there are several different ways to…
Despite the fact that many people have difficulty finding a family physician, there remain many options for medical care. From emergency departments to urgent care clinics to clinics based in retail stores and pharmacies, there are several different ways to see a physician, physician assistant, or nurse practitioner.
This is can be useful when one has no family physician, or can’t get an appointment. It can be difficult and downright dangerous …
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The downsides of going to the ER for primary care
Physician voices
My small community ED has a fairly high acuity. As such, I was recently trying to transfer a couple of patients, one of whom was an NSTEMI, pain-free but with a rising troponin. In the process of trying to arrange…
My small community ED has a fairly high acuity. As such, I was recently trying to transfer a couple of patients, one of whom was an NSTEMI, pain-free but with a rising troponin. In the process of trying to arrange things, I learned that our main regional referral center was holding a staggering 150 patients in their own ED, all waiting for inpatient beds.
I’ve spent the majority of my career …
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We can’t expect large medical centers to absorb every case
Conditions and diseases
I have been writing columns for physicians for twenty years. And year after year, I have had physicians say this: "I'm glad you said what you did. If I said it, I'd be fired." There are variations on the theme,…
I have been writing columns for physicians for twenty years. And year after year, I have had physicians say this: “I’m glad you said what you did. If I said it, I’d be fired.” There are variations on the theme, but they’re much the same. Twenty years, and far more than 20 years, during which the alleged health care leaders in America have been routinely muzzled because they aren’t supposed …
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Truth dies in silence. Sadly, so do people.
Conditions and diseases
This is a frightening time. The coronavirus is called “novel” because it is new, and what is new is often terrifying. We don’t know enough about our new microscopic enemy. Scientists, clinicians, and policymakers are all working tirelessly with limited…
This is a frightening time. The coronavirus is called “novel” because it is new, and what is new is often terrifying.
We don’t know enough about our new microscopic enemy. Scientists, clinicians, and policymakers are all working tirelessly with limited data and learning along the way. Consider that many diseases that we regularly face have been observed, reported, studied, and treated for decades; some for centuries (although with less success than now). Novel coronavirus …
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In these dark times of a pandemic, look to history for hope
Conditions and diseases
Coronavirus, a.k.a. COVID-19, is lurking on the edges of the United States. What it will do here has yet to be seen. I was initially very concerned since I work on the front lines in community emergency medicine. For the…
Coronavirus, a.k.a. COVID-19, is lurking on the edges of the United States. What it will do here has yet to be seen. I was initially very concerned since I work on the front lines in community emergency medicine. For the last week or so, I have felt a little better after reading several articles. I suspect it will not have a high lethality among otherwise healthy individuals. But I’m no …
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COVID-19 will expose EMTALA and the physician shortage
Physician voices
I once saw an older gentleman who was mentally impaired from birth. A hard enough blow, he had slowly, inexorably drifted into dementia. He cut his head in a fall, suffering the ravages of gravity as so many do every…
I once saw an older gentleman who was mentally impaired from birth. A hard enough blow, he had slowly, inexorably drifted into dementia. He cut his head in a fall, suffering the ravages of gravity as so many do every day, every night.
He was Caucasian. His full-time care-giver was African-American. That young man was the only person who could calm the angry, profane mood swings of his increasingly difficult, neurologically …
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Not only do the worst need love, the best are made better by offering it
Physician voices
I sometimes work as a church security volunteer. And when I do it, I get to simply stand and watch. Watch for someone sick or injured (we have defibrillators and wound care equipment). Watch for someone coming to cause harm.…
I sometimes work as a church security volunteer. And when I do it, I get to simply stand and watch. Watch for someone sick or injured (we have defibrillators and wound care equipment). Watch for someone coming to cause harm. Watch in order to call the police. Watch to keep the children safe.
And it occurs to me, when I do it, that watching is incredibly important. I know this as …
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Watching is incredibly important. I know this as a physician.
Physician voices
It’s hard to explain what we do. And so maybe, it’s hard for others to sympathize with our situations. I mean, physicians, mid-levels, and nurses in emergency departments are tied to computers in often cramped work-spaces, even as they are…
It’s hard to explain what we do. And so maybe, it’s hard for others to sympathize with our situations. I mean, physicians, mid-levels, and nurses in emergency departments are tied to computers in often cramped work-spaces, even as they are required to be at the bedside almost constantly for the latest emergency or (in other cases) the latest bit of pseudo-emergency drama.
If you haven’t worked there, or haven’t for a …
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Taking food and drink away from doctors and nurses is just cruel
Physician voices
In the emergency department, we see them all the time. The person with a medical problem too serious to ignore, but not quite bad enough to require admission. The patient referred to the specialist who comes back to the ER.…
In the emergency department, we see them all the time. The person with a medical problem too serious to ignore, but not quite bad enough to require admission. The patient referred to the specialist who comes back to the ER. “I couldn’t afford the cash upfront.” The new cancer in the uninsured. The pneumonia without a doctor. The homeless not eligible for Medicaid.
The senior barely able to stand, but whose …
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What can I do differently in the ER?
Physician voices
I hate confrontation. It’s just the way I was raised. I’m not saying it’s right, or healthy, it just happened. My parents and I almost never confronted one another; even when it would have been healthier. That, of course, is…
I hate confrontation. It’s just the way I was raised. I’m not saying it’s right, or healthy, it just happened. My parents and I almost never confronted one another; even when it would have been healthier. That, of course, is water under the bridge and not in any way a condemnation of my folks who were kind and loving and indulgent parents.
But this tendency caused me to suppress emotions. Whether …
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Why this doctor was so uncomfortable arguing with another physician
Physician voices
It seems that all day, every day, I care for patients who simply won’t take care of themselves. And I sometimes think that we in emergency medicine have caused more harm than we expected. Now let me first say, I…
It seems that all day, every day, I care for patients who simply won’t take care of themselves. And I sometimes think that we in emergency medicine have caused more harm than we expected.
Now let me first say, I also take care of those who can’t care for themselves. There are those who, through age, infirmity, or poverty, simply have no means. The patient with a chronic condition who can’t …
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What has emergency medicine wrought? Helplessness.
Medical education
Job shadowing is a long-standing tradition. High schools often have dedicated shadowing days, during which students can come and spend time with people working in careers that the students find interesting. While a few hours isn’t really enough to know…
Job shadowing is a long-standing tradition. High schools often have dedicated shadowing days, during which students can come and spend time with people working in careers that the students find interesting. While a few hours isn’t really enough to know if you like, love or hate a job, it’s a start.
In health care, it can be especially important to spend time shadowing. In fact, PA schools want applicants to have …
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The medical profession needs more shadowing opportunities
Physician voices
Many years ago, it was called the emergency room. Now we call it the emergency department. However, unlike so many departments in the world, the emergency department has almost too many purposes, duties, and mandates to number. However, in the…
Many years ago, it was called the emergency room. Now we call it the emergency department. However, unlike so many departments in the world, the emergency department has almost too many purposes, duties, and mandates to number.
However, in the process of being the under-funded safety net for American health care, it has also become a place of remarkable danger where medical and nursing staff, support personnel and even patients face …
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ER staff deserve a safe place to do their jobs
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