Dear emergency department clinicians:
We at the top of the administrative and regulatory chain understand that you deal with enormously complicated mental health and substance abuse patients all the time. Your resources are limited, and the demands placed upon you are growing.
As such, we (the anointed and well-meaning) wish to offer you some guidelines based on our committee’s extensive lunch-time meetings and brainstorming sessions. All of which, you will certainly understand, …
Read more…
I hear it all the time. Young resident physicians are taught it. It infects our failed attempts to staff rural hospitals. (Among other things.)
It’s this. ‘If you’re well trained in a teaching center, and you go to a small rural hospital, you’ll lose your skills. Better to stay in the big center. Let less qualified people work in ‘the hinterlands.’ It won’t matter that much out there. They’ll be fine. …
Read more…
Here is a standard emergency department situation, played out all across America today.
Patient X has schizophrenia. He takes medication, but only until he feels better. He is calm when he takes it, but sometimes aggressive and assaultive when out of treatment and off medications.
Patient X decides to leave town and drive somewhere else because he is angry at 1) family 2) significant other 3) health care system 4) situation.
He is …
Read more…
When the paramedic calls in and says “transporting non-emergent …” I think of this wonderful story.
I was once “deposed” by the state medical board to speak on behalf of a friend who had been charged with “unprofessional behavior,” because he missed an abnormal lab that resulted in a patient having unforeseen (but non-lethal) complications. It was really a systems issue, but somebody thought my friend needed to be made an …
Read more…
“Mens sana, in corpore sano,” goes the old Latin saying. “A healthy mind in a healthy body.” It’s vital that way pay proper attention not only to our physical existence but to our minds and souls; to the intangible but essential part of who we are.
While I write a lot about things we need to do to keep our bodies healthy, it’s important to remember that our eyes and minds …
Read more…
If you ask people if there is evil in the world, a lot of them will smile politely at such an obviously Medieval (or Neanderthal) view of the world. Which, of course, is a bit of an insult to both groups who were from all evidence quite intelligent folks.
Some might rattle off some examples of evil. Things like intolerance, racism, sexism, homophobia, transphobia, Islamophobia, and assorted others. Disregard for the imminent …
Read more…
There are a lot of unhappy physicians in a lot of bad situations. I know because I write for them, and they write to me. The thing is, we deal with patient satisfaction all day long. Why not work harder on physician satisfaction? I want my colleagues to have a higher “physician satisfaction score.”
So first off, what makes us dissatisfied? What lowers that score for the hard-working physicians of America, …
Read more…
“Remember that patient you saw?”
What a horrible question that always was. You came to work, and a friend would come up to you quietly and take you aside.
“Remember that guy yesterday with the chest pain?”
“Mr. Hayes?”
“Yeah him.”
“What happened?”
“He came back with a heart attack.”
“Oh wow, I feel terrible.”
It wasn’t always bad news. Occasionally it went like this: “That child with leukemia you diagnosed last month? His mother stopped by to …
Read more…
I was working a few days ago and pulled a tooth. Mind you, it’s not something I do with any regularity. However, it was a very sweet little lady who was too weak and ill to get to the dentist and had other issues. That lower incisor was loose, and constantly in the way. Furthermore, it was painful.
I had seen her for something else in the emergency department. I took …
Read more…
I write for several publications, and I’m always pitching to new venues. Recently I pitched an idea to an editor. I wanted to write about gun research from the perspective of a rural physician. In particular, I wanted to ask what might physicians say if researchers found answers that were uncomfortable. What if they found that intact families, strong fathers, religious engagement or familiarity with guns were factors that reduce …
Read more…
My friends and family used to say that I was born 30 years old. I get it. From the time I was young, I was controlled, risk-averse, studious, and polite. In addition to the fact that I was naturally reserved, I learned over time to do my best not to make anyone uncomfortable. I frequently refused to stand up for what I wanted, always deferring to the wishes of others. …
Read more…
I use social media. Specifically, I use Facebook, Twitter, and LinkedIn. In the beginning, I did so for utilitarian purposes. As a columnist and aspiring writer of books, these were (and indeed are) useful marketing tools.
I have, in the past, carried around a note-pad to jot down ideas. I was never without my note-pad. I always wanted a small legal-pad with a blue or black gel-ink pen. It was my …
Read more…
Does anyone in medicine, particularly emergency medicine, understand why we lose money? Why we have to push those metrics so hard to capture every dime?
I mean, we’re constantly reminded that satisfaction scores, and time-stamps and time to door, time to needle, time to discharge, reduced “left without being seen” scores are connected to the money we make.
Medicine now is far less about the wonder of the body, the ravages of …
Read more…
Dear Lord Jesus,
I just finished my shift in the ER. Of course, you knew that. But I was thinking about how often I’m ungrateful and irritable. I know that I complain about rules and regulations, about time-stamps and metrics and satisfaction scores and all the rest. I know I’m that guy. I get annoyed by people who are annoying. (I’m glad you don’t.) I get annoyed when I’m tired, and …
Read more…
We all know that there’s a remarkable shortage of physicians in America and that it’s growing worse. This is especially true in primary care but it’s present across all specialties. This shortage alone is a significant stress on practicing physicians. But when it is coupled with corporatization, the increasing complexity of medical care, unrelenting electronic charting requirements and the explosion of administrative tasks, physicians barely keep up each day.
This is one of the …
Read more…
School is back in full swing. The kids are packed up, scheduled and loaded with notebooks, pens, pencils, computers, and calculators. Long lines form outside school drop-off areas. Tired, pajama-clad parents drop off bleary-eyed children, accustomed to sleeping and playing all day, now headed off to fill their little brains with knowledge.
Of course, it isn’t just the little ones. All of our children were home over the Summer. Now our daughter is a high school …
Read more…
There’s an ugly undercurrent that sometimes shows up in the emergency department: indeed all over the world of medicine. I’ve seen it in doctors and nurses alike. It’s a meanness, a smallness, a kind of moral judgment that can lead us to make poor medical decisions. Or it can simply make us poorer in spirit.
I remember the day I had a young man who was in custody. He was 18, …
Read more…
So let’s get down to it. Everyone is tired of shooting sprees. If you’re a gun owner, you’re tired of seeing weapons abused and misused to harm the innocent. If you’re a gun opponent, you feel the same way but can’t imagine why anyone has these weapons in the first place. I get it. I hope both sides get it.
I’ve thought about this a lot. I’m a gun owner. I …
Read more…
This summer, new resident physicians begin their training all across the United States. Today, our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (OK, not really a specialty, just a sideline) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school. Anxiety-filled and debt-ridden, they will embark on four …
Read more…
It’s peculiar, I think, that we live in a time of physician shortage and yet some things remain abundantly clear:
1. Physicians can’t work together to fight, either for their own good or the good of their patients.
2. Like hostages, or abused spouses, they just keep going back for more of whatever bad policies they endure.
3. They are devalued.
Now, this isn’t about money. I’m not enough of a medical economics expert …
Read more…
