Edwin Leap, MD

Edwin Leap is an emergency physician who writes at the Substack, Life and Limb, and is the author of the Practice Test and Life in Emergistan.

A surprising way to connect with the most difficult individuals

Edwin Leap, MD

Physician

June 19, 2018

I have met, in the emergency department, some fierce individuals. Sometimes they can be terrifying. Their clothes, their manner, their demeanor, the way they pace, all suggest potential danger. They seem clearly capable of violence. They look at me with distrust, expecting to be disrespected, dismissed, treated harshly.

Sometimes, they are covered in piercings; a thing alien to me. Other times, the symbology on their clothes speaks volumes. My colleagues in …

Today’s unassailable fact could become tomorrow’s flat earth

Edwin Leap, MD

Physician

June 13, 2018

It’s easy to be excited about facts when they support our own opinions. It’s nice to believe that uncomfortable facts are fake. Likewise, it’s comforting to believe that everyone who disagrees with us is ignorant. When the truth is so obvious, we say, “How could anyone but an uneducated bumpkin deny it?”

And yet, it seems that much of our knowledge is incomplete and that our deeply held beliefs may be …

The cognitive dissonance of prescribing narcotics

Edwin Leap, MD

Physician

June 13, 2018

I know a bit about the opioid epidemic ravaging America. My wife and I grew up in West Virginia and follow the news from home. I practice emergency medicine in rural South Carolina, and have worked in Georgia, North Carolina, Kentucky, and Indiana. I have seen the enemy, and it is terrible to behold.

The genesis of the epidemic has been covered over and over. It is a complex problem with …

The frustrating obstacle facing the physician-writer

Edwin Leap, MD

Physician

May 30, 2018

I am convinced that I have one of the best jobs a writer can possibly have. I practice medicine, in an emergency department. My life, every day, is filled with conversation with humans. I see their faces and touch their hands. They bring me their children, their very children (!) and trust this stranger to make their precious ones well.

I hear their stories! Such stories. Of sorrow and sadness. Loss …

Bias is widespead on both sides of the political spectrum

Edwin Leap, MD

Physician

May 17, 2018

Without doubt, the future of medicine will include mandatory education for physicians on their conscious and unconscious biases. The politically and culturally progressive nature of medical education and graduate medical education almost ensure that this will eventually be a deeply-ingrained part of our training and our continuing certification. I’m sure that as our culture purports to discover ever new and egregious forms of bias, we will be endlessly reminded, in …

Emergency physicians are glorified secretaries with medical degrees

Edwin Leap, MD

Physician

April 15, 2018

We had a pretty busy shop when I was in residency. So busy, in fact, that we had three secretaries working simultaneously — one for paging, one for order entry, and one for admissions. I haven’t been back there in a long time, but I hope the secretarial staff has grown commensurately with the volume and acuity of the ED. But from what I’ve seen around the country in my …

An emergency physician delivers a baby, and realizes that it isn’t for him

Edwin Leap, MD

Physician

March 27, 2018

I’m an emergency physician. In common parlance, an ER doc. Which means, like a little kid who will eat dirt on a dare, there’s not much I won’t try in the practice of my profession. Many of my colleagues have had far more challenging careers than me, I assure you. But I have some stories to tell. Cyanide overdose while moonlighting as a resident. Patient nearly dying from bite by …

The critical importance of wisdom

Edwin Leap, MD

Physician

January 11, 2018

What are the most important things we can teach our kids? These days there are a lot of possible answers. Obviously, STEM skills (science, technology, engineering, mathematics) often lead to lucrative, stable careers; they seem to be tickets to “the good life,” or so we’re taught. Languages are helpful. You can’t go wrong with basic computer programming skills.

But in a world where people seem increasingly unkind, dishonest, greedy, violent and …

Read more…

The critical importance of wisdom

Doctor: So you made a mistake

Edwin Leap, MD

Physician

December 1, 2017

So you made a mistake. I know you’re busy beating yourself up about it. I know that after years and years of training in life-saving medicine you’ve also trained yourself to accept the blame for all sorts of things beyond your control.

You’re asking, “How could I have missed that,” or “Why didn’t I think about that?” You’re wondering why you didn’t give a different drug, order another test or do …

Read more…

Doctor: So you made a mistake

My heart goes out to all of the first responders

Edwin Leap, MD

Physician

October 25, 2017

It’s hard to put into words the horror we all feel about the events in Las Vegas. So I won’t try. But what I will try to do is point out an often unspoken reality. Which is that those who work in emergency care constantly face terrible things with courage and skill and keep coming back for more. And everyone needs to remember that all those folks society counts on …

Emergency medicine can be exhausting. Here’s what this doctor does to unwind.

Edwin Leap, MD

Physician

October 15, 2017

So I’ve finished up at one job and moved on to another. I was a director for a year, and it was a learning experience. Right now I’m nearing the final approach after working a long run. Last week I had five nights, 12 hours duration each. I stayed in a hotel near the hospital. Then, after two days off at home, I started a run of five days, of …

How the pain scale and patient satisfaction leads to death

Edwin Leap, MD

Physician

October 9, 2017

Unless you’ve been living under a rock, you’re well aware that the United States is in the grip of a really big epidemic of opioid abuse. The epicenter of much of this has been my beloved Appalachia. My home-town, Huntington, WV, might as well be re-named “Oxycontin,” or maybe “Heroinville.” It’s ugly.

Enormous amounts of ink have been spilled on this topic, and …

How can we solve the rural clinician shortage?

Edwin Leap, MD

Physician

October 4, 2017

I was recently at a meeting where some very influential physicians were discussing a question that I’ve been thinking about for a while: how do we find medical staff for rural emergency rooms and hospitals? It’s a tough question, because, increasingly, it seems that young physicians are trained to work in urban hospitals. Those are also the places these young doctors prefer to practice. Big hospitals and teaching centers in …

The surprising sleeping arrangements of an emergency physician

Edwin Leap, MD

Physician

September 15, 2017

I used to practice locums medicine; which for the lay person means traveling to different jobs, sometimes several states at a time. During that time I stayed in a lot of hotels. But, occasionally, I had more unique accomodations. Obviously, if you travel enough, you’ll sleep in an airport here and there. No big deal. I actually like sleeping in airports occasionally. When you’re stuck, you’re stuck. Weather or …

The plight of mid-sized emergency departments

Edwin Leap, MD

Physician

September 3, 2017

I know, I know, I spend way too much time ranting about work in the emergency department. But after some recent shifts, my box of rants is full once more. And what I want to point out is the enormous struggle of the mid-sized emergency departments in America today.

I know this is a problem; I work in them, and I know and talk with people who work in them. It’s …

Parents: Interact with your kids!

Edwin Leap, MD

Physician

July 31, 2017

After years and years of practicing emergency medicine, I’ve seen and treated thousands of children for everything from beads in the nose to leukemia, ruptured spleens to sprained ankles.

A father of four myself, I take great delight in interacting with the kids that come through my workplace. I consider it a personal challenge to make them smile whenever possible and to put them at ease.

I’ve learned a few things over …

Read more…

Parents: Interact with your kids!

Cheaper health care isn’t hard

Edwin Leap, MD

Physician

July 20, 2017

I have never wanted to be the medical advice columnist. “Dear Dr. Leap: My feet sweat all the time. I’ve tried everything! What should I do?” Nope, I’m not your guy. Nor do I want to opine on study after study about statin drugs for cholesterol or discuss whether women should take estrogen. There are physicians who love those questions! And I think they’re fantastic. But I’m an emergency medicine …

Read more…

Cheaper health care isn’t hard

This is what practicing medicine in rural America is really like

Edwin Leap, MD

Physician

May 27, 2017

“So tell me why you think you you’re having a stroke?”

The nice lady, mid 40s, sat on the ER exam table in work-clothes, an anxious look on her face. “Well, I was working the cattle up in the timber, and when I got back to my 4-wheeler my heart was racing, and I was short of breath. My arms were tingling, and so was my face. I’m concerned it might …

Emergency medicine is a model for unity

Edwin Leap, MD

Physician

May 12, 2017

How do you define yourself? How do you describe yourself? In the past, I have tried to avoid immediately categorizing myself by my profession. I always agreed with The Little Prince: “Grown-ups love figures … When you tell them you’ve made a new friend they never ask you any questions about essential matters. They never say to you “What does his voice sound like? What games does he love best? …

Read more…

Emergency medicine is a model for unity

The one person that sustains this emergency physician

Edwin Leap, MD

Physician

March 26, 2017

When I go to work, I take a lot of things with me. Everyone has their ritual, right? I take my backpack with my computer inside. I take my phone. I take charging cords, the true modern lifeline. I take lunch. I carry a pen, flashlight and pocket knife.

On a more abstract level, I take the wonderful education I received as a medical student and resident, coupled with my years …