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.
I was at a locums assignment yesterday using FEEMRS. (You know, “Fancy Expensive Electronic Medical Records System.”) It was all kinds of busy, with wait times of many hours. And as I slogged along, relearning FEEMRS after a few weeks away, I realized that it takes about one hour of looking at that screen for me to become exhausted.
It’s just too busy. Every bit of the screen seems filled with …
Currently, in American health care, experts are wringing their hands in confusion. I mean, people have insurance, right? And yet, health care is still expensive and dang it, people just keep going to the ER. Visits are climbing everywhere, and I can speak from personal experience when I say that we’re tasked with more and more complex and multi-varied duties in the emergency departments of the 21st century.
I’m not a …
I was working in a hospital recently and saw a note from a CEO on the computer. Notes and memos are ubiquitous these days. Bathroom walls, break-rooms, computer screens. Everywhere there is another reminder to check this, do that, mark those, record metrics, hurry up, don’t make mistakes, sign orders, complete charts, be nice and all the rest.
But this note stood out. In it, the administrator was reminding the medical …
I’ve written a lot lately about caring for our patients, and about caring for our spouses, and those things make me very happy. But now and then, things rub me the wrong way.
I was recently working at TMH, or Tiny Memorial Hospital, my vague name for small facilities since I work at several and wish to preserve their anonymity. While there a patient checked into the ED for a fairly unremarkable …
How do we know what to believe about anything? In times past we read books, we took classes, we spoke to experts. These days? These days we do the same, but we also search the Internet. And we seem to do it with special fervor when it comes to questions about our health.
I can’t throw any stones here. Even a physician has knowledge that is limited to his or her …
I have never been the director of any professional group. I have, however, been directed. As such, I have a few tips for those who are directors and administrators. I give you my physician satisfaction system. It is arranged in no particular order.
In every physician break room or lounge, there should be a wall for photos of girlfriends, boyfriends, children, spouses, parents, dogs, cats, horses, boats, new shotguns or whatever …
It’s a well-known reality of health care economics that Americans spend a lot of money in the last year of life. I suppose that almost goes without saying, since serious illnesses and injuries that result in death are costly, at whatever age they occur. Being hit by a car and dying means you were hit by a car … in your last year of life. And that two weeks in …
“Gunshot wound to chest, pulseless, 20 minute ETA.”
When that’s the EMS report, it gets your attention. Despite the wonderful theatrics of modern medical shows, and the best efforts of real-world, sweat-drenched paramedics, those of us who have done this long enough can translate that report. For the layperson it means: “Dead.”
I saw that last week. And the week before I saw another tragic, unexpected death in a man not much …
The following excerpts will give you an idea of what life can be like while practicing emergency medicine in very beautiful, very coveted areas of the United States. I will not name towns or hospitals, as the situations are highly reproducible from place to place and season to season. We’ll just call it St. Resort hospital. If you doubt me, call up your friends who work in such locales, with …
I was working at a small hospital when I heard the nurses talking about a new rule. The rule was that the only people who could wear lab coats would be physicians and administrators. It made me laugh a little. I’ve hated lab coats since medical school.
I currently sport what a family medicine resident told me was the ER mullet: khakis and polo shirt. (Who knew?) I find it much …
My family was driving to see our new niece this past Saturday. While passing through a town on the way, we came upon a motorcycle accident. The rider had been hit by a vehicle and was lying on the pavement with a growing crowd of people who wanted to help. I’ve done it before. I did CPR at the scene of a wreck when I was in medical school, and …
When we take our sick or injured loved ones to the hospital, we often hope that they will be admitted. In many instances, this is a very reasonable request. When heart or lung disease are at work, when severe infections, dehydration, fractures or strokes occur, admission may well be the only option. However, sometimes our desire to admit our family members is a throwback to a simpler time in medicine; …
So, there I was yesterday, working frantically to keep myself above the water level of the rapidly rising swamp of patients. Navigating, haltingly, the onerous and demonic EMR. So I thought I ordered three nebulizers, but it was only one. The respiratory tech approached me and informed me that she would put them in, but only this time. That I’d have to …
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I have worked in a lot of hospitals over the past two years. Quite a few of the facilities have been critical access hospitals, which is to say that they are very small, typically having fewer than 25 inpatient beds, and are usually somewhere in the boonies. A number of characteristics allow a hospital to qualify as critical access and receive additional …
Do you remember Mad Libs from when you were a child? A story is filled with blanks, and as you fill them in with inappropriate and ridiculous words, you laugh until you can’t see straight. You laugh until you can’t breathe, and your parents beg you to stop! Let’s be children again. Share these with the nurses, and give the shift a little levity.
Pain medication. You see, doctor, my pain specialist …
I recently found something I had lost. Or rather, I found someone I had lost. He was a dear friend from my childhood. We spent days and nights roaming the woods near our homes, catching crawdads and minnows in the creek and turning rocks over to look for banded water snakes. We shot bows and arrows and rode bikes. Standard Appalachian stuff, that.
In the winter, we would sled until we …
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One of my favorite physician sayings is, “Don’t just do something, stand there!” Which means that it’s better to do nothing than to do something that doesn’t help. As I move through my career, I find myself agreeing. I am endlessly amazed at the number of things we do for no good reason, and that patients come to expect, also for …
They say that there may be children, born now, who could live to be 1,000 years old. Can you fathom that? Some humans could continue to live for what would be well more than ten current lifetimes. We aren’t there yet. But this isn’t so far out of the possible. Some medical researchers are already talking about resuscitating those who die up to five hours after death. It involves special …
For my entire life as a physician, from medical school, through residency and now until this 22nd year in practice, I have subscribed to the idea that I should have a chaperone when performing breast, pelvic or rectal exams on women. I was taught to do this from the beginning, and I still do it.
Why is this? On some level, the …
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While working at small rural hospital I was once again faced with the emergency physician’s dilemma. Admitting a patient and being told to write holding orders. In the midst of a very busy department, I sat with a nurse who guided me through the ridiculously complex and counterintuitive electronic orders system. All this so that the admitting doctor wouldn’t have to log onto the computer, from home mind you, and trouble …
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