How did the emergency department staff of a Texas hospital see, and discharge, a patient infected with Ebola? Despite the fact that blame spreads through hospitals faster than hemorrhagic fever viruses, I’m not interested in pinning down a single person or a single thing, which may have allowed that to happen. I am very interested, however, in offering a few insights …
An ER missed Ebola. Here’s how it could happen to you.
We fling open the doors of America’s emergency departments to help those who can’t afford health care. We have legislated this protection: No person can be turned away for financial reasons. This is very compassionate and represents the higher angels of our culture. Alas, it also is emblematic of the stupider demons of government. You see, the ER demonstrates the inverted priorities …
The ER demonstrates the inverted priorities of American society
Ebola virus is rampant in West Africa. So far, the death toll is around 2,296, which makes it one of the largest outbreaks ever. Ebola is what’s known as a hemorrhagic fever virus, and belongs to a large family of nasty viruses that are widespread around the world. There’s even one in the American Southwest known as hantavirus, that lives in a species of mice. Yellow fever, which killed so …
Ebola: Don’t forget the patients who are left behind
I went to the hospital cafeteria one day last year and experienced an epiphany. It was around 4:30 p.m. and the place was supposed to close at 6:00 p.m. As I entered, the folks inside were covering up the food and putting it all away. “Did you want something, I mean, we can make something for you.” “Nope, I guess not,” …
Don’t forget to feed the doctors and nurses
Welcome to college, young people! It’s an amazing time in your lives. These years will impact your life dramatically if you use them well. So, to help you along the way, allow me to give you some wisdom.
First and foremost, get some wisdom. You are bright and capable, otherwise you probably wouldn’t be in college in the first place. But for all …
Don’t be stupid, and other wise words to new college students
Ink is everywhere these days, and I don’t mean on newspapers or in magazines. Tattoos are far more pervasive than I can ever recall in my fifty years. There was a time, when I was young, that boys were awestruck by the old Navy veterans, whose arms bore anchors, and the Marines with Semper Fi across their battle-scarred chests. Occasionally, …
Consider the messages that tattoos are sending
I recently did a tally. Since starting my locums adventure last year, and going to full-time locums in January, I’ve worked in a grand total of 11 emergency departments. Let me qualify that for the occasional visitor to my blog. I decided to do this for purposes of flexibility, finances and a much needed change of scenery. Not because I’m a problem physician, or unable to do the work in …
Why bad EMRs are forced on physicians
We live in an incredible age. Life expectancies continue to rise. The environment in the U.S. is cleaner than it has ever been. The sum of the world’s knowledge is at the fingertips of any and every smartphone user, waiting to be accessed when they finish playing Candy Crush. The face of poverty in America is still terrible to behold; but it bears little resemblance to poverty down the long …
Why the ER is a mixed blessing for society
I have a shiny new Bluetooth device. So now, as I zip around town, I can speak without my hands touching my phone. It’s relevant because our county is passing a ban on cell phone use, unless it is hands-free. This is a national trend, of course, and the catch phrase is “distracted driving.” Everyone knows that distracted driving is bad. …
We practice distracted medicine everyday
Who watches the watchers? It’s an old Roman saying from the poet Juvenal, and it had to do with infidelity. But over the years it has been applied to politics as well. It means, “How do I know that the people guarding me are worthy?” It has also been translated, “Who guards the guards?”
But it seems to me that it applies to medicine quite appropriately. Who watches those watching physicians? We …
Who watches those watching physicians?
I was working overnight in Tiny Memorial Hospital, located in scenic rural America. My call room there was a converted patient room. As such, my bed was a hospital bed. Lying there one night, I rolled to the side and raised the head of the bed using the button on the rail. The blanket was standard hospital fare: stiff and thin. And the television remote, fully two pounds and connected …
The elderly fail to understand our complex health system
A Southerner at heart, I find myself in love with places. We are forever pining on about our family homes, our small town barbecue restaurant, the sound of some lake where catfish splash in the night, or the woods where our favorite treestand sits. Sometimes our afflictions for place become the stuff of novels; Scarlett O’Hara is always associated with her beloved Tara just as Faulkner is ever infused into …
Hospitals are part of who we are
Think for a second about the most treasured drug or device in your medical bag. Or about the procedure you find most appealing, the disease or injury you most enjoy treating. Personally, I really enjoy doing lumbar punctures, opening abscesses, placing IO lines and applying splints. And because I’m an emergency physician, I am duty bound to say that I love to intubate … and I do.
I also enjoy doing …
Physicians stand on the shoulders of some very brilliant people
They used to tell us, as physicians, that “if it isn’t on the chart, it didn’t happen.” We could protest all day, to billing companies, insurers or attorneys, “I did that. It’s assumed. I always do the same thing every time.” But they would retort, “nope, it’s not in the chart.” So we learned to detail everything, every time, every movement. Every consideration and justification. The idea being, our ‘thought process’ …
If it’s not in the computer, you didn’t order it
You have to earn your cynicism. That’s my rule. Young pre-med and medical students, even some residents don’t have the same right to cynicism as the rest of us who have labored in emergency departments for years, for decades. The same goes for nurses fresh on the job from training, and ward secretaries who so recently were high school kids.
It always troubles me when these people start working in our …
Doctors need to earn their cynicism
When I was a resident in emergency medicine, at what was then simply Methodist Hospital of Indiana, I was blessed with the opportunity to fly with Lifeline. While I am originally from West Virginia, where rural means mountainous, I came to love the beautiful, stark emptiness of Indiana as seen from the sky. And over time, I came to truly appreciate the small, rural hospitals that called us for help …
I wonder, sometimes, are physicians valued professionals, or merely problems to be solved? Are we skilled clinicians vital to the well-being of our patients? Or are we merely assets to be managed? It occurs to me as I walk around hospitals these days, and see the overgrowth of people with clip-boards, people with undue authority over our lives and practices, people trained in business and management but untrained in either …
Are physicians really valued, or merely problems to be solved?
I have noticed over the years that physicians who write about medicine, particularly for the general public, are limited to very specific discussions. For instance, it is perfectly acceptable to write about the plight of the poor and uninsured. It is always reasonable to advocate for a single payer system. It is perfectly acceptable to discuss how one downsized in order to make less and “give back” more. And it …
Recently, while on a locums assignment in a very small, rural hospital, I cared for a gentleman with chest pain. His discomfort seemed classic for an MI, but his EKG did not. So I treated him as normal with aspirin and nitrates, and waited for his cardiac markers to come back from the lab. In the interim, his chest pain worsened. Sure enough, he developed an anterior MI. The tombstones …
Rural medicine reminds physicians of their value
Whether they are young or old, we do not want our loved ones to die. Period. Even if we live with faith in our eventual, eternal reunion with them, we know that their passage will leave a void. I completely understand.
But I want to take a few lines to try and make things clearer, or easier, for those who have family members who are very aged and infirm. You see, …
We don’t really get to die of old age
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