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.

I cheated on my hospital with locums, and I’ll do it again

Edwin Leap, MD

Physician

September 14, 2012

For 19 years since residency, I have worked in one facility and one facility only. I have paced its halls and touched its walls, known every crack and heard every sound. I have seen life and death, laughed and cried there. And yet, I began to have a wandering eye…

Actually, I needed a little more immediate cash. I began to flirt with … locums!

So, after some phone calls, some furtive, …

Why must medical care be provided for free?

Edwin Leap, MD

Policy

August 16, 2012

Our septic tank backed up recently. When I say backed up, I mean, into the basement. And when I say into the basement, I mean, out of the bathroom and onto the carpet. And under the walls. The stars were aligned, and I had to go to work. My wife borrowed a Shop-Vac and rented a steam cleaner. I was assigned to call the septic-tank guy. The kids helped clean …

Doctors experience trauma to their hearts and stress to their souls

Edwin Leap, MD

Physician

July 23, 2012

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I was talking to some new friends over lunch recently, at the nationally renowned Hominy Cafe, in Charleston, SC. Any place with a fried green tomato BLT, and shrimp and grits for breakfast, has my vote!

To the point: my question to these esteemed emergency medicine educators was this: “Do you ever have irrational fears about the people you love, because of …

When self-evident truth in medicine is systematically ignored

Edwin Leap, MD

Physician

June 3, 2012

Some things in medicine are obvious. Despite the endless worship of ‘evidence-based’ medicine, and the constant barrage of studies on every conceivable topic, we do certain things because we know they just seem right. I take as evidence the fact that we daily try to save lives, devoting research time, untold gazillions of dollars and heroic clinical effort to our continued goal of staving off death. Why is this? Do …

The future of medicine for aspiring young doctors

Edwin Leap, MD

Physician

April 11, 2012

March 29, 2012

Calhoun Lecture Series
Strom Thurmond Institute, Clemson University

Thank you for the invitation to speak tonight. I’m very humbled to stand before you. And what a delight to speak to people who are neither bleeding, intoxicated nor asking for Percocet! And in a setting where no one will burst through the back door on a stretcher!

As you know, I’m an emergency physician …

It’s time to look critically at the concept of board certification

Edwin Leap, MD

Physician

January 4, 2012

In 1994 I was thrilled to become certified by the American Board of Emergency Medicine. I had worked very hard. I studied and read, I practiced oral board scenarios and even took an oral board preparatory course. It was, I believed, the pinnacle of my medical education. Indeed, if you counted the ACT, the MCAT, the three part board exams along the way and the in-service exams, it was my …

Medicine introduces us to loss early in life

Edwin Leap, MD

Physician

November 14, 2011

I recently sat by a man whose young wife was dying. Her cancer was taking her away from her husband and toddler. She was sleeping intermittently as the pain medication we administered did its work. Her husband’s eyes were red from crying and he could barely suppress a sob. He touched her and looked at me. I barely kept my own composure.

I wanted to avoid that room and that patient. …

America’s broken disability system

Edwin Leap, MD

Patient

September 29, 2011

I once asked a man in his 30’s why he was on disability. He had fallen attempting to ford a swift stream while fishing. He replied: “Well, the judge said I have a bad attitude, I don’t like people and I can’t hold a job.” Shocking as it sounds, it wasn’t very different from other reasons I’ve heard. “I don’t remember, my Dad put me on it.” “I have anxiety.” …

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America’s broken disability system

The free market of smartphone apps can teach medicine a lesson

Edwin Leap, MD

Policy

August 5, 2011

So I have a Droid. I purchased it in July, not long after taking my old flip-phone for an oceanic bath at Hilton Head, SC. I waffled for a long time. In fact, I almost purchased a Casio phone that was marketed as water and impact resistant. “Mil-spec,” was the phrase used … a phrase which appeals to me as a one-time Air-Guard flight surgeon. What it meant to me …

Practical tips for new July resident physicians

Edwin Leap, MD

Education

July 7, 2011

July is the month that new resident physicians begin their training all across the United States.

Our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (ok, not really a specialty, just a side-line) 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 …

Why confused, weak elderly patients are subjected to aggressive care

Edwin Leap, MD

Physician

May 23, 2011

Lying on the backboard, a frail little old lady moaned with discomfort.

She had fallen beside her bed in the nursing home and was then tightly bound by straps onto the backboard, a cervical collar pushing her chin up and holding her immobile. A person not familiar with modern medicine might think the ensemble looked like a torture device. Indeed, it can …

Mental health and the shortage of psychiatric help in the ER

Edwin Leap, MD

Physician

May 12, 2011

Every day, mental health clinics, emergency departments, psychiatric hospitals, physicians’ offices, counselors’ offices, school counselors and police officers are faced with an almost impossible responsibility. It is a responsibility, a burden, often highlighted retrospectively, after a tragedy. Their job is this: identify every dangerous person, treat them properly and avoid horrific events like the recent murders in Tuscon.

I sympathize greatly, since I work in the emergency department of a hospital …

Why patient satisfaction scores won’t decrease health care costs

Edwin Leap, MD

Physician

May 4, 2011

So now, in addition to the many other bits of medical meddling we have from CMS (Centers for Medicare and Medicaid Services), there’s this.

Reimbursements to hospitals, from Medicare, will be partly tied to patient satisfaction scores. We’ve seen payments already being tied to ‘quality indicators,’ as dictated by the federal government; rewards for doing a better job on care for heart attacks, pneumonia, etc.. At least that’s quantifiable, whether scientifically …

Federal workers worried about a shutdown should do what doctors do

Edwin Leap, MD

Physician

April 10, 2011

I have a suggestion for all of those federal workers who were concerned about a government shutdown.

To all those who already have better insurance and better benefits than most in the private sector; for all those whose jobs pay more than equivalent private sector jobs for the same activities. Do what hospitals do. ‘Go to your jobs, and do the necessary work anyway.’

It is ironic, but hardly surprising, that the …

Why medical education needs to be more affordable

Edwin Leap, MD

Education

March 29, 2011

I was talking to a young man who is starting medical school this fall. His tuition at one of South Carolina’s newer schools will be $40,000 per year. That’s admittedly on the high end. On the low end, it runs a paltry $33,000 per year.

And this is all after college, of course. He and others like him are taking out loans to the tune of $240,000 to pay for their …

Fewer physicians are taking call in rural emergency rooms

Edwin Leap, MD

Physician

February 28, 2011

My partners and I have long struggled with the lack of specialty back-up at our hospital. Semi-rural hospitals, out of the way facilities, just can’t always attract specialists. So, we’re happy to have cardiologists every night, but understand that we only have an ENT every third night. We’re thankful to have neurologists, even if they don’t admit anyone. We’re glad to have radiologists, even if they don’t read plain films …

Physicians the government wants to see

Edwin Leap, MD

Education

November 15, 2010

I was talking with a pre-med student recently. He had completed his very first medical school interview and was, understandably, excited. But he told me the interviewer had asked him what he thought would be the outcome of the current health-care reform measures.

I laughed to myself. After 17 years in practice, even I don’t know the outcome, though I have my suspicions. It seemed a loaded, almost unfair question. After …

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Physicians the government wants to see

Why the medical chart may not improve patient care

Edwin Leap, MD

Physician

June 15, 2010

Why do we physicians chart the way we do? Hopefully, you do it perfectly well and have no concerns at all. But where I practice emergency medicine, we are approaching maximum inefficiency in charting.

It all became much clearer when we started using our new EMR system. Let me make it clear, I’m not against EMR. In fact, typing and templates work better for me than dictating. My dictations were usually …

Psychiatric patients detained in the ER

Edwin Leap, MD

Physician

April 22, 2010

Our state of South Carolina is a delight. From wonderful people to beautiful landscapes, from a vibrant Southern culture to excellent food like shrimp and grits, it’s a place I’m thrilled to live. But we do lack a few things. And one of the most striking is adequate mental health care.

The state budget, like so many state budgets, has been trimming anything and everything. And of course, mental health coverage …

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Psychiatric patients detained in the ER

Hospital admissions may require watching and waiting

Edwin Leap, MD

Physician

April 6, 2010

A sweet little lady came to the emergency department recently. She said she felt short of breath and sweaty at home. In the department, she looked like a rose! Normal oxygen levels, normal labs. Her chest x-ray had a faint area that ‘one might possibly imagine could perhaps be’ a pneumonia. It looked remarkably like her previous film.

But her history was concerning to me, and it was concerning to …