WhiteCoat, MD

A patient is angry with her emergency care bill. But here’s what she really got.

WhiteCoat, MD

Physician

July 17, 2015

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Natalie Fuelner created a well-written article in the Bangor Daily News describing some of the tribulations many new parents go through with young children. One weekend, her toddler fell face first onto a metal patio table. Immediately, the toddler’s face is full of blood. The dad panicked. Natalie was a “trembling mess” on the inside.
Their physician neighbor wasn’t available to look at the child. …

An emergency physician defends the profession from the New York Times

WhiteCoat, MD

Conditions

May 11, 2015

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With the flurry of Twitter posts about Maureen Dowd’s article “Stroke of Fate” in the New York Times, it almost seems as if the subject is already stale.

Maureen Dowd is the Pulitzer Prize-winning op-ed columnist for the New York Times who tells a compelling story about a young patient who suffered from a stroke. The patient was …

Bad medical care: Is it better than none at all?

WhiteCoat, MD

Physician

July 21, 2014

In my past few shifts in the emergency department, I have seen the following patients who were seeking further care after being treated by other providers.

One was a child who had been seen twice at an urgent care clinic. He had a fever of 103 degrees and wasn’t eating. The first time he went to the urgent care center, he was diagnosed with an ear infection. He was started on …

Look to China for the future of American health care

WhiteCoat, MD

Physician

May 1, 2014

Chinese hospitals are recruiting 1,500 “guardian angels” to protect doctors from violent patient attacks. Patients who are angry about the Chinese health care system, medical expenses, long waiting times, and uncaring doctors have become more violent over the years, with violent attacks occurring every two weeks on average — according to state media — which in reality means that it probably occurs a lot more frequently …

What affects hospital CEO pay the most: Patient satisfaction

WhiteCoat, MD

Physician

April 10, 2014

Hospital-CEO-Pay-Linked-to-Patient-Satisfaction

Dan Diamond (@ddiamond) tweeted this slide from a lecture by Harvard’s Ashish K. Jha at this year’s Association for Healthcare Journalist’s Annual Meeting in Denver. The slide shows how CEO incomes are affected by different variables and contains a few interesting tidbits of information.

First, hospital CEOs earn around $600,000. Far more than most physicians.

Second, hospital CEO salaries are not significantly affected by multiple …

Did a New York Times column unfairly attack ER doctors?

WhiteCoat, MD

Physician

February 6, 2014

Cardiologists are causing patients to get cancer.

It’s true.

Cardiologists routinely perform angiograms on patients who have no heart disease whatsoever.

As shown in this Harvard newsletter, each angiogram exposes the patients to about 7 mSv of radiation. Add in the myocardial perfusion imaging at another 25 mSv of radiation and you have enough radiation to cause cancer in an otherwise healthy individual.

And cardiologists routinely subject patients with normal …

14 ways to drive your doctor crazy during a physical exam

WhiteCoat, MD

Physician

August 31, 2013

1. When your doctor looks into your eyes with a flashlight, shut your eyes tightly so he can’t see your pupils. Later, when your doctors asks you to shut your eyes tightly to test your eyelid strength, look at him like he’s speaking in tongues and keep your eyes open. If he whips out his flashlight to look at your pupils …

Physicians are often expected to prove a negative

WhiteCoat, MD

Physician

May 8, 2013

A young lady comes to the emergency department and wants to be evaluated for a somewhat non-urgent problem.

Chief complaint: “I’ve lost 50 lbs in the past month.”

She felt a little weak as well, but she had just lost too much weight. No other symptoms.

The patient weighed 132 pounds. Her skin wasn’t sagging. Her jeans didn’t appear to be new and they seemed to fit pretty well. Nothing about her seemed …

Working in an urban ER: We need more moms like this one

WhiteCoat, MD

Physician

April 20, 2013

When you work in an urban hospital, sometimes it’s difficult not to become jaded.

There are certain neighborhoods that generate a disproportionate number of patients for some emergency departments. Meth is rampant. Marriage pretty much nonexistent. More bars than there are restaurants. Domestic abuse frequent, but prosecutions rare. Police know people more by their street names than by their real names.

South Heights was one of those neighborhoods.

The emergency department frequently treats …

Why coroners should fill out death certificates

WhiteCoat, MD

Physician

March 27, 2013

I happened to read an article in the Columbus (Ohio) Dispatch where Ohio coroners are complaining because some doctors, including emergency physicians, are refusing to sign death certificates listing a patient’s cause of death. The coroners are concerned because they are being “burdened” with hundreds of extra cases every year that they must handle. And if other doctors don’t sign off on the cause of death, sometimes it takes two …

Providers who want the authority of doctors: Let them have it

WhiteCoat, MD

Policy

March 4, 2013

California doesn’t have enough doctors to provide healthcare to newly insured patients.

California state senator Ed Hernandez asks, “What good is it if they [state citizens] are going to have a health insurance card but no access to doctors?”

Wait. Health care insurance doesn’t mean that patients will have access to health care? Where have I heard that being said for more than 3 years?

The government is going to …

The cost of blaming doctors for prescription drug abuse

WhiteCoat, MD

Physician

January 31, 2013

An article written by two physicians in Time questions whether we should blame doctors for the large number of chronic pain patients and the abuse of prescription pain medications.

There are two frames of reference to this article.

First, no one can argue that prescriptions for pain medications in this country are excessive. The article notes that in 2011, “enough …

One fight that the patient wished he could lose

WhiteCoat, MD

Physician

January 18, 2013

He used to be a boxer.

Those days were long-gone, though.

Now he was a shell of his former self.

The hands that formerly knocked opponents to the mat were now contracted and full of arthritis. Dementia had taken away his ability to tell the stories about his career. Metastatic lung cancer ravaged his body. Multiple bed sores ate away at his sacrum and …

More than half of my ER shift was spent on entering data

WhiteCoat, MD

Physician

November 21, 2012

I work at several hospitals and each uses a different electronic medical record system. When I switch from hospital one to another, I obviously have my favorite EMR systems and my not so favorite EMR systems. In the previous post, I was using the EMPOWER charting system, which I liked for its simplicity, but disliked because of the layouts of the charting interface and some of the macros it contained.

After …

Reduce health waste through deregulation and free market principles

WhiteCoat, MD

Policy

October 14, 2012

Emergency Physicians Monthly has an important debate between ACEP President David Seaberg and EP Monthly founder Mark Plaster about the “Choosing Wisely” program.

Choosing Wisely is being pushed by the ABIM Foundation as a way to get specialty societies to label certain tests as “unnecessary” or of questionable benefit.

I side with Dr. Seaberg in this argument.

I disagree with the concept some people advance …

9 essential tips for new medical students

WhiteCoat, MD

Education

July 17, 2012

Whether you’re starting medical school or beginning your second year, this post is for you. Will probably work just as well for PAs, NPs and any other health professional student who hasn’t started clinical rotations.

Our former babysitter just graduated from medical school and the WhiteCoats are just as proud as her parents are. Then I started thinking, what advice would I give to students starting medical school?

Our first day of …

Go ahead, let patients buy prescription drugs over the counter

WhiteCoat, MD

Meds

May 14, 2012

The FDA is deciding whether to allow patients to purchase prescription medications over the counter for many common ailments.

This idea is controversial.

On one hand, deregulation would remove one of the largest barriers to receiving treatment for some conditions – the doctor’s visit. If no doctor’s visit is necessary to receive necessary blood pressure medications or diabetes medications, then patients don’t have to wait for an appointment and the patient/government …

How many people expect perfect outcomes in medical practice?

WhiteCoat, MD

Physician

March 6, 2012

Want more evidence about how many people expect perfect outcomes in medical practice?

Look no further than the Wall Street Journal: “What if the Doctor is Wrong?” by Laura Landro.

As a substantive basis for the conclusion that initial treating physicians are “wrong” when they haven’t yet reached a diagnosis, Ms. Landro interviewed two patients who, in the midst of a workup, left the doctor who was trying to diagnose and …

Patients lose if physicians are expected to practice perfect medicine

WhiteCoat, MD

Physician

September 9, 2011

I discussed whether or not ambulances should be required to add equipment costing $12,000 in order to be able to transport 850 pound patients recently, so I won’t belabor the point here. Providing medical care to morbidly obese patients presents multiple challenges.

Then I read an article in the Florida Sun Sentinel about how some obstetrician-gynecologists in South Florida are refusing to provide medical care to obese women. …

How far should hospitals go to treat obese patients?

WhiteCoat, MD

Physician

June 17, 2011

Boston Emergency Medical Services recently debuted an ambulance with a mini-crane and reinforced stretcher to transport patients weighing up to 850 pounds. It cost $12,000 to retrofit the ambulance.

My problem is this: I think we need to do our best to provide medical care to all patients. But patients need to take some basal level of responsibility for their own health. If you’re saying that you …

WhiteCoat, MD

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