The lab says the potassium is critically low. You walk in, and the patient looks completely fine. Duane Penshorn is an emergency physician and author. This episode is based on his article "Automation bias is the new medical error," published…
The lab says the potassium is critically low. You walk in, and the patient looks completely fine. Duane Penshorn is an emergency physician and author. This episode is based on his article “Automation bias is the new medical error,” published on KevinMD. He explains that automation bias got …
Some of the most useful information I get as a medical director does not come from a dashboard or a meeting. It comes from working a clinical shift. When you are seeing patients alongside the people affected by the processes…
Some of the most useful information I get as a medical director does not come from a dashboard or a meeting. It comes from working a clinical shift.
When you are seeing patients alongside the people affected by the processes you help oversee, problems become difficult to ignore. You see where the workflow slows down, where responsibilities are unclear, and where a seemingly simple administrative change creates extra work. That is …
An emergency department can stabilize a mental health crisis. It cannot, by itself, provide the relationships, housing, and continuing support that sustain recovery. For First Nations patients in Canada, we should promote mental health and substance use services that communities…
An emergency department can stabilize a mental health crisis. It cannot, by itself, provide the relationships, housing, and continuing support that sustain recovery. For First Nations patients in Canada, we should promote mental health and substance use services that communities help govern, and patients can reach before, during, and after a crisis. For example, a patient receives instructions to arrange counseling, attend substance misuse therapy, and return if symptoms worsen. …
Every patient who has spent time in an emergency department knows it's overcrowded. They've sat in the waiting room for hours. They've watched physicians move fast and nurses move faster. They've heard the department through the curtain: the monitor alarms,…
Every patient who has spent time in an emergency department knows it’s overcrowded. They’ve sat in the waiting room for hours. They’ve watched physicians move fast and nurses move faster. They’ve heard the department through the curtain: the monitor alarms, the overhead pages, the sound of a place where everyone is doing too many things at once.
What they haven’t seen is the board.
The board is how an emergency physician experiences …
I work in Dallas-Fort Worth (DFW) emergency departments where Spanish and English share the same hallway. Residents ask me the same question every block: Can we use ChatGPT for triage? My answer is short. You can use it to practice…
I work in Dallas-Fort Worth (DFW) emergency departments where Spanish and English share the same hallway. Residents ask me the same question every block: Can we use ChatGPT for triage?
My answer is short. You can use it to practice thinking. You cannot use it to decide who waits. Here is what I actually teach on shift and in conference.
Ask most physicians outside emergency medicine how they'd handle a patient presenting with three possible diagnoses, incomplete labs, and a deteriorating vital sign trend, and you'll usually get a version of "I'd want more information first." Ask an ER physician…
Ask most physicians outside emergency medicine how they’d handle a patient presenting with three possible diagnoses, incomplete labs, and a deteriorating vital sign trend, and you’ll usually get a version of “I’d want more information first.” Ask an ER physician the same question, and you’ll get an action plan within seconds. That gap isn’t intelligence. It’s training. And I think it’s worth naming exactly what that training builds, because most …
People ask what being an emergency physician is like, and they expect the blood, the saves, the codes, the worst nights. Those happen, and they matter, but I try not to carry those home. What I try to keep is…
People ask what being an emergency physician is like, and they expect the blood, the saves, the codes, the worst nights. Those happen, and they matter, but I try not to carry those home. What I try to keep is the people. You meet everyone in …
In South Louisiana, hurricane season is treated like a fifth season of the year. Angela C. Johnson explains what that means for physicians and patients. She is an internal medicine physician and member of the American College of Physicians Board…
In South Louisiana, hurricane season is treated like a fifth season of the year. Angela C. Johnson explains what that means for physicians and patients. She is an internal medicine physician and member of the American College of Physicians Board of Regents. This episode is based on her article “Physicians …
Last summer I received a $9,000 bill for an overnight hospital stay that I probably could have done without, medically speaking. It started two days earlier, when I went in for a prostate biopsy. Mind you, this was my third…
Last summer I received a $9,000 bill for an overnight hospital stay that I probably could have done without, medically speaking. It started two days earlier, when I went in for a prostate biopsy. Mind you, this was my third biopsy and each one, including this one, turned out to be negative. Nevertheless, my doctor keeps asking me to undergo these invasive …
It is late evening on a Tuesday. Not a remarkably unusual Tuesday, but the typical day that we have all experienced after a hard day at work. She sits alone at the kitchen island after working a 12-hour day in…
It is late evening on a Tuesday. Not a remarkably unusual Tuesday, but the typical day that we have all experienced after a hard day at work. She sits alone at the kitchen island after working a 12-hour day in the OR. She is doing something that she has done countless times: moving money back into cash during a time of market volatility.
My shift started at 7 a.m. The overnight physician wishes me a good shift. We both know that's mostly luck. I pick up my first patient before I've taken a sip of coffee. My first few patients are what we…
My shift started at 7 a.m. The overnight physician wishes me a good shift. We both know that’s mostly luck. I pick up my first patient before I’ve taken a sip of coffee.
My first few patients are what we affectionately call “bread and butter.” An ankle injury. A cough that’s lingered for two days. Back pain. A medication refill. Someone wants an MRI today because they’ve had headaches for three …
I'm the guy who doesn't need help at the Apple Store. Thirty years as the family IT department, the one who sets up everybody's phone at Thanksgiving. So I can't tell you why, when I bought a new iPad Pro…
I’m the guy who doesn’t need help at the Apple Store. Thirty years as the family IT department, the one who sets up everybody’s phone at Thanksgiving. So I can’t tell you why, when I bought a new iPad Pro in June 2022, I walked into the store to have them move everything over for me. Habit, maybe. A slow afternoon. I figured I’d be out in ten minutes.
When catastrophic floods struck Texas on July 4, 2025, killing 78 people, questions quickly emerged about the timing and accessibility of public emergency warnings. In the hours before the disaster, some alerts were delayed amid staffing shortages and funding cuts.…
When catastrophic floods struck Texas on July 4, 2025, killing 78 people, questions quickly emerged about the timing and accessibility of public emergency warnings. In the hours before the disaster, some alerts were delayed amid staffing shortages and funding cuts. Others were posted on private social media platforms, which can often only be viewed with an account. In a crisis where every minute matters, even the smallest obstacles to …
I recently had the opportunity to speak with a group of neurogastroenterologists who practice at a major referral center. These specialty physicians treat people with complex digestive disorders such as gastroparesis, abnormal motility, and irritable bowel disease. They also treat…
I recently had the opportunity to speak with a group of neurogastroenterologists who practice at a major referral center. These specialty physicians treat people with complex digestive disorders such as gastroparesis, abnormal motility, and irritable bowel disease. They also treat patients with illnesses categorized as “functional gastrointestinal disorders,” where no specific physical or lab abnormality can be identified. The people who have these disorders can get very frustrated and unhappy …
In 2024, I joined a medical mission trip across East Africa with my spiritual community. Our guiding principle was simple: "Love all, serve all." The goal was selfless service: providing free medical care to anyone who needed it. Roughly sixty…
In 2024, I joined a medical mission trip across East Africa with my spiritual community. Our guiding principle was simple: “Love all, serve all.” The goal was selfless service: providing free medical care to anyone who needed it. Roughly sixty of us traveled together, physicians, pharmacists, nurses, and support staff, moving across rural sites to set up temporary medical camps.
We saw hundreds of patients in environments that shifted constantly: church …
The call came at 2 a.m. Not about a new patient. About one who had left. She had been in my department three days earlier. Eighteen years old. Came in with chest tightness after a night out. Tox screen negative.…
The call came at 2 a.m. Not about a new patient. About one who had left.
She had been in my department three days earlier. Eighteen years old. Came in with chest tightness after a night out. Tox screen negative. Discharged. Three days later, fentanyl overdose. Dead. I have replayed that visit more times than I can count.
New data published in Emergency Medicine News puts a number on how many families …
Picture a health system where family medicine and emergency medicine physicians work together as true partners within the same emergency department. Both specialties share responsibility for the same patients by providing comprehensive and coordinated care. This is probably how the…
Picture a health system where family medicine and emergency medicine physicians work together as true partners within the same emergency department. Both specialties share responsibility for the same patients by providing comprehensive and coordinated care. This is probably how the founders of emergency medicine, many of whom were family physicians, imagined the future when they started this specialty.
Although this collaborative approach may seem new to some, it has been …
As a physician trained in musculoskeletal care and neurologic deficits, and as a qualified medical evaluator (QME) and independent medical examiner (IME) dealing with personal injury accident cases and work-related incident cases, and also as an expert witness, we are…
As a physician trained in musculoskeletal care and neurologic deficits, and as a qualified medical evaluator (QME) and independent medical examiner (IME) dealing with personal injury accident cases and work-related incident cases, and also as an expert witness, we are dealing with establishing causation of the accident or incident to the impairment that is being claimed. This is done using biomechanics to relate the mechanism of injury to the …
I have been an emergency medicine physician for many years. Trauma, cardiac arrests, strokes, lacerations. I've seen them all. But sometimes I wonder how I would do in an actual emergency. I mean, I can run a trauma or cardiac…
I have been an emergency medicine physician for many years. Trauma, cardiac arrests, strokes, lacerations. I’ve seen them all. But sometimes I wonder how I would do in an actual emergency. I mean, I can run a trauma or cardiac arrest code without much problem on my own turf. Get them into the resuscitation room where I have a full team and multiple resources at my disposal. Everyone knows their …
"Time of death, 17:49." "Let's pause for a moment of silence." Stillness settles over the room. What had been a flurry of activity becomes something different. Something reverent. Sixty seconds pass. "Thank you." There is a collective exhale, followed by…
“Time of death, 17:49.”
“Let’s pause for a moment of silence.”
Stillness settles over the room. What had been a flurry of activity becomes something different. Something reverent. Sixty seconds pass.
“Thank you.”
There is a collective exhale, followed by a harsh realization. We must now move into cruel acceptance, into a place where hope no longer lives. With two words, I have ushered in a new reality.
