Emergency Medicine

How COVID accelerates change: Bridging business principles with emergency medicine

Conditions
January 27, 2021

Over the past year, we have experienced massive organizational change at an unprecedented pace. Traditionally, we could spend weeks planning how to best make a change in our workplaces, but COVID-19 was anything but traditional. Our emergency department at Saint Barnabas Health System in Bronx, NY, needed to pivot on a daily and even hourly basis, and to do so took planning and effort. In general, change is difficult, and …

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It’s time to revisit the 4 R’s of the doctor-patient relationship

Physician
January 7, 2021

“We have met the enemy in medical education, and he is us!”

My paraphrase of the “philosophy of Pogo” is pertinent to today’s crop of graduating medical students. We have inserted them into the most toxic environment for learning medicine, ever.

Dr. Michael Halberstam once stated that the most powerful treatment the ER had to offer (after CPR, of course) was “the sight of your own doctor at the bedside.”  Yet look …

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I am an emergency and critical care physician. I had COVID-19 infection twice and I’m tired.

Physician
November 22, 2020

I am a critical care and emergency medicine physician, I have had COVID-19 infection twice, and I’m tired.

My first infection was early on in the pandemic.  I had to place a Blakemore tube in a young man who was going to die from his massive bleeding from cirrhosis.  I didn’t know then that the patient was positive for COVID, as he didn’t have any “typical” symptoms. I placed the tube …

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The issue of tie-downs in the emergency department

Physician
October 21, 2020

During a typically busy Saturday evening shift in the emergency department (ED), I am summoned to the trauma room for a “tie-down,” an agitated patient needing restraints. I find the entrance choked with police officers and push my way through to see the patient.  Once there, I see a large, young appearing Black man lying on his back, his hands cuffed tightly together on his stomach, a netted hood over …

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This physician is tired, and he’s not alone

Physician
October 18, 2020

I have a lot of energy. I have been going and going and going for so long.

And today, it hit me.

I’m tired.

I began this pursuit of medicine in 1983 when I decided to be a zoology major. I worked and went to medical school. And I went to medical school and worked. Then I worked and went to three years of emergency medicine residency and worked hard for those three …

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How blessed was I to witness this true love story

Physician
October 8, 2020

The little things?

The little moments?

They aren’t little …

I noticed the two of them shortly after I arrived for my shift. I was standing at the counter, immersed in a chart, when out of the corner of my eye, I saw them walk out of their treatment room. Together.

Slowly, they walked into the hallway, looking first to their left and then to their right, wondering which way to go. One of …

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How to (almost) never have a bad shift

Physician
October 3, 2020

Walking through the sliding glass doors at 10:55 p.m. on a Monday, I found myself wondering if it would be a good shift or a bad shift. In emergency medicine, a “good shift” has to strike many delicate balances. It can’t be too busy, but it also can’t be too Q-Word-That-Must-Not-Be-Named. It should have some high acuity patients, but not so many that care becomes unmanageable. The staff and residents …

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We can’t expect large medical centers to absorb every case

Physician
September 22, 2020

My small community ED has a fairly high acuity. As such, I was recently trying to transfer a couple of patients, one of whom was an NSTEMI, pain-free but with a rising troponin. In the process of trying to arrange things, I learned that our main regional referral center was holding a staggering 150 patients in their own ED, all waiting for inpatient beds.

I’ve spent the majority of my career …

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Why everyone needs a six-word story

Physician
September 21, 2020

Being humane makes you a hero.

It is a privilege to serve.

Be the voice, for those without!

Six words. One Story. These are examples from the My Six-Word Story Project, an innovative activity that supports the psycho-social well-being and emotional resilience of our healthcare professionals. My Six-Word Story has the power to reconnect us to our purpose and connect us as a community.

“It’s your reaction to adversity, not adversity itself that determines …

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I am tired. But I still love emergency medicine.

Physician
August 30, 2020

I love being an emergency doctor. I loved my residency, my co-residents, and my attendings.

I love my training: watching, learning, treating.

I love the emergency department, the vastness, and the variability of emergency medicine.

But I am tired.

I am tired of feeling like a workhorse, a production line made to just churn patients in and out.

I am tired of being told that my worth as a doctor is based on my time …

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Why it’s so important to look at the big picture

Physician
July 11, 2020

One of the last things my dad said to me before he passed was, “remember to always look at the big picture.” He said this many times throughout my childhood and teenage years, but it never quite resonated until I was thinking about it in retrospect.

As I near the end of my intern year, my dad’s words hold true. As an emergency medicine resident, I am often running on adrenaline. …

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Who should be the first responders to mental health crises?

Policy
July 2, 2020

First and foremost, a mental health crisis is a medical emergency well within the sector of public health. Therefore, the question of who should respond to mental health emergencies is one in which physicians and all medical providers should have a say. Medical providers should not only be aware of the systems in place to respond to mental health crisis but must advocate for patient safety as a measurable outcome …

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How working as a flight attendant made me a better physician

Physician
May 25, 2020

June 2020 will mark 15 years of my departure from flying the friendly skies. I have had the privilege of working as a flight attendant for JetBlue Airways from 2001 to 2005. Today, I am proudly grounded as a physician specializing in pediatric emergency medicine.

Gratitude is a positive mindset where you see your life and experiences as a gift. Practicing gratitude is a powerful way to reduce stress and build …

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A physician wedding in the age of COVID

Physician
May 23, 2020

April 2020 was to be a month of personal milestones. I would be traveling to Mexico with sixty closest friends and family to marry the woman of my dreams. Twelve days later, I would celebrate my thirtieth birthday. Suffice it to say, I was looking forward to April with the excited anticipation of a child on Christmas Eve.

But that was before COVID. Before all eyes were focused on the novel …

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Bearing witness: the physician’s role in a time of crisis

Physician
May 15, 2020

Like many physicians not initially on the front line of the COVID-19 pandemic, I watched with growing dread as stories from doctors and nurses started coming out from hot spots first in China then in Italy and then Seattle and New York. Seeing their faces and hearing their voices, I was struck by their exhaustion and fear but also by their sense of responsibility and duty. I wanted to help, …

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Is there a doctor on board? Yes, but we might not be the right doctor.

Conditions
April 17, 2020

My husband and I travel internationally at least three times a year to give courses with live surgical demonstrations of colorectal conditions in children.

During the past 13 years making those trips, we had our share of hearing the famous announcement in the plane: “Is there a doctor on board?”

Those have happened in many different scenarios including having been on call the night before and therefore being on an almost semi-coma …

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A thank you to emergency physicians

Conditions
April 10, 2020

I want to write a letter of thanks for all the sacrifices you have made for our nation during this COVID-19 pandemic.

Thank you for all the lives you have saved.

Thank you for fighting to save all the lives that were lost.

Thank you for leaving your homes each day, not knowing if or when you will hold your children or see your spouse …

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The fragile economics of America’s emergency departments

Conditions
April 2, 2020

On the front lines, America’s emergency departments (ED) are currently in at the center of a crisis treating patients with COVID-19.  Emergency physicians and other clinicians are placing themselves and their families at risk. Yet, there is also another important crisis facing hospital-based EDs: surprise billing legislation. Certain forms of surprise billing legislation have the potential have a substantial and negative impact on how America’s EDs are supported, and our …

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