An excerpt from Changing How We Think About Difficult Patients: A Guide for Physicians and Healthcare Professionals.
After I finished my residency in EM and started working as an attending physician, I realized I had a problem. I believe a lot of you have the same problem. Some of our patients are so angry, oppositional, and non-compliant that we get angry …
Changing how we think about difficult patients
Before I worked as a medical scribe, I didn’t realize how many mildly ill people visited the emergency department (ED). In my first few weeks, though, I learned that patients with minor complaints, such as sprains, cavities, rashes, and common cold symptoms, actually present to the ED quite often – often enough that the hospital where I worked had to dedicate an entire 12-bed wing to them. In most EDs, …
Solving the low-acuity emergency department problem
My patient was trying to kill himself by refusing to treat a bladder infection. I looked down at him. His aura was black, indicating the premeditated murder of a human. Guess they hadn’t caught him for that one. His gang tats were Latin American, and his eyes were black. He didn’t like me much.
I wasn’t phased. He couldn’t do much about it, paralyzed from the neck down.
“It’s not going to …
A gang member shot by cops and paralyzed just wanted a radio
Each time I am in the emergency department (ED) as a medical student, I meet new members of the health care team that make superior patient care possible. I have quickly developed a greater appreciation for the fact that no medical professional works in an isolated bubble. The strengths that each other bring to the table are paramount to the flow of patient progress. Before my time as a medical …
The work of an emergency department nurse through the eyes of a medical student
Microaffirmations are the antidote to microaggressions. Microaggressions are the little insidious comments or acts of barely perceptible injustice and bias that bite and nip and slowly erode our confidence in our belonging, worth, and power. As I continued the medical training journey, I continually searched for the antidote. Mere protection against the daily barbs and arrows was not enough. I needed more than protection- I needed an offensive strategy as …
A physician’s running list of microaffirmations
I am a physician at a critical access hospital. I manage both the ER and inpatient service and am the only physician in the hospital. This is the reality for many rural hospitals across the country. With no urgent care in town, and with primary care offices few and far between, these hospitals see everything.
We see patients with ailments from a minor finger laceration to those with septic shock from …
Is EMTALA really protecting patients during COVID?
As a working mom of three kids and an emergency medicine physician, I have had to embrace home workouts since before the pandemic. I am a huge Peloton fan! In December of 2020, Robin Arzón, VP of fitness and an instructor for Peloton, partnered with Shonda Rhimes (creator of Grey’s Anatomy) to do a series about Rhimes’ book Year of Yes.
The power of saying yes. In 2020, just pre-pandemic, I …
Setting boundaries and the power of saying no
At the beginning of August 2021, during the early stages of opening my practice, I decided to take an opportunity that I would be forever grateful for. The organization International SOS was looking for physicians and other health care providers to join a massive once-in-a-lifetime operation at Fort Lee military base.
At the time, the country was attempting to end the war in Afghanistan quietly. We were told that there would …
What it’s like to work with International SOS
So I am on the road again — sort of. What I do is work away from home, which isn’t quite the same thing. Where I work as a radiologist is not within commuting distance, so I stay at a nearby hotel. In general, that has worked out fairly well.
Not long ago, however, when I went to start the car after breakfast, I became immediately aware of a roaring sound.
The …
The world according to Steinbeck
In 2017, I read an article called “I Don’t Know How to Explain to You that You Should Care About Other People.”
I don’t remember the details of the article; the name was enough.
As we enter our third year of a global pandemic, I think about that often.
I don’t know how to explain to you that COVID is real.
I don’t know how to talk to the ex who …
I can’t make you care. But you should.
Reflect and earn 1.0 AMA PRA Category 1 CME for this article.
You used to come to us struggling to breathe and begging for our help, and while we stood over you preparing for intubation, we would feel all the feels while looking into eyes that we knew might never open again. We would break down and cry while telling your family that you didn’t make it or …
An excerpt from All Bleeding Stops.
42nd Surgical Hospital
Phu Bai
Republic of Vietnam
December 1967
Private Ira Stein has so many wounds, has lost so much blood, that the corpsmen nearly bring him straight to Graves. Steve Benson can’t get a pressure. He shakes his head. “Matthew, there’s no point taking this kid to the OR. He’s too far gone. He has no chance.”
“Bullshit!” …
War is really not all it’s cracked up to be
Working in an ER is unlike any other branch of medicine. Your specialty is unpredictable. You have no scheduled patients and no set pace. You could be fighting boredom one hour and running around with your hair on fire the next, or the next 11, for that matter. Your patients are not stratified by age, gender, body part, or severity of injury. Your next patient could have an infected cuticle, …
Reflections after the last ER shift
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I remember the cacophony of tiny chirps outside of my childhood home made by frogs that lived in the ice grass. I remember this sound in particular because of the beauty in their voice and because in what seemed like the blink of an eye, they stopped. They were gone. It was only decades later that I learned about the devastating losses that frog populations have faced around the world …
The climate crisis as viewed by an emergency physician
It felt like watching a train go by with no control over its destination and no way to stop it. We simply had to watch our loved one as he made his way towards death.
The doctor said he had a traumatic brain injury with herniation. His pupils were fixed and dilated on arrival to the emergency department, which meant that he was not a candidate for any neurosurgical intervention. And …
Every patient is someone’s loved one
I had surgery recently, and as most physicians do at some point, I found myself on the other side of the bed. Definitely not the side where I have the most experience or feel most comfortable, but it is what it is. The whole process makes a person feel vulnerable and out of control: not a feeling most doctors are accustomed to. But I knew the procedure, so I peed …
Should the Doctor Card make a difference?
After a minor bike accident, you go to the emergency room with a broken wrist. While you’re being triaged, you tell the nurse you take blood thinners because you had deep vein thrombosis a few years ago. The doctor treating you says he’s read your medical records, so you assume he knows what medications you take.
When you tell the doctor about the blood thinner, however, your doctor says that’s not …
3 strategies to lower the risk of fragmented medical care
I broke down crying. Again. — In this cold heart, I can live, or I can die. — It isn’t even on my sad song playlist, so why am I so upset? My scientific brain encouraged me to recreate the environment, remove the variables, and play the song again in isolation. — I believe if I just try, You believe in you and I — Oh no, it’s happening a …
Having a sad: A physician leans into the feeling of sadness
On the first day of medical school, our anatomy lab instructor handed us scalpels and told us to skin our cadavers. Early on, I learned: A good physician does not betray her feelings. A good physician suffers long. A good physician embodies resilience. A good physician is imperturbable. This lesson continued throughout training.
I contemplated leaving medicine during my second year of residency. I was no longer an intern, which meant I could …
“If you think a mother’s pain is unimaginable, you should see her strength.”
You were visiting your mother when, while in another room, you became unresponsive and fell to the floor. She heard the thump of your fall and raced into the room to find you pale and barely breathing. Drug paraphernalia sat beside you.
Your mother screamed. She cried. She fell to her knees and tried to wake you, slapping your …
If you think a mother’s pain is unimaginable, you should see her strength
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