Emergency Medicine

The continuing battle between the emergency department and radiology

Physician
December 28, 2019

I overheard a disappointing phone call while supervising a radiology resident recently. I could tell that the resident was struggling in a conversation with an emergency department physician, so I asked him to switch over to speakerphone. Eventually, I heard the emergency physician say, “Listen. This is how it works. A patient points to what hurts. Then I have that part scanned, and you tell me what is wrong.”

Disheartening as …

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10 things you need to know about strangulation and domestic violence

Conditions
December 27, 2019

Having recently testified in several legal cases involving strangulation, here are some facts we all need to know about this extreme form of domestic violence (DV). I invite other subject matter experts to share their personal opinions on what is important.

1. Strangulation is assault with a deadly weapon – an act with known potential lethal consequences. Formally defined, strangulation is an external force applied to the neck cutting off blood …

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Your medical career won’t last forever

Physician
December 25, 2019

“Slowly comes the hour, it’s passing speed how great.”
– Samuel Cowper

Our careers will end someday.

Of course, we know this deep down, but I think we lose sight of it amid our training and the day-to-day grind of our jobs.

But just this past week, I was given a little reminder.

At our Christmas party, we took some time to honor one of our colleagues on his journey to retirement. He had spent …

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Doctors: Always be prepared to suture wounds

Physician
December 20, 2019

Ninety minutes before my Sunday night shift, my two-year-old, Titan, comes screaming up the stairs looking like a scene out of a slasher horror movie. His older sister sheepishly admitted to chasing him into the edge of a door frame. We created an ED bed on our kitchen counter and slipped a pillowcase up his arms, behind him, with him laying …

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Taking food and drink away from doctors and nurses is just cruel

Physician
December 10, 2019

It’s hard to explain what we do. And so maybe, it’s hard for others to sympathize with our situations. I mean, physicians, mid-levels, and nurses in emergency departments are tied to computers in often cramped work-spaces, even as they are required to be at the bedside almost constantly for the latest emergency or (in other cases) the latest bit of pseudo-emergency drama.

If you haven’t worked there, or haven’t for a …

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A brilliant song about the perils of texting and driving

Video
November 25, 2019

“Words Kill” is a brilliant song about the perils of texting and driving. Spread the message.

Courtesy of The Fever Breakers, a band made up of hospital employees. Their socially conscious songs are crafted in the basement of the hospital using a piano used for cancer patient music therapy and subsequently recorded in a studio.

It’s OK to cry when a patient dies

Physician
November 23, 2019

As a young medical student, in my early 20s, I was still too inexperienced to know how a physician was “supposed to” act.

But I took the model of stoicism that I learned from my East Indian father and applied it to the medical model. Lectures on “professional detachment” reinforced this. I remember being told that it was the doctor’s job to keep a professional distance from a patient. By getting …

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Why choose a woman doctor?

Physician
November 20, 2019

Like all doctors, I’m a lousy patient. My doctor is a lovely man, but going to see him? That’s right there with weighing myself, getting a flu shot and doing my taxes, and behind celebrating Thanksgiving with the in-laws and getting a root canal.

And I’m not the only one. If I had a dollar for every patient who told me they hate doctors (no offense), I’d be long retired.

If you’re …

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Why this physician never tells anyone she’s a doctor

Physician
October 22, 2019

I’m an ER doc, and proud of it. But I never mention it when I meet new people. Unless someone’s fixing to die, I avoid it like the plague. “I work in a hospital,” I say. “Where in the hospital?” “The ER. How about you?” That’s a topic changer, since most people would rather talk about themselves.

Why not own it, you ask? There’s no shame in being a doctor. It’s not like …

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Physicians need moments of reflection throughout their days

Physician
October 12, 2019

“The music is not in the notes, but in the silence between them.”
– Achilles Charles Debussy

Silence is an important part of our everyday lives. Yet, we often don’t consider its critical importance in helping us to reflect on what we’re doing. This is especially important in medicine where we’re so busy sometimes that we forget that what we say and do actually has huge implications on people’s lives.

This is even …

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This doctor defines himself as a Christian, not a physician

Physician
September 29, 2019

What is life? It’s the cumulation of the daily processes all wrapped up into one, filling the void of each day. These processes coalesce hour by hour, filled with demands, expectations, current crisis, and bills to pay. Life is a full-contact sport, each hour brimming with all-encompassing activities, expectations, and trivial pursuits. We live every second to its fullest, squeezing every ounce of information and productivity only to repeat it …

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A thank you from doctors to nurses

Physician
September 5, 2019

Earlier this year, I asked a group of nurses what gifts doctors could give that would help them know they are appreciated. There were hundreds of comments that included many I expected: Food (pizza, chocolate, cake, tacos, bourbon, Starbucks, healthy snacks), pens, cash, and/or gift cards for all shifts.

There were some interesting “high end” ideas: Massages or a massage chair. Trips. Cars. Stethoscopes.

Some still make me shake my head and …

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A nurse’s powerful ER exit letter

Policy
September 1, 2019

Dear hospital,

The last three years, I have had the pleasure of working in our state’s renowned emergency department and level-1 trauma center. My departure closes out a decade of my nursing career as an emergency room and flight nurse. This department — the staff, in particular — will forever hold a very special place in my heart. I leave with a great amount of respect and thanks for this exceptional …

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5 lessons from an emergency physician

Physician
August 21, 2019

The emergency room is an interesting place to work. It’s controlled chaos. Walk through the hallways, and you’ll hear people screaming, see others crying, and others wincing in pain.

Over time, you get a unique perspective on the human condition. In my years of training and practice, I’ve seen so much. People experiencing their worst days. Others receiving news that will change everything. Some lives ending. Others returning from the brink.

Certainly, …

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ER staff deserve a safe place to do their jobs

Physician
August 14, 2019

Many years ago, it was called the emergency room. Now we call it the emergency department. However, unlike so many departments in the world, the emergency department has almost too many purposes, duties, and mandates to number.

However, in the process of being the under-funded safety net for American health care, it has also become a place of remarkable danger where medical and nursing staff, support personnel and even patients face …

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36 things I learned in 36 years of medicine

Physician
July 22, 2019

Thirty-six years ago, I arrived an hour early for my first medical school patient care rotation at the East Orange, NJ, VA hospital. Over the years, ‘I’ve seen and learned (and unfortunately also forgotten) a lot about medicine and life. I have been writing down wise nuggets since that first year and keep reviewing and adding at times.

Here are 36 random reflections in honor of these 36 years that I …

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Workplace violence in the health care setting is a public health emergency

Physician
July 16, 2019

Health care providers may have one of the most dangerous jobs out there — and it is only getting worse. Nearly 74 percent of workplace assaults occur in the health care setting, and health care accounts for almost as many serious violent injuries as all other industries combined. The statistics are alarming. Seventy-eight percent of emergency physicians report being targets of workplace violence in the …

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The default for psychiatric patients: “Send them to the ER”

Conditions
July 15, 2019

Here is a standard emergency department situation, played out all across America today.

Patient X has schizophrenia.  He takes medication, but only until he feels better.  He is calm when he takes it, but sometimes aggressive and assaultive when out of treatment and off medications.

Patient X decides to leave town and drive somewhere else because he is angry at 1) family 2) significant other 3) health care system 4) situation.

He is …

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A physician volunteers with migrants. Here’s what she saw.

Physician
June 26, 2019

“At least seven children are known to have died in immigration custody since last year,” according to a NBC News report last month.

I recently spent a Saturday working with amnesty-seekers that had been detained at California detention centers in the desert. They were dropped off at bus and train stations in the desert in Southern California, most with no money and no ability to …

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