Emergency Medicine

As society shuts down, hospital workers continue to fight the pandemic

Anonymous

Conditions

March 17, 2020

Collectively across our country, as society shuts down, physicians, along with our brave co-workers in the hospital, will be going to work to combat the largest pandemic we have seen in our lifetimes. While such a crisis frightens us all, it has also served as a soul-renewing time for medicine. Over the next several months, our tribe worldwide will be risking their health and lives to serve and treat patients …

Who are responsible for outrageous medical bills? Hint: It’s not doctors.

Ashima Vohra, MD

Physician

March 14, 2020

Over the last few years, there has been a slew of articles about patients receiving surprise bills after ER visits. One woman was charged $5,751 for an ice pack and a bandage. An infant was charged $937 for an antibiotic ointment. Who sends bills like that? Is it the ER doctors? No. It’s large corporations.

ER docs want to help you regardless of …

Do patients addicted to drugs truly have capacity?

Gregory Jasani, MD

Conditions

March 4, 2020

Is it time to rethink how we determine the capacity of our patients who are addicted to drugs? I recently began debating this question after I took care of a young woman with endocarditis. She had a long history of IV drug abuse that had led to the development of endocarditis. She had been admitted one week earlier and was being prepared for surgery, but she left against medical advice …

Doctors: It’s OK to sometimes suck

Navpreet Sahsi, MD

Physician

March 4, 2020

I’m here today to let you in on a little secret. It’s not something that I’m particularly proud of, and it’s work that I’m always trying to improve upon. But it’s true. And today you’re about to find out something I’m desperately trying to hide.

So here it is. Yes, I’m a doctor. And yes, I’d like to think that I’m pretty good at my job. But you know what? There …

Read more…

Doctors: It’s OK to sometimes suck

The art of diagnosis is like a riddle

Raj Waghmare, MD

Physician

February 26, 2020

“I have a riddle,” Paul says, as the dining room falls silent.

“You’re at the bottom of the stairs. And on the wall, there are three light switches labeled one, two, and three. There’s a room upstairs with three lamps, labeled X, Y, and Z.

You can turn on and off as many switches as you want while you’re downstairs, but you can only go upstairs once. And once you’re upstairs, you …

Read more…

The art of diagnosis is like a riddle

Urgent care is emblematic of problems in our health system

Rosalind Kaplan, MD

Policy

February 23, 2020

Working in urgent care, I’ve started supervising some of the other providers at sites other than my own — 19 sites in all in Pennsylvania and Delaware — so I hear about a lot of patient situations.

The urgent care site where I work is in an affluent area. Most of our patients are employed or retired and have health insurance, though I have certainly encountered a number of patients …

How you can show patients you are listening

Navpreet Sahsi, MD

Physician

February 8, 2020

Being a physician is an important role. It’s easy to forget the impact that you have on a patient just by being at their bedside.

It’s huge.

Have you ever been a patient? It’s an incredibly vulnerable experience.

You’re not really sure what’s happening and what is going to happen next.

People are really putting their faith in you to understand their needs and to ease their suffering. It’s a powerful thing to ease …

There is no such thing as medical swag

Nina Shapiro, MD

Physician

January 30, 2020

A recent excellent piece by Dr. Karen Sibert, an experienced anesthesiologist at my institution, raised some critical issues regarding how physicians are thought of by non-physicians, and how misguided that thought process is. Indeed, our stress levels associated with the moves we make and the decisions we contemplate, some of which are made and done in milliseconds, do not come with a price tag, but do …

Read more…

There is no such thing as medical swag

Beyond red flags: Beware of black butterfly warnings

Raj Waghmare, MD

Conditions

January 23, 2020

I’ve just discharged a kid with a cough, and there are no patients waiting to be seen. “I’ll be back,” I tell the nurse, as I slip away to the hospital kitchen and unlock the door. I steal two frozen grilled cheese sandwiches from the freezer and throw them into the microwave. Minutes later, I’m in the call room.

I take a couple of bites and can already feel acid rising …

This is a real problem in our ER. This is a real problem nationwide.

StorytellERdoc, MD

Physician

January 21, 2020

One of the largest problems in our ER, it seems, is that there is a subset of patients who visit us on a routine basis. Commonly known as “the regulars,” these familiar faces are sprinkled throughout our day between all our other patient visits. Whether it be for chronic pain, for chronic illness, for companionship, simply to have a place to hang out for a few hours, or to get …

After child sexual abuse, being “physically intact” doesn’t tell the whole story

Dr. Nkeiruka U. Orajiaka

Physician

January 13, 2020

The recent pardon of a convicted child rapist by the ex-Kentucky Governor has sparked a lot of controversies. The basis of the pardon was- “the victim’s hymen was noted to be physically intact.” Evolving studies have continuously shown that the hymen is not a reliable or accurate means to conclude sexual assault.

But if physical damage is the only criterion used to assess …

What’s the hardest part of a physician’s job?

Rada Jones, MD

Physician

January 5, 2020

I work in the ER. It’s not an easy job. Not glamorous either. At least not as glamorous as my mother-in-law used to think.

Years ago, when I declared I was going into emergency, she looked at me askance. She didn’t ask why. She looked at me with her wise old eyes. “Let me tell you about ER,” she said. “I know all about it. I watch every show.”

She was politely dismissive …

What makes the perfect doctor?

Rada Jones, MD

Physician

January 3, 2020

I’m an ER doc, and I spent my last two decades in the house of medicine. First, training to become a doctor. Then, trying to be a better doctor. No matter how hard I tried, I’ve never been the “perfect doctor.” I started wondering: what makes one a “perfect doctor”?

The perfect doctor lives in the moment, focusing on the here and now: This patient. This case. This encounter. They devote …

Read more…

What makes the perfect doctor?

The continuing battle between the emergency department and radiology

Cory Michael, MD

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 …

10 things you need to know about strangulation and domestic violence

Dan Field, MD

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 …

Your medical career won’t last forever

Navpreet Sahsi, MD

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 …

Read more…

Your medical career won’t last forever

Doctors: Always be prepared to suture wounds

Nathan Whittaker, MD

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 …

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

Edwin Leap, MD

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 …

A brilliant song about the perils of texting and driving

Admin

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.

A brilliant song about the perils of texting and driving

It’s OK to cry when a patient dies

Navpreet Sahsi, MD

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 …

Read more…

It’s OK to cry when a patient dies