Emergency Medicine

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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5 lessons from an emergency physician

ER staff deserve a safe place to do their jobs

Edwin Leap, MD

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 …

36 things I learned in 36 years of medicine

Joe Bocka, MD

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 …

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

Amy Costigan, MD

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 …

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

Edwin Leap, MD

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 …

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

Sheryl Recinos, MD

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 …

Fasting for Ramadan and being the on-call orthopedic trauma resident

Adil Shahzad Ahmed, MD

Physician

June 20, 2019

A patient groans in agony lying atop a rigid spine board, carried by paramedics into the ER, his neck in a protective collar. The paramedics shout a summary of the accident. Monitors are attached to the man, flashing and beeping the cadence of vital signs. Nurses and physicians swarm. Gloved hands comb through brown hair for bumps or lacerations. They remove his clothes, feeling for pulses in the neck and …

Working in the ER taught this doctor what evil really means

Edwin Leap, MD

Physician

June 17, 2019

If you ask people if there is evil in the world, a lot of them will smile politely at such an obviously Medieval (or Neanderthal) view of the world. Which, of course, is a bit of an insult to both groups who were from all evidence quite intelligent folks.

Some might rattle off some examples of evil. Things like intolerance, racism, sexism, homophobia, transphobia, Islamophobia, and assorted others. Disregard for the imminent …

The 9 types of manipulative patients

Jeffrey E. Keller, MD

Physician

June 7, 2019

One of the more common complaints that I hear from medical practitioners in jails and prisons (especially new practitioners) is, “These manipulative patients are driving me crazy!” Well, to be honest, I ran into a lot of manipulative patients when I worked in the ER, as well. But it is true that many of our patients in jails are especially …

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The 9 types of manipulative patients

8 tips for having a baby while applying for residency

Molly Johnson, MD

Physician

June 5, 2019

Being a medical student is tough, applying for a competitive residency spot is tough, and being a new mother is also very tough. I am one of the lucky women to do all three at the same time. I had my child early August of my fourth year of medical school. The fourth year of medical school is a great time to become a new mother. The schedule is more …

Here’s the secret to emergency department efficiency

Phillip Stephens, DHSc, PA-C

Policy

June 5, 2019

A gray-haired emergency medicine physician once provided the most succinct view of ED efficiency ever uttered. He said, “Sometimes they ask us to dig a ditch. Then they give us spoons with which to do the job.” Though cynical, it is the view of many. There really is only one problem and a single solution to ED efficiency. The problem is variation. The answer is scale.

Biologists understand variability best. Biologic …

A medical student’s biggest fear

Ariana Trautmann

Education

May 22, 2019

It was the last week of my EMS elective. I was incredibly lucky to ride with one of the EMS captains who was eager to take me to any call that sounded interesting. We were called to a possible stroke. An 82-year-old woman with sudden-onset unilateral weakness and expressive aphasia. The paramedic and EMT on scene were two I had met before. We actually talked earlier that day about the …

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A medical student’s biggest fear

The truth about Caribbean medical schools

Jessica K. Willett, MD

Education

May 15, 2019

I graduated from St. George’s University School of Medicine in Grenada and now work as an emergency medicine physician at a trauma center in Northern California. To some, that may seem like an extreme jump or a rare success story. The stigma of a Caribbean medical school education is built on rumors — and they’ve run their course. Let’s address some.

1. Students only go to Caribbean medical schools if they …

Why doctors crash planes

Phillip Stephens, DHSc, PA-C

Policy

May 6, 2019

Physicians actually make good pilots. But, in 1966 they received a bad rap due to a report published by the FAA’s Chief of Aviation Medicine, Dr. Stanley Mohler. Mohler had a point. Physicians were crashing planes at a higher rate as opposed to the general aviation population. His report would be a cautionary tale for all of us. It would be three decades before we even began to understand why …

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Why doctors crash planes

Fleece pajama bottoms in the ER

StorytellERdoc, MD

Physician

April 12, 2019

Can someone please tell me the exact moment when fleece pajama bottoms became the fashion sensibility of America?

I can’t pinpoint the moment exactly, but several years ago I began to notice that many of our ER patients were presenting for treatment wearing nice fluffy fleece bottoms. Men. Women. Old. Young. These fleece bottoms seemed to be enjoyed by a variety of the population. Most of these earlier bottoms for the …

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Fleece pajama bottoms in the ER

Important new information in the tragic cases of child abuse

Christopher Johnson, MD

Conditions

April 9, 2019

Like many pediatric intensivists, I care from time to time for victims of child abuse in the form of what is often called “shaken baby syndrome.” This syndrome is a characteristic constellation of finds that happen when a strong person grasps a child around the chest and aggressively shakes the infant. It was first described by Caffey, a pediatric radiologist, fifty years ago. The baby may have …

Should medical residents appear in reality TV shows?

Skeptical Scalpel, MD

Physician

April 6, 2019

This notice appeared on a general surgery news website in early February.

I don’t know who has been long anticipating this, but I’m pretty sure it’s not people on medical Twitter. My informal, nonscientific Twitter poll garnered 707 votes with 87 percent of those responding saying they would not allow their residents to participate in a reality television show.

Many of those who …

Can you put me to sleep? Why ER physicians have to say no.

Rada Jones, MD

Physician

April 2, 2019

The heavy young man curled on his left side is in the ER for a pain in his backside. The sweaty blue dragon on his chest smells like fear.

“It’s an abscess. I’ll have to open it. It’s gonna hurt.”

“Can you put me to sleep? I hate pain.”

I can. Should I? Remember Michael Jackson? I do.

His neck would make a Hereford bull proud; he’s missing a chin but he’s got a …

An emergency physician does a tooth extraction

Edwin Leap, MD

Conditions

April 2, 2019

I was working a few days ago and pulled a tooth. Mind you, it’s not something I do with any regularity. However, it was a very sweet little lady who was too weak and ill to get to the dentist and had other issues. That lower incisor was loose, and constantly in the way. Furthermore, it was painful.

I had seen her for something else in the emergency department. I took …

A tragic Fentanyl story without redemption

Marcia Glass, MD

Physician

April 1, 2019

Matt was 40, my sister’s age. He was training for a marathon and trying to talk his many friends into joining. He lay in bed with his three-year-old son every night to help him fall asleep. It’s hard to sleep train a toddler with a newborn to nurture at the same time, but he loved spending this time with his two kids and being the dad everyone counted on.

Matt’s best …

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