Emergency Medicine

An emergency in public: When should doctors help?

Chiduzie Madubata, MD

Physician

October 12, 2015

Recently, Pope Francis visited Philadelphia to finish out his five-day visit to the United States. Prior to his visit, many hospitals in the city were preparing for possible emergencies involving visitors from many countries around the globe, particularly elderly visitors. On-call teams were present in these hospitals, and contingency plans were in place in case people needed to be transported emergently to different hospitals despite the high level of security …

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Pain tolerance: A story of two patients

Christopher Stookey, MD

Physician

September 21, 2015

One thing I learned early on as a doctor is different people have different tolerances for pain. At one end of the spectrum, for example, I recall a woman who came to the emergency department with a small splinter in her foot. She arrived wailing in pain, and we had to take her back to a treatment room ahead of other patients because her howling was scaring the people in …

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An emergency physician stops at a roadside accident. He finds out he’s not needed.

Physician

September 6, 2015

My family was driving to see our new niece this past Saturday. While passing through a town on the way, we came upon a motorcycle accident. The rider had been hit by a vehicle and was lying on the pavement with a growing crowd of people who wanted to help. I’ve done it before. I did CPR at the scene of a wreck when I was in medical school, and …

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Why physician burnout and work-life balance is a first-world problem

Karen S. Sibert, MD

Physician

September 5, 2015

Did it ever occur to some of today’s physicians that many people work awfully hard and complain a lot less than they do about “burnout” and “work-life balance”?

Did it ever occur to them that “work-life balance” is the very definition of a first-world problem, unique to a very privileged class of highly educated people, most of whom are white?

Every day, I go to work and see the example of the …

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The truth behind why doctors don’t tell the truth

Kristin Prentiss Ott, MD

Physician

August 20, 2015

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There are two key scenarios when doctors fail to tell “the whole truth and nothing but the truth so help me God.”

Sometimes doctors give a diagnosis we’re not 100 percent sure of and other times we don’t diagnose something we’re almost 100 percent sure of. The truth is complicated and often more gray than black and white.

Scenario #1: “You have [insert diagnosis …

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Want to keep ER nurses from leaving? Focus on patient safety instead of satisfaction.

Thomas Paine, MD

Physician

August 6, 2015

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I have been an emergency physician for 12 years. I have had the opportunity to learn from and try to emulate an impressive number of amazing clinical physicians. These doctors seemed god-like at first, but as my training and career progressed, I realized that they were mostly teaching me through their own experiences.

One of my favorite teachers had a humbling saying: “Good …

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10 things you might not know about the emergency department

Kristin Prentiss Ott, MD

Physician

July 22, 2015

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1. Wait times in most emergency departments are ridiculous. But, if you have a real emergency, you won’t have to wait. If you have abnormal vital signs, a worrisome ECG, or concerning chief complaint, you will be seen long before the person who checked in with a sore throat to get a work excuse.

Patients with chief complaints like “GSW abdomen” and “found down/unresponsive” don’t wait to …

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A patient is angry with her emergency care bill. But here’s what she really got.

Physician

July 17, 2015

Natalie Fuelner created a well-written article in the Bangor Daily News describing some of the tribulations many new parents go through with young children. One weekend, her toddler fell face first onto a metal patio table. Immediately, the toddler’s face is full of blood. The dad panicked. Natalie was a “trembling mess” on the inside.
Their physician neighbor wasn’t available to look at the child. …

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Mad Libs for medicine. Do you think you can use these?

Physician

July 5, 2015

Do you remember Mad Libs from when you were a child? A story is filled with blanks, and as you fill them in with inappropriate and ridiculous words, you laugh until you can’t see straight. You laugh until you can’t breathe, and your parents beg you to stop! Let’s be children again. Share these with the nurses, and give the shift a little levity.

Pain medication. You see, doctor, my pain specialist …

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Idioms and axioms provide a glimpse into medical culture

Kristin Prentiss Ott, MD

Physician

June 28, 2015

Idioms are expressions everyone understands as something other than what the literal words say. For example, when I talk about “putting all of my eggs in one basket,” everyone knows I’m not really talking about eggs.

We say things like:

It’s raining cats and dogs.

It was a piece of cake!

I heard it straight from the horse’s mouth.

We have a few idioms in medicine, too. If I talk about “hanging crepe” in a …

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How to improve patient satisfaction in the emergency department

Angelo Falcone, MD

Physician

June 20, 2015

In the last several shifts I’ve worked in the ED I’ve had more people stop and compliment me on my care. I’ve heard the usual, “Do you have a private practice?” compliment and, “I’ve been here a lot and you really took the time to hear what I was saying, I appreciate that.”

Kudos are nice. They are what makes a tough …

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What’s it like to be a rural surgeon? Read this to find out.

Hope Amantine, MD

Physician

June 15, 2015

Recently I’ve been asked to write about rural surgery, what it’s like, what’s good about it. Everything has its ups and downs.

First of all let me say that whatever your job is, the money you get paid to do that job is for the crappy part, and every job has a crappy part. The trick is to find a job that …

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How heartburn caused a patient to lose her left leg

Rourke Stay, MD

Conditions

June 10, 2015

Note: This case is meant to illustrate the potential negative effects of inappropriate imaging. It is not intended as a diatribe towards any member of the health care team. Really the only “mistake” made here was the ordering of the CT scan in the first place.

A 37-year-old woman presents to her local emergency department (ED) with a 4-hour history of heartburn …

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Tips to avoid medical errors in the emergency department

Physician

May 12, 2015

Emergency medicine physicians: Could these be your cases?

A 35-year-old presents with shortness of breath and numbness to the legs. CXR and EKG are normal. She is discharged to see her doctor in two days, but is found dead at home. Autopsy reveals a dissecting aortic aneurysm.
A 15-month-old is triaged to fast track and seen by a physician assistant for fever, lethargy, …
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We’re going to need more medical chaperones. Here’s why.

Physician

April 29, 2015

For my entire life as a physician, from medical school, through residency and now until this 22nd year in practice, I have subscribed to the idea that I should have a chaperone when performing breast, pelvic or rectal exams on women. I was taught to do this from the beginning, and I still do it.

Why is this? On some level, the …

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The old school physician is who we should aspire to be

Suneel Dhand, MD

Physician

April 9, 2015

A couple of weeks ago I was on-call and had to go down to the emergency room to see a patient. Before I entered the room, I was told that the patient was accompanied by her long-time physician who was a bit “crazy and old school.”

“Hmm … that’s strange … why would her physician be in the room with her?” I …

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From an ER physician: Write your own admitting orders

Physician

April 7, 2015

While working at small rural hospital I was once again faced with the emergency physician’s dilemma. Admitting a patient and being told to write holding orders. In the midst of a very busy department, I sat with a nurse who guided me through the ridiculously complex and counterintuitive electronic orders system. All this so that the admitting doctor wouldn’t have to log onto the computer, from home mind you, and trouble …

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Capturing moments of innuendo in the emergency department

StorytellERdoc, MD

Physician

April 1, 2015

Although I pride myself on catching the obscure snapshots of typical life moments that occur daily while dealing with patients and their families in the emergency department, occasionally there are times when I am so focused on the task at hand that I completely fail to see a glaring moment of obvious humor, sadness, or tenderness. At times like this, then, I am glad to have our hard-working nurses and …

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Patient refuses ED discharge: Admitted to the hospital against medical advice

FirstWorldEM, MD

Physician

March 27, 2015

The following article is satire.

In the first application of a new “reverse AMA” system put into place to improve patient satisfaction, a patient was admitted to the hospital for the first time against the wishes of her treating ED physician. Constance Dolor, a 37-year-old morbidly obese patient with chronic unexplained pain and a frequent visitor to the emergency department, became the first person in known history to be admitted the …

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Want your ER physician to leave happy? Do these things.

Thomas Paine, MD

Physician

March 17, 2015

I have been doing emergency medicine for almost ten years — thirteen if residency counts, and I sure think it does. I face the same issues that cause my work colleagues, physicians and nurses alike, to burnout. I struggle with burnout myself, but I keep coming back. Many days (and nights), I ask myself why I continue to do what I …

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