In the emergency department, we see them all the time. The person with a medical problem too serious to ignore, but not quite bad enough to require admission. The patient referred to the specialist who comes back to the ER. “I couldn’t afford the cash upfront.” The new cancer in the uninsured. The pneumonia without a doctor. The homeless not eligible for Medicaid.
The senior barely able to stand, but whose …
What can I do differently in the ER?
Did I ever get to thank you for helping me? I am one of the pediatric residents you see running around like a headless chicken. We first met over a year ago when I was just a wee intern. You helped me calm an anxious boy who was about to get stitches. He had sliced his arm with a box cutter, creating a gaping wound for me to close. I’m …
An appreciation for a hospital volunteer
An excerpt from A Mistake: A Novel.
“Hello there,” Elizabeth said, leaning over the girl, smiling. “Hello. Hello Lisa.”
The girl looked up at her accusingly.
“My name is Elizabeth Taylor. Please call me Liz. I’m the consultant surgeon, and this is my registrar, Richard Whitehead.”
Elizabeth smiled wider for her.
“How are you …
The pale, very sick girl in the emergency department
It’s fascinating — the strange clarity that a little panic brings.
I remember thinking this in the days after, startled at the level of detail in my memories of the first time I watched a patient die.
“Just got a call, transport’s bringing in a code. You good to standby for compressions?”
I nodded as I felt my stomach free fall ten-thousand feet, managing a, “Yeah, totally,” that sounded more confident than I …
Our doctors are dying in medical school
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 …
Why this physician never tells anyone she’s a doctor
There are limited studies regarding pediatric malpractice claims, especially for the emergency department (ED). A recent study of malpractice claims involving children highlights the role of communication and systems issues. This 10-year study is important because it focuses exclusively on children and provides data on the top specialties named as defendants, including emergency medicine. The study found communication breakdowns between patients/families, and providers contributed to 15 to …
When treating kids, learn communication lessons from the emergency department
In journalism, the lede is the first part of a news story. A good lede will entice the reader to read more. It contains the key points and gives the general idea of the article. Ledes are also crucial in the field of medicine. As a graduate student in journalism and a general practitioner, I can appreciate the value of ledes in both fields.
When health care professionals communicate with each …
In medicine, use a strong lede
“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 …
Physicians need moments of reflection throughout their days
On Saturday morning at the breakfast table surrounded by my husband and kids, I suddenly felt chest pain, palpitations, and was about to collapse. Being an internist, I knew it: arrhythmia. Paramedics at arrival confirmed it. I was running ventricular tachycardia.
Out of the chaos surrounding me at that moment, my physician’s brain assessed the situation: “VT. Serious arrhythmia.”
After that, I lost it. I became a scared-to-death patient who has a …
How physician burnout hurts patients
I hate confrontation. It’s just the way I was raised. I’m not saying it’s right, or healthy, it just happened. My parents and I almost never confronted one another; even when it would have been healthier. That, of course, is water under the bridge and not in any way a condemnation of my folks who were kind and loving and indulgent parents.
But this tendency caused me to suppress emotions. Whether …
Why this doctor was so uncomfortable arguing with another physician
Anyone who has spent any time on the internet knows better than to spend much time on the comments from an opinion piece. The comments section, even one on a site as reputable and respected as the New York Times, is often a minefield of trolls, contrarians, and conspiracy theorists.
But after reading “The American Medical System Is One Giant Workaround” by Theresa Brown, I couldn’t resist. Among …
Is automation the anti-workaround?
The clinic intake form we used had a space for an asylum number. The number assigned when people first presented to the border requesting asylum. It’s not a tattoo, yet.
Refugee Health Alliance (where I worked for much of July 2019) provides care for asylees, refugees, and deportees just across the border from San Diego in Tijuana. On Saturdays, RHA volunteers roll bulging suitcases filled with supplies to migrant’s shelters to …
What it’s really like to be a doctor on the border
I walked into the room and said: “Hi, Jason.”
“Do you think it’s deep enough to need stitches? I am really scared of needles,” was his reply to me.
I said, “Why don’t you let me take a look, and we can both come up with a plan of how to make it look better?”
“So do you think it needs stitches or not? I’m really scared.”
After taking a good look at his …
A patient confesses that he cuts himself
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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 …
This doctor defines himself as a Christian, not a physician
It seems that all day, every day, I care for patients who simply won’t take care of themselves. And I sometimes think that we in emergency medicine have caused more harm than we expected.
Now let me first say, I also take care of those who can’t care for themselves. There are those who, through age, infirmity, or poverty, simply have no means. The patient with a chronic condition who can’t …
What has emergency medicine wrought? Helplessness.
Dr. Wesley Boyd, an associate professor of psychiatry at Harvard, has spent years working with state programs that help doctors, nurses and other health care workers who have become addicted to opioids get back on their feet professionally.
He supports these non-disciplinary programs, in which doctors and nurses enroll for a number of years and are closely monitored by addiction specialists and state authorities as they seek to maintain or restore …
What’s the best way to treat doctors and nurses with drug addiction?
The water continued to rise as the rain pounded Marsh Harbor, a town on Abaco, one of the 700 islands of the Bahamas archipelago. Hurricane Dorian plodded along, nearly slowing to a stop directly over their meager homes. The rain and wind continued to lash their wood and aluminum dwellings, but the real threat came from the sea. Changes in climate mean the ocean started higher than it did only …
A physician is on the scene in the Bahamas after hurricane Dorian
EMTALA is born
The machine beeps alarmingly as it breathes for your child. The various numbers on the monitor are foreign to you, but you know something isn’t right because the nurse briskly walks away from the stretcher to grab the doctor, who then orders more medication and makes adjustments to the machine. The beeping stops, and the anxiety eases from the staff.
The official in business clothes — standing next to …
An important health care safety net is at risk
With August recess at a close, Congress has yet to find a solution to end balance (or “surprise”) billing, where patients are charged the remainder of their medical bill for out-of-network (OON) expenses not reimbursed by their health plan. About the only compromise for-profit health insurers, hospitals, and physician groups can agree on is that patients should be taken out of the middle, but they can’t agree on how.
Physician groups …
Let’s end surprise billing without a Trojan Horse
It’s difficult to put into words the honor I feel as an emergency physician. Strangers invite you into their lives, trusting in your training, knowledge, and compassion as they battle crisis. We are involved in intimate details of triumphs and loss on a daily basis, sharing in tears of joy and sorrow as we fight and advocate for our patients. It’s a humbling calling that I’ll never take for granted. …
Modern health care and the Burger King mentality: Sometimes you can’t “have it your way”
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