Every ER has its call roster, that sacred list of oracles, laying out who we can call when our patients need some service that we cannot provide. If I need a cardiologist, or a neurosurgeon or even a dermatologist for some acute emergency condition, all I need to do is ring up the operator and tell them, “This is the ER …
“My wife died uncomfortable and alone. She died thirsty!”
The man who spoke those words came in to the emergency room recently where I was working a shift. He was accompanied by his wife, a 70-year-old with high sugar, weakness, and nausea. The team worked to get her seen under the presumption that her diabetes needed control. Once she was brought back to …
What I found most disturbing about the man’s arm was not the deep, stellate laceration on the underside of his biceps.
It was the swastika tattoo next to it.
“Sir,” I said, “we’ll have you fixed up in no time. I’m going to numb up the wound, irrigate it, then repair the laceration with sutures and send you home on antibiotics and pain …
“They need you in room 13,″ she said when I answered the phone and I ran back to the ICU. The patient was coding and for each minute that felt like an hour, we tried, and failed, to save her. She wasn’t breathing, her heart wasn’t working, and despite the 30 people gathered in the room, in the end, she died.
Running a code, as we call it, means that someone is …
Patients are being stuck with huge and unexpected medical care bills in circumstances where they have no say in selecting the physician who is billing them, and no way for them to know in advance which services the physicians would render or what it would cost them, says the New York Times.
Mr. Peter Drier received a “surprise $117,000 medical bill from …
I have been following the progress of bedside ultrasound (using ultrasound as a diagnostic tool during my physical exam of patients) as it gets a foothold in standard medical practice since I first started learning to do it about 3 years ago. Every so often a study comes out which warms my heart as it proves that less (radiation, expense) is more in treating patients.
An article came out in the …
The case
A thirty-five-year-old female presents to the emergency department on a weekend afternoon with the following chief complaint: “I want to give up custody of my son.”
The patient is well dressed — and so is her four-year-old son, who is sitting comfortably on the bed playing a video game on his mother’s cell phone.
According to the patient, she is a single mother with no support system. Her son’s father deserted …
Recently, I was on call for surgery at a hospital in New York City. At 2 a.m. in the morning, we were paged to a trauma in the ED. After we stabilized the patient and moved him for CT scans and x-rays, I noticed a small stretcher tucked away in the back part of the ED, a place typically reserved for overflow patients when we run out of rooms.
The patient …
I have long been a fan of the Case Records of the Massachusetts General Hospital, which is published weekly in the New England Journal of Medicine. For many years, I made a point of recommending them to medical students and internal medicine residents as a model of concise yet comprehensive case presentations.
No wasted words, no missing information, and none of the filler that trainees often added when they presented cases, such …
I would like to explain why Michael Kirsch’s article, “Why the ER admits too many patients,” is wrong, in all the myriad ways, in his contention that emergency physicians (EPs) admit too many patients because of improper motivations. Note that I am not going to argue that EPs don’t admit too many patients — that’s a legitimate discussion to have and there may be some merit …
Every player in the medical arena has found itself challenged by conflicts where one’s self-interest competes can skew what should be pure advice. This issue is not restricted to the medical universe. Every one of us has to navigate through similar circumstances throughout the journey of life. If an attorney, for example, is paid by the hour, then there is an incentive for the legal task to take longer than …
Today, a patient attacked me. A nurse got kicked. Another punched. I was gouged to the point that blood was drawn. The patient was neither intoxicated nor psychotic. Rather, she was a meek 92-year-old grandmother, and she was terrified. It took five of us to hold her down, as she summoned the strength of a woman fighting for her life.
Linda is an elderly woman with moderate dementia. She is blind …
It was recently Nurses Week in early May and there were a lot of adulations being offered on social media and throughout hospitals regarding the appreciation we have for those among us who have chosen to be on the “front lines” of caring for us when ill or injured.
As an emergency physician I could speak about the many times a nurse has grabbed me and pulled me into a room …
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One of my most treasured stories as an ED physician belongs to a lovely couple who valued quality of life. It was a routine day in the ED when an elderly woman rolled through the ambulance doors on a cold, narrow stretcher, unaccompanied by family. She was placed in bed 5, which is where we met. She was frail and her memory was poor. The EMS run sheet reported “change …
Medical scribes are a burgeoning field with many institutions and practices exploring their use while the many commercial enterprises who lease out scribes are pushing for their widespread acceptance. There is no accepted definition of what scribes do or what their background or training should be. There is no mechanism for licensure of them in any state. They are poorly defined medical assistants. The field is in its infancy and …
A small case with big implications almost escaped my notice recently The Boston Globe reported a case in which a family sued after a 23-year-old man died after being diagnosed with a lung infection.
According to the Globe, the young man went to one of the Boston emergency rooms complaining of cough, fever, and chest pains. OK, stop right there all …
As a medical scribe working with a large, well-known scribe company, unnamed to protect my job, it makes me proud reading all the articles published about how much having a scribe benefits a physician, especially in the emergency department. I enjoy my job immensely and I am grateful for the opportunity to learn and engage in patient care. However, as a …
There are few professional careers centered around protecting and caring for others that garner so much verbal and physical abuse than a career in emergency medicine. Mental health workers, police, fire, and EMS personnel are the other fields that come to mind when I think of a service that “helps” people yet gets abuse dished upon them on nearly a daily basis.
A 2006 survey of emergency nurses showed that 25% …
I came across a really good post on the Daily Beast written by a pediatrician in New England, griping (appropriately) about parents who were unwilling to trust his judgment about vaccinating their children.
Why have so many patients lost trust in their doctors?
You might challenge the assumption that patients used to trust their doctors more, and that would be a fair question. I haven’t …
During my internal medicine rotation, the medical students had the opportunity to attend intern morning report, an interactive teaching session where attending physicians walk the interns through a patient’s story, starting from the moment they hit the door of the emergency room to the final stages of diagnosis and treatment.
After discussing the patient’s symptoms, complaints and past medical history, the attendings always ask the group to think carefully about the …
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