Emergency Medicine

When patients abuse emergency department workers

Conditions

February 16, 2014

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% …

Why patients have lost trust in their doctors

Myles Riner, MD

Physician

February 15, 2014

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 …

Shotgun medicine: An arrow is often better

Jennifer Adaeze Anyaegbunam

Education

February 5, 2014

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 …

The toxicity of Medicaid

Edwin Leap, MD

Physician

January 28, 2014

I have noticed over the years that physicians who write about medicine, particularly for the general public, are limited to very specific discussions. For instance, it is perfectly acceptable to write about the plight of the poor and uninsured. It is always reasonable to advocate for a single payer system. It is perfectly acceptable to discuss how one downsized in order to make less and “give back” more. And it …

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The toxicity of Medicaid

When children are abused by foster parents

S. Terez Malka, MD

Physician

December 26, 2013

I click open the x-ray viewer. After 4 years in emergency pediatrics, I am not really surprised that a tibia fracture underlies the bruised ankle I unexpectedly encountered on physical exam. Yet I audibly gasp as the chest x-ray loads. The torso in question belongs to a chubby little cherub of a 3-month-old in room 11, brought in for red eyes. I begin to count the fractured ribs — 1, …

What is the best metric to measure a hospital?

Michael Cetta, MD

Policy

November 20, 2013

If you had to pick a single metric to a measure a hospital, which would you choose?

Of course, you can’t boil everything about a hospital down to one, single data point. Defining quality, throughput, and other factors used to evaluate a hospital is difficult business. The Centers of Medicare & Medicaid Services (CMS) tracks dozens of core metrics related to both quality and process, both inpatients and outpatients. As a practicing …

The focus on patient satisfaction is enough to make you sick

BirdStrike, MD

Physician

November 19, 2013

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All patients should be treated with professionalism and respect. We all want our patients leaving our care happy, healthy and satisfied, if at all possible. However, sometimes patients don’t leave an emergency department very happy or satisfied. Sometimes the doctor could have prevented it, but many if not most times, such dissatisfaction has little if anything to do with what the …

Boxer at Rest: A physician’s interpretation

Jeffrey M. Levine, MD

Physician

November 16, 2013

Boxer_02

Recently, an ancient sculptural masterpiece has been on temporary display in the Metropolitan Museum of Art’s Greek and Roman halls. On loan from Rome’s Museo Nazionale Romano, “Boxer at Rest” depicts a battered pugilist immediately after a fight. His face bears evidence of broken nasal bones, swelling and hematoma under his right eye, and multiple lacerations and abrasions to his nose, cheeks, and forehead. One secret …

The outrageous ER markup for a tetanus shot

Olivier Van Houtte

Conditions

November 13, 2013

In March of last year I began and quickly ended a cycling career. In my first race of the weekend I placed second, and in a moment of hubris felt emboldened to reach for more.

In the second race, the very next day, I signed up for a higher category. The race was tougher, and I got stuck behind the pack, which slowed immensely around turns. In an effort to advance, …

What an old doctor taught me about palliative care

Monica Williams-Murphy, MD

Physician

October 19, 2013

Many years ago when I was a “young” doctor, moonlighting in the ER of a tiny country town, I had an experience that challenged my training. You see, most young, new doctors often think their training and knowledge is superior to that of “old” doctors, which is often malarkey. A wise and sage old doctor in this tiny country town taught me an important lesson on where and how one …

Reinventing the pain scale in the emergency department

Rob Brandt, MD

Conditions

October 12, 2013

pain scale-37--

All people are gifted. As an emergency room physician, I see a wide variety of gifts, such as yodeling, knitting, and swearing (mostly swearing). One gift I rarely see is math. As a whole, the U.S. sucks at math. When compared with other nations, the U.S. ranks 32nd in math (though first in confidence). Despite this, we expect mathematical coherency …

What do we do with the extreme elderly?

Janice Boughton, MD

Physician

October 10, 2013

A 100-year-old woman is brought to the emergency room by a concerned friend because she can no longer get out of bed to get food or go to the bathroom. Other than being unwashed and a little confused, she is fine. Her electrolytes are pristine, her electrocardiogram the definition of normal, her blood count and chest x-ray perfectly mirror the expected physiology for her age. Even her urinalysis is normal. …

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What do we do with the extreme elderly?

Being a good medical student doesn’t mean you’ll be a good doctor

Amy Faith Ho, MD

Education

October 6, 2013

There is a saying that you enter medical school wanting to help people but exit it wanting to help yourself. It may be a cynical view, but a realistic one. The criteria for being a good medical student are far different from being a good doctor. Medical education may be breeding a legion of self-serving, grade-grubbing, SOAP-note spewing machines rather than …

Why aren’t hospitals more attentive to the needs of patients?

Leslie Kernisan, MD, MPH

Physician

September 24, 2013

In a recent post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.

On the bike path where Jha took his initial tumble, people went out of their way to …

14 ways to drive your doctor crazy during a physical exam

WhiteCoat, MD

Physician

August 31, 2013

1. When your doctor looks into your eyes with a flashlight, shut your eyes tightly so he can’t see your pupils. Later, when your doctors asks you to shut your eyes tightly to test your eyelid strength, look at him like he’s speaking in tongues and keep your eyes open. If he whips out his flashlight to look at your pupils …

Calling a consult: Disrespect from specialists hurts patients

Heidi Roman, MD

Physician

August 26, 2013

A while back I was working in pediatric urgent care and had occasion to do something I have done many times since starting out in medicine. I called a consult. The reason, like many consults, was an abnormality on a study that required a specialist’s opinion. I paged the resident on call for this particular specialty.

When they called back I was treated, right from the get-go, to some serious attitude. This was a legitimate …

How much information should doctors give to patients?

James Hubbard, MD

Physician

August 17, 2013

In my over three decades of family practice, I have come to the conclusion that we, as doctors, should provide non-medical people with as much medical information as we can. Not as much as we think they should have, or information just related to the problem at hand, but as much as we can provide. Period.

I started practicing when many still debated whether we should tell a patient if he …

A ruptured eardrum turns out to be something much more

BirdStrike, MD

Physician

July 9, 2013

My shift is over, and I’m ready to head out the emergency department door. When I walked in 12 hours ago, the department had 20 waiting patients. I look up at the monitor and after 12 hours of trying to wrestle the department under control, not only is it not under control, now we’re 25 patients deep in the weeds. My partner Dr. Jim looks at me and says, “Get …

Reflections after 4 years of emergency medicine training

Leana Wen, MD

Physician

July 3, 2013

On July 1st, four years ago, I walked through Massachusetts General and Brigham and Women’s Hospitals with an odd mixture of fear, relief, and excitement. Now, as I leave the hospital after my last shift of emergency medicine residency training, I am filled with a similar hodgepodge of emotions and reflections.

1. “You were terrified of being a doctor!” I mentioned this article to the attending who oversaw my first shift as …

Should doctors be available to patients around the clock?

Kevin R. Campbell, MD

Physician

June 25, 2013

Nothing exemplifies more the complete lack of understanding of the issues surrounding our healthcare system than an article that appeared in the New York Times recently.

Author Jane Brody’s piece attempts to address issues with the astronomical costs and misuses of emergency department (ED) visits in the US today. While I agree that ED visits for routine issues are a waste of resources and money, her suggestion that physicians should …

Emergency Medicine

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