Emergency physicians, nurses, and residents writing on KevinMD from the emergency department: acute care, the realities of the ER, boarding and overcrowding, violence against staff, and medicine practiced under pressure. Most contributors work in emergency departments. For what emergency physicians and nurses have said about being assaulted at work and told it was part of the job, see Violence against health care workers: what physicians and nurses say, in their own words. For what emergency physicians wrote in the first weeks and months of the pandemic, see COVID-19: what physicians wrote as it happened. For what emergency physicians and pain patients have said about opioid prescribing, see Opioids: what physicians and pain patients say, in their own words. For what physicians in the highest-burnout specialty have said about burnout since 2009, see Physician burnout: what physicians say, in their own words.
“The patient in room 17 needs an IV line! Hey, have you ever put in an IV before?!”
Everybody looked at me at once. I tried my best to maintain a confident outer appearance. But I’ll admit, I was caught off guard. I thought back to my attempted IV insertions throughout my anesthesia rotation earlier in the year. I struggled with getting the IV line smoothly into the vein. I followed …
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A surprising example of how medicine is learned from our patients
Six months ago, I had severe right flank pain. In the ER, I had an ultrasound showing a possible kidney stone. I deferred a CT scan and went home with medication. I fit the textbook picture: I had abnormal imaging, and I was given a treatment and discharged. I was advised to return if the pain worsened or failed to resolve. I briefly improved, but then the pain returned much …
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A physician’s personal crisis with pain
He was younger than I was — still in his twenties — but the patient had already had his chest opened twice. Deadly bloodstream infections contracted from sharing needles had destroyed his heart valves on two separate occasions. And now six months out from his most recent operation, he was back with fever and chills: ominous signs of another infection.
That was years ago. The opioid epidemic hadn’t yet been declared …
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Stop shaming those with addiction
“Hey, man, I’ve been getting destroyed all night running four ORs and haven’t eaten. I am going to eat dinner before I get out of here. If anything emergent comes up, I can help out. Just let me know.”
As I wash my hands right after I hang up the phone, the overhead call comes out: “Attention. Your attention, please. A Level 1 trauma code has been activated in the adult …
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A doctor’s life. Ready. Rinse. Repeat.
Recently there was an article in the Washington Post titled, “Uber and Lyft think they can solve one of medicine’s biggest problems,” in which these two companies are angling to provide better, safer more reliable transportation for patients. While I applaud this mission, given the depth and reach of both companies, I think they may be underselling their abilities to improve health care delivery and reduce cost.
Recently, one of my …
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A better way of using Lyft and Uber in health care
The two-page letter of complaint was typed on crested letterhead. The words “utter disappointment” jumped off the page, bold-faced and caps-locked. “The doctors left me to bleed,” she wrote, banging on the exclamation key as if she was firing lasers in a game of Space Invaders. “I was hemorrhaging, and they did nothing except pop in and tell me it would stop.” The tirade was directed toward me and the …
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When the nurses’ work goes unnoticed in the ER
Whether to circumcise a newborn male child is not the simple, binary “yes/no” question it appears to be. Rather, the choice is affected by an astonishing array of issues: religion, culture, health and hygiene, sexually transmitted infections, expense, pain and medical recommendations. Some cite ethical concerns regarding usurpation of a child’s free choice. Others claim an equivalency between neonatal male circumcision and the practice of female genital mutilation.
As a practicing …
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An emergency physician makes the case for circumcision
I’m an ED physician, so I’m used to patients screaming at me — sometimes with earsplitting demands for heavy-duty painkillers, morphine drips and similar remedies that will numb or “fix” them. I can deal with this. What I can’t deal with is a health system that incentivizes physicians like me to medicate adult patients, especially those at high risk for substance abuse, with little thought given to their long-term wellbeing.
As …
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Addressing the health care system flaws that feed the opioid crisis
I did not enjoy dating. It was not fun to figure out who liked me, who didn’t, how did the date go, should I call them, should they call me, how long should I wait, the anxiety of rejection … the list goes on. My husband and I knew each other for years, and although we did not start dating right away, things worked out. I met the love of …
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Finding a new physician job is just like dating
I hadn’t thought about this call night in a while, as it happened three years ago. It came back into my consciousness this past week, when I re-experienced the events in a dream. (Of note, my stress dreams used to be about my car accident in 2014, which was a high-speed collision that left me in crutches. I guess I can now safely say that some call nights are actually …
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When mansplaining kills patients
I grabbed a few beach pillows, put on my old worn-out blue beach button down, poured myself a glass of whiskey and walked down to the beach from our villa to watch the sunset. My four friends and I were ten days deep into a two-week vacation. We had already toured Seoul, South Korea for three days, Tokyo, Japan for four days and Hong Kong for three days. So, I …
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No matter where you are, you’re still a doctor
When you see your doctor, you want to know what’s wrong, follow the steps to recovery and get predictable results. Sadly, this is not always possible. Medicine is an art based on science that is constantly changing and full of things we don’t know.
Here are four reasons why it seems like your doctors didn’t get it right — when we actually did:
- Your symptoms or exam findings were not typical …
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Why can’t my doctor get it right? Here are 4 reasons.
On a weekend night, I received a strange phone call from an emergency room resident. “This is an emergency,” he said, adding fragments of details, “… vaginal bleeding … her heart rate is in the 150s.” It was hard to figure out what was happening and his tone was oddly calm. “Is she in an exam room?” I asked. “No,” he replied, “we’re in the trauma bay.”
I ran downstairs with …
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Outrage at how the health care system “cares” for women
It is well known that smoking cigarettes negatively impacts health and leads to an increased risk of stroke, heart disease, lung cancer and death.
No one debates this anymore. But it wasn’t always this way, and it didn’t come easily.
In the 1940s, almost half of the population in the United States smoked, and the tobacco industry was subsequently incredibly powerful and politically active. It spent millions of …
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Fight gun violence with science
For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications.
As recently as two months ago, trauma surgeon Michael McGonigal blogging at the Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable …
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The fall of the digital rectal exam
It has been documented that 1 in 3 women will experience rape in her lifetime, and this is most common in women under the age of 25. Over 95 percent of victims of sexual assault are women worldwide, while in North America estimates place that at 85 percent. These are the assaults we know about — generous estimates say that, at most, 10 percent of rapes are reported to police …
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Sexual assault in the emergency department: What can you do?
We had a pretty busy shop when I was in residency. So busy, in fact, that we had three secretaries working simultaneously — one for paging, one for order entry, and one for admissions. I haven’t been back there in a long time, but I hope the secretarial staff has grown commensurately with the volume and acuity of the ED. But from what I’ve seen around the country in my …
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Emergency physicians are glorified secretaries with medical degrees
I always warn my medical students to be careful what they say in front of patients, or patients’ families or friends. “You never know who’s listening!” I add. They may think that I’m exaggerating — but I have my reasons.
Early in my career as an internist/nephrologist, if I had a free moment, I’d head for the emergency room. I might get a referral, and the coffee and conversation were usually …
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Watch what you say around patients
Jenna had it all: She was smart, pretty, inquisitive and popular, with just one more year until she graduated from high school.
She was at the top of her class and couldn’t wait until high school was over, and she could become a pediatrician just like her dad. One day, Jenna would be an MD.
“One day at a time,” her parents always told her, even though she wanted to rush to …
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Texting and driving: what happens every day in America
I’m an emergency physician. In common parlance, an ER doc. Which means, like a little kid who will eat dirt on a dare, there’s not much I won’t try in the practice of my profession. Many of my colleagues have had far more challenging careers than me, I assure you. But I have some stories to tell. Cyanide overdose while moonlighting as a resident. Patient nearly dying from bite by …
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An emergency physician delivers a baby, and realizes that it isn’t for him
