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.
For the past four years, this is James Beck’s routine: After a morning spent guzzling $5 vodka, he stumbles into a Dunkin’ Donuts parking lot, lying on the cement with his dusty oversized coat splayed open to reveal a cachectic chest. A concerned patron (cigarette and coffee in hand) will call 911 and, in accordance with protocol, an ambulance will deliver him to our emergency room.
Upon his arrival, we unpredictably …
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In tragedy, practicing medicine both an honor and a privilege
As part of my medical school’s inter-professional learning, I shadowed a hospital chaplain this afternoon. While physicians principally attend to the physical healing of patients, chaplains also fulfill an important role in health care: meeting the spiritual needs of patients. When faced with disease, patients often grapple with deeper questions about their illness beyond just what the diagnosis and treatment plans are.
Immediately upon arriving at the hospital, there was a …
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The irony of me observing death on a day celebrating my birth
As a boy growing up in a small town in Pennsylvania, I never gave much thought to the concept of a kiss. My family gave and received kisses without hesitation. I continue to give and receive kisses from my wife and kids in the same nonchalant manner.
Until one night — on shift.
I work in the ER of a medium-sized town in southern Oregon. It was late into my shift. The …
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A kiss changed this doctor’s life
The final year of any residency is a time of accelerated independence, moonlighting, and an intense search for that first job as an attending. This decision is critical as one embarks on a life-long career in medicine, and it will undoubtedly blend a mix of analytics, emotion, and finance into the final analysis.
With a bit of candor, I want to share the mistakes I made when accepting my first contract …
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5 mistakes this doctor made when negotiating his contract
A young woman stands in the freezing cold outside an urban Baltimore hospital. The woman, covered only by a thin hospital gown, moans incoherently at the man capturing her suffering on cellphone video. As seen on the now-viral video, she’d been left there by security personnel employed by the supposed place of healing just a few yards away. It hurts to watch.
Mass …
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The truth behind that Baltimore patient dumping video
I am an emergency medicine physician.
I save lives.
As an ER physician, my job is frequently misunderstood. A common question that patients ask is, “What specialty are you hoping to go into?” The misconception is that emergency rooms are staffed by cardiologists, internists, etc., who are trying to make extra income. That’s likely not the case anymore. Some also believe that we can take the place of their family doctor. Or …
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What exactly does an emergency physician do?
On September 1, 2017, four children and their grandparents drowned while their uncle was trying to drive them to safety. Their van was swept off the road by rushing floodwaters. The uncle was able to escape through a half-open window as the van sank headfirst into the bayou. As the van sank, he could hear the four children screaming and crying. Two days later, the van was found, with all …
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A lesson from Hurricane Harvey: Compassion has meaning
I had just taken my final anatomy exam and finished a long two-month ordeal dissecting through and memorizing every component of the human body. At the beginning of the course, I had been excited, energized, honored to commence such a foundational experience in medical training. By the end, I was exhausted, wanting nothing more than just to sleep.
The very next day, we began physiology with two weeks of cardiology separating …
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A near-death experience taught this medical student a lesson
My pediatric practice is one which harkens back to days long ago when physicians knew their patients and pertinent medical histories by heart. My 81-year-old father and I were in practice together for the past 16 years; he still used the very sophisticated “hunt and peck” to compose emails. The task of transitioning to an electronic record system seemed insurmountable, so we remain on paper. Our medical record system has …
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A 16-page note with little information to help physicians
Sometimes life just walks right up and slaps you in the face. It happened to me while attending the dynamic FIX17 conference in NYC, and it led to an epiphany: At the ripe old age of 59, I am officially a dinosaur.
I was giving a talk on the history of women in medicine. Passionate about the topic, I spent months planning and organizing the lecture, weaving what I hoped was an intriguing tale …
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Women in medicine: Getting to this point came at a cost
“Same team!” bellowed all the frustrated parents from the sideline of a lacrosse game as we watched two teammates clash sticks while fighting to catch the same pass. Both players missed the ball, and the other team scooped it up and scored, perfectly illustrating to our kids what happens when they battle among themselves.
It’s easy to remind our kids that teammates shouldn’t fight, but it’s harder to remind each other …
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The practice of emergency medicine is a team sport
The fact that unexpected outcomes and rare events occur is one of the realities of medicine that is difficult to comprehend until you have personally experienced it. There are over 130 million emergency department visits annually, over 16 million of which require admission to a hospital. With that many encounters, even the rarest of events becomes possible. However, practicing medicine is impossible if you are constantly looking for the 0.0001 …
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Bad things happen to every doctor
The kids were asleep, and I could hear a muted, distant moaning coming from our bedroom. It reminded me of labor pains, but there were three things making labor unlikely: my wife’s IUD, the absence of a gravid abdomen and the kind of unintentional celibacy that occurs between working parents raising two toddlers. I tried to ignore the moaning. In part, because it was a Sunday night, and the sound …
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A story of 2 torsions
This discussion is something I’ve tossed around in my head for awhile. As I have gone back and forth on the topic, I decided to debate myself while I answer the question:
Is work-life balance a real thing? If so, what is it and can it be achieved, specifically in a demanding field such as medicine that often expects your job to be your life?
In this corner: Cynical Rogue Dad
Of course, …
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Is work-life balance for physicians a unicorn?
In the emergency room, the stress is palpable. The hairs on your neck rise up as you enter the resuscitation bay where the next unconscious patient has just arrived. You can almost feel death as it circulates through the air, like a vulture in the sky. The air tastes sterile, and you hear the crash cart and ultrasound being rolled over to the patient’s bed.
The patient was fine 20 minutes …
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An apology from a telemedicine physician
When I read the Washington Post article about the CDC censoring seven words last Friday night, my mind immediately jumped to the youth I take care of every day in my Baltimore clinic. It felt like a direct attack on the very patients I became a doctor to treat: the transgender young person initiating gender-affirming hormone treatment; the young woman seeking inpatient addiction treatment for the first …
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The CDC word ban: an attack on the patients I treat
“I don’t teach IMGs.”
It was such a simple and concise statement. Four words. But it felt like a bullet that was heated in the depths of hell had pierced through my heart when I heard those words. My ears burned and I felt physically ill. I wondered to myself, “Am I really that bad at medicine? Am I even going to make it? Should I just quit?” I felt lesser …
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If you don’t teach IMGs, maybe you should start
As I walked into the room, I see my patient lying in bed, eyes closed. His wife of 50-plus years sat in the recliner next to him grasping his right hand. The holiday season was upon us. My patient has spent the better part of the last month in the hospital.
His wife was staring at the pretty scenery outside with her weary, tired eyes. It had started snowing this morning. …
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During the holidays, we should take time to be a little kinder
The complaint was constipation. In the exam room, a quiet girl stood in a too big johnny, her eyes staring down at the floor. The 13-year-old was here with her “aunt.” Like over 50,000 children before her, she’d made the fifteen hundred mile plus journey from El Salvador to escape the violence of government and gang fighting, perhaps not knowing Mara Salvatrucha and the other gangs hung out only a …
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To this physician, thankfulness is his lifeline
