A meme forwarded to me last year showed a chimp with the caption: “Monkey trained to dispense Z-Paks at urgent care.” As one of the medical directors for a multi-office urgent care practice, one of the tasks is performing a…
A meme forwarded to me last year showed a chimp with the caption: “Monkey trained to dispense Z-Paks at urgent care.”
As one of the medical directors for a multi-office urgent care practice, one of the tasks is performing a chart review. One of the patterns we see too often is ubiquitous Z-Pak prescriptions for purported cough, sore throat, sinusitis and even an allergic rhinitis this last batch. Z-Paks are one …
It’s 7 a.m. The hospital is just starting to wake up from its slumber, stretching arms and blinking eyes. I’m 54 minutes away from the end of another night shift. Night shifts are curious creatures. They are a part of…
It’s 7 a.m. The hospital is just starting to wake up from its slumber, stretching arms and blinking eyes. I’m 54 minutes away from the end of another night shift.
Night shifts are curious creatures. They are a part of the fabric of emergency medicine life — one of the often hated aspects of our jobs. They steal us away from our families, cutting short bedtime snuggles and picture books so …
He looked tired and worn down, more so than many of the other patients I had seen that day. He didn’t speak English and I did not speak his language, but I could feel his anxiety as it filled the…
He looked tired and worn down, more so than many of the other patients I had seen that day. He didn’t speak English and I did not speak his language, but I could feel his anxiety as it filled the exam room. One of my employees translated, in fact, what his “boss” was telling us. The boss was worried that he was more tired than usual, and not getting his …
On a Sunday afternoon, I arrived at the hospital for my psychiatry ER shift. As medical students, we keep an eye on the track board for new patients to see. Two names turned bright red, and I chose to follow…
On a Sunday afternoon, I arrived at the hospital for my psychiatry ER shift. As medical students, we keep an eye on the track board for new patients to see. Two names turned bright red, and I chose to follow Jackie Swanson*. Her initial ER evaluation read “Patient is a 30-year-old female here for SI, HI, and AVH in context of recent sexual assault and cocaine use.” She was brought …
“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…
“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 …
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,…
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 …
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…
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 …
“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…
“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 …
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…
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.
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…
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 …
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…
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.
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…
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.
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 ...…
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 …
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…
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 …
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…
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 …
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…
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:
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…
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.”
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.…
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 …
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 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 …
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…
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 …
