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.
Even after all this time, the phone calls aren’t always easy to make.
“Hi, Mrs. Smith, this is Dr. Kass at camp, don’t worry, everything is OK.” I usually get that out in one breath, then immediately transition to concrete details. “It’s a finger. It might be broken.” It doesn’t matter if I’m calling about a cough, a fever or a bite from the camp pet pig — I know that …
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Being a camp doctor is the most rewarding physician job I’ve ever had
Recently, I had an opportunity to drop in on two of the foremost researchers in physician burnout, Sara Poplau and Mark Linzer of Hennepin County Medical Center in Minneapolis. We chatted about various aspects of the current burnout crisis and exciting new initiatives on the horizon. Then we spent some time contemplating a frustrating truth: leaders in health care often fail to acknowledge a reality that leaders in other industries …
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Scribes for physician burnout: How scribes help reconnect doctors with their patients
After years and years of practicing emergency medicine, I’ve seen and treated thousands of children for everything from beads in the nose to leukemia, ruptured spleens to sprained ankles.
A father of four myself, I take great delight in interacting with the kids that come through my workplace. I consider it a personal challenge to make them smile whenever possible and to put them at ease.
I’ve learned a few things over …
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Parents: Interact with your kids!
In February 2010, I completed my final ward round and said goodbye to my patients in Haiti just six weeks after a tragic earthquake. This earthquake was a natural disaster so devastating that within a momentary blink, a minute’s tremor and a rumbling collapse, an estimated one-hundred-thousand people lost their lives.
Amidst the wreckage, hundreds of thousands more were left severely injured, shocked, …
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Hope is the ultimate cure
We emergency physicians are often thrust into the frontline battles raging in society. The pain, blood, and emotions are so real, so thick and ever present, creating an undertone that is difficult to deny. We walk the corridors of our departments actively involved in life or death, where the span of mere millimeters might as well be miles as we explore wounds, clinical scenarios and presentations. How do we do …
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Emergency physicians have to build emotional walls. Sometimes they break.
It’s 1 a.m., and I’m afraid this guy is going to die. He’s gasping for air, hunched over a table as I poke his chubby back and try to find a rib. Oxygen is flowing through nasal prongs at six liters per minute, and it’s barely making a difference as his oxygen saturation hovers around eighty-five percent (it should be in the high-nineties.) He’s sick, but what’s more worrisome is …
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He was fine when I discharged him, now he might die
How applicable are the lessons we learn in the hospital to other areas of our personal and professional lives? Over the past eight years in the emergency department, I have learned most about people. These lessons have been crucial to my success in the ER and as a father to my teenage children.
These are my top 5 insights:
1. Clear communication is key and overly clear communication is even better. It …
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Working in the ED has made me a better parent
I cried this morning. It wasn’t because of the patient who coded with a wide-complex tachycardia and died in front of me, and it wasn’t because of the patient who tried to spit on me for not giving her a prescription for narcotics. Nor was it my intoxicated 2 a.m. bar fight patient yelling at my other patients, including one whom I’d recently diagnosed with metastatic cancer. It was because …
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These physicians are crying. Here’s why.
I want to sincerely thank you from the depths of my heart. I don’t show it, and I certainly don’t say it, but you have always been my role model. You positively shape who I am as a man, and your staunch encouragement is invaluable to me.
In a world of words, texts and tweets, you have let your actions speak. You have remained apolitical and areligious, choosing to focus your …
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A letter from a physician to his father
I am an emergency physician, forever grateful of the responsibilities entrusted by my patients. This is a relationship I hold dear. As such, I’m an active participant in the war of life and death for our patients. I’m in the trenches with the best nurses, techs and EMS personnel holding the line as the battle continues. We have our victories and share our defeats, all in the name of what …
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There’s something wrong with emergency care. Here’s what it is.
During my salad days, I — like a lot of physicians — thought I could take on the world. Despite working in a smaller, community hospital, our ER saw a lot of the same type of orthopedic trauma I saw during residency. And my young partners and I took virtually every case that came in except spinal trauma. We did this whether we were on unassigned ER call or not …
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Think you can do anything you set your mind to? Think again.
After another long shift of patients with colds, bug bites, ankle sprains and sore throats I eagerly looked through the wine selection at the local grocery store. It was my wedding anniversary and nearing 9 p.m. at the beginning of a holiday weekend. While at the checkout line, an elderly woman in front of me thanked me for my service. At that moment, I realized that I was wearing my …
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This is what it’s like to be a military physician
Independent physician groups and solo physicians have been the historic bedrock of medical practice. While it is true that there is intense pressure on the single-physician group, and this market is shrinking, independent physicians are here to stay. Some single practice physician groups may merge with larger groups, some physicians will break off from the large contract groups, but there is no plan on them becoming extinct.
Independent physician groups have …
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5 myths about emergency physician groups
I carried it around with me the entire shift. I showed it to my E.R. colleagues, the internists, and even a couple of surgeons. I’d tell them the story. “Never,” one of them said. “Not in twenty-eight years. Never seen that before.”
One of them held the small urine jar up to a light and began unscrewing the lid.
“Don’t!” I said.
“Why not?”
“It stinks. You wouldn’t believe how much it stinks. We …
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The abscess that surprised this emergency physician
“So tell me why you think you you’re having a stroke?”
The nice lady, mid 40s, sat on the ER exam table in work-clothes, an anxious look on her face. “Well, I was working the cattle up in the timber, and when I got back to my 4-wheeler my heart was racing, and I was short of breath. My arms were tingling, and so was my face. I’m concerned it might …
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This is what practicing medicine in rural America is really like
While Muzak plays (think Kenny G covering John Mayer) and courteous expressions like “excuse me” and “thank you” are exchanged in hospital waiting rooms, behind the front desk, angry patients are firing curse words into the hallway like their mouths are assault rifles with an endless supply of ammunition. Nurses are being cussed out by patients who sound like characters in “Platoon.” And medical professionals are dropping f-bombs. All of …
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Why medical professionals have potty mouths
Today, I cleaned the laceration above your eye from where he punched you with a closed fist. As I was stitching up the gaping wound with two layers of sutures, I told you that the scar would fade into the line of your eyebrow. I helped you apply your foundation on your neck to cover the bruising from where he strangled you. I monitored you for any swelling of your …
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Tomorrow, we may fail you: Vignettes of pre-existing conditions
On my first trauma shift as a fourth-year medical student, a young, disheveled man with blood-soaked pants hobbled into the emergency department. Wincing in pain, he offered me a bizarre history of being shot in the leg by a nail gun that went off after he dropped it on some stairs while helping a friend move. He lifted his right pant leg and removed the bloody, tattered bandana wrapped around …
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Doctors aren’t cops: We need to change gunshot reporting
“Sorry, excuse me, can I get through please?” I wiggled my way to the head of the bed. Quickly, I set up the necessary intubation tools as the patient arrives shortly thereafter. A frenzy ensues, tubes flying over the patient, people talking over each other.
“Can you draw me up some RSI meds? Let’s get this guy intubated now. Sorry, but I need it quiet in here.” Tube placed, a wave …
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The dangers of being overly apologetic
