It was around 2 p.m. when a 380-pound woman came into the ED. She was in her late 30s. The physician went to see her and then ordered IV fluids, some basic blood tests, and a urine sample.
At a hospital, everyone’s job is made harder when a patient is obese. Getting the patient on the bed requires more personnel. Inserting an IV — an intravenous catheter to infuse fluids or …
Obese patients are among our most vulnerable
The boom in telemedicine is here, and understandably so. The “consumer” is in control now, and they sure don’t want to be “patient” anymore. When Americans want care, they want it cheap, and they want it now. Telemedicine has grown to accommodate 7 million annual patient encounters, up from 350,000 five years ago. What savvy health care administrator doesn’t see numbers like that and get dollar signs in …
Telemedicine encounters inherently sacrifice quality
In this podcast, I share insights from a doc who barely survived his suicide attempt plus simple ways to prevent the next suicide. Listen in. You may save a life.
Dear Pamela,
I’ve never been so happy to fail at something in my life. Four weeks ago today I died. Cardiopulmonary arrest in jail. Why was I in jail? My wife alerted …
Doctor revived after suicide tells all
Gather round kids! Let Grandpa Doctor Leap tell you a few things about the old days of doctoring in the emergency room:
Back in the good old days, medicine was what we liked to call “fun.” Not because it was fun to see people get sick or hurt or die, but because we were supposed to do our best and people didn’t wring their hands all the time about rules and …
Once upon a time, being a doctor was great. Not anymore.
The U.S. rings the bell on health care spending, and some point fingers at patients themselves.
But why do patients choose the paths they choose? Just about every shift, I and my coworkers shake our heads, and wonder what may be driving our patients’ decisions. Parents who haven’t yet tried a drop of acetaminophen bring kids in at 2 a.m. with fevers. Patients show up with nose bleeds that …
How much are patients to blame for ER overuse?
For those who are not avid followers of President Trump or his decisions, often his decisions have far-reaching consequences that affect lives and people. As a health care provider, I understand quick decision making, but also the importance of risk versus benefit and consequences of your decisions. I would like to tell you my story and how his actions have affected my life, the lives of my patients and their …
How the government hiring freeze dishonors veterans
It was 3 a.m. and 3 degrees outside, and I was about to discharge Mike from our emergency department for the third time in less than 24 hours.
“Doc, let me finish this episode,” he said, his eyes glued to the TV in the ER waiting room.
Mike was homeless, and this was our routine all winter last year, when it was too cold to sleep in shop doorways or the bridge under …
We must be committed to putting patients over politics
Brian is one of the coolest nurses I have ever met. Overall, he is a cool dude. Sporting a sleeve of tattoos, he has swag. We have been side-by-side in many traumas and sick medical arrests. He always remains calm, cool and collected as he navigates the resuscitation bay. So, when Brian ran into the pediatric ED looking a little flustered, I knew we were in for something.
“I just got …
Can doctors always stay “cool?”
Sometimes the minuscule moment is the most relevant; the least anticipated becomes the most profound. Endless searches for wisdom and insight fade with each passing day, only to be shadowed by an unintentional conversation or event. Wisdom is profound in the simple, while often hidden, complicated or forgotten in the complex or intentional. This ironic phenomenon is as old as time, obvious in God’s creations and man’s discoveries. I’ve reached …
What this physician learned from teaching his kids to ride bikes
“CODE BLUE, 7 SOUTH. CODE BLUE, 7 SOUTH.” I’m up and out of my call room bed before fully regaining consciousness from my light sleep. It’s 4 AM. I should feel ready: I’ve trained with simulations labs, mock codes, and test questions. I passed my CPR and ACLS courses. I’ve done chest compressions as an intern. But this is different. I’m the resident on call, and if I get there first, I’ll be running the …
A physician’s first code. See how it turned out.
The report from the field was not promising by any stretch: extensive trauma, and perhaps most importantly unknown “downtime” (referencing the period where the patient received no basic care like CPR). The patient remained pulseless en route; we were all aware of the markedly poor prognosis.
On arrival, the patient was swarmed by providers. Trauma surgeons at the foot of the bed cut down at the femoral artery to deploy a …
The ethics of procedures on the nearly dead
It’s almost 7 p.m., and I’m handed the chart of a man in his sixties. “Can you see this one first,” the nurse says, “he needs an ultrasound.” I skim the triage note, which is often like reading the blurb at the back of the DVD. If it says “pain all over for eight months,” it’s not likely to be a hot new rental.
Frank Martin (name changed) has been sent from a walk-in …
The curious case of a swollen scrotum
It’s the first day on my 4th-year elective in the emergency department. I had orientation in the morning and just my luck I am scheduled for a night shift. I had the good fortune of finding an emergency physician in New York who let me shadow him before my rotation, but the truth of the matter is, I had no idea that what I was getting myself into. I guess …
A bloody baptism into emergency medicine
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My wife who is eight months pregnant went to a routine prenatal appointment last week. She told the OB doctor that she was concerned she had pink eye. OB providers, along with pediatrics, family medicine, and internal medicine all constitute primary care providers (PCP) and pink eye is a common primary care condition.
Surprisingly, the OB physician referred her to the nearest acute care facility. Attributing this provider’s recommendation as rare …
My primary care doctor sent me to the emergency department
Seconds after I arrive at the ER on a Sunday afternoon, I’m called to see an elderly woman who can’t breathe. She’s ninety-four, and gurgling for air. On my way, I pass two middle-aged women. They are hovering outside a nearby room, trying to get my attention. One gestures like a traffic guard as she tries to wave me into the room. The other throws up her hands as I …
How in the heck would three nurses and I ever orchestrate ECMO in the middle of the night in my community ED? I pondered this over tuna tartare while listening to ivory tower docs discuss cutting-edge modalities like they were part of treatment algorithms everywhere. The conversation turned to REBOA, and I wondered how many academicians had ever manned a single-coverage ED.
Ivory tower medicine and my world, where there is …
Don’t engage in fishbowl emergency medicine
For soldiers, there are many fears. Will I do my job? Will I succeed in my mission? Will my colleagues in arms be harmed? Will I be injured? Will I die? For the American Muslim who volunteers to engage the enemies of the United States on foreign soil, there is a new worry. What will my home country do to my family while I am gone?
Recently, Dr. Ghazali A. Chaudry, …
A Muslim American physician goes to war
A friend of mine recently had a very sore throat. She knew how to manage her symptoms — lozenges, warm tea and the like. But she was worried she might have strep and would, therefore, need antibiotics. That should be a simple question to answer with a quick trip to the primary care clinic. Except that her primary care physician was booked, and if she wanted an unscheduled appointment with …
Going to a walk-in clinic? 6 essential things you must know before you visit
I remember that morning in January 2016 very well. I opened up my Twitter feed to find many people linking to an article that made me stop dead in my tracks. The New York Post was reporting that Dr. David Newman had been accused of sexually assaulting a patient in his emergency department. He was accused of giving the patient a dose of propofol and then sexually assaulting …
David Newman betrayed patients and emergency medicine
Recently, Dr. Michelle Herren, a professor of pediatric anesthesiology at the University of Colorado and Denver Health Hospital, resigned after posting racist comments on her Facebook page. In particular, she wrote that Michelle Obama speaks “ebonics” and stated that our first lady has a “monkey face.” Dr. Herren ended her post by affirming that she is not racist but was “just calling it like it is.” This post remained on …
Does racial bias compromise patient care?
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