Emergency Medicine

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.

Speech recognition errors in the ER. It’s a problem.

Skeptical Scalpel, MD

Health Technology

October 17, 2016

Speech recognition errors occurred in 71 percent of emergency department notes, and 21.1 percent of notes with errors were judged as critical with potential implications for patient care says a recent study in the International Journal of Medical Informatics.

Investigators looked at a random sample of 100 dictated notes and found 128 errors or 1.3 errors per note.

More than half of the errors were ascribed to speaker mispronunciation. Although …

Female physicians told to get out of the way during emergencies as patients nearly die

Pamela Wible, MD

Physician

October 14, 2016

It’s true. Man nearly dies on plane because crew didn’t believe black woman was doctor. The medical fiasco on Delta Airlines has now gone viral after a Facebook post by Tamika Cross, MD, the physician who was turned away as a fellow passenger was unresponsive. Tamika joins a long list of female physicians who have experienced the same discrimination.

Meet a few of these doctors below.

A physician experiences a medical error. Here’s her story.

Maja Castillo, MD

Physician

October 4, 2016

As a physician, I knew exactly what was happening when I walked into the emergency room. My eyes were nearly swollen shut. My throat was closing. I was in the midst of a severe allergic reaction known as anaphylaxis. I urgently needed epinephrine, a potent medicine that could halt my life-threatening symptoms. When I told the nurse what was happening, she rushed me to the trauma room where doctors and nurses encircled …

The serenity of an emergency physician’s commute to work

Edwin Leap, MD

Physician

October 4, 2016

These days, I work most of my shifts about 45 minutes from my “house on the hill.” At one of those jobs, the day shift starts at 6:30 a.m. Which means I’m rising from my bed at 4:30 a.m. in order to get on the road in time. I’ve started waking up at four, spontaneously, as if it were the most natural thing in the world.

I lay out my clothes …

When EMTALA forms meet EMRs, chaos can ensue

Edwin Leap, MD

Physician

September 28, 2016

Ah, EMTALA! The revered Emergency Medical Treatment and Active Labor Act! It’s one of those things which is like a nursery rhyme to emergency medicine folks like me. We’ve heard about it from the infancy of our training. “And then the bad doctor sent the poor lady to another hospital because she couldn’t pay! And the King came and crucified him for doing it!” The end.

EMTALA, for the uninitiated, is …

How to create a modern superhero

Alberto Hazan, MD

Physician

September 23, 2016

You start out by working in a busy emergency department.

You see patients with all sorts of complaints: abdominal pain, headaches, and chest pain. Vomiting, diarrhea, and dysuria. Ankle sprains, bug bites, and allergic reactions.

Domestic violence, rape, and child abuse.

You don’t ever let the stress of the job take away your humanity. You treat your patients with empathy and respect. You listen to their stories, treat their symptoms, contact the police, …

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How to create a modern superhero

You can’t prepare for a rotation in the pediatric ER

Austin Beck

Medical Education

September 12, 2016

Walking into Riley Pediatrics Hospital in Indianapolis, Indiana, and having just completed two prior rotations in emergency medicine at two different level 1 trauma centers, I thought I would be able to easily fit in with pediatric population here. I thought I would be able to slide fluidly from patient to patient, oral reports to consults, while staying connected with the rest of the team. I thought I would be …

6 steps to overcoming physician burnout

Anonymous

Physician

September 9, 2016

Exercise. Growing up I competed in multiple sports. The physical enhancement of the human body through movement sparked my interest in human physiology and kinesiology. Consequently, my interest in physiology ultimately led me to medical school. It only felt natural, when medicine became what felt like the bane of my existence, that I’d revert back to this pursuit’s humble beginning. Given the fact that time was a scarce resource during internship, …

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6 steps to overcoming physician burnout

Is burnout inevitable during medical training?

Anonymous

Medical Education

September 5, 2016

Medical training in the United States is a long and tedious process. It begins in college, when one must complete the mandatory prerequisite curriculum and take a medical entrance exam; your score on which is directly compared to other applicants, immediately labeling you as a competitive candidate or not. The process of applying requires the completion of multiple comprehensive applications, the compilation of countless hours of research, clinical experience, letters …

Why are ERs so busy? It’s really no surprise.

Manuel Momjian, MD

Health Policy

August 29, 2016

If the emergency room is the most expensive place to receive health care, then why are more patients visiting the ER than ever before? There are no local doctors’ offices that can charge $1,000 to put a Band-Aid on your finger or $8,000 to tell you that your abdominal pain is due to drinking too much coffee. But, I don’t think you would mind paying this premium if you were having …

Laughter? That’s the sound of resiliency you hear.

Cindy Winebrenner, MD

Physician

August 21, 2016

Sometimes, the loudest sounds I hear in the emergency department are laughter. It may seem irresponsible. It may seem discordant. It may seem callous. To me, it is the sound of survival. It is the sound of resiliency. It is the sound of making it through the day.

My father was at work when he suddenly became cold, clammy, and collapsed to the ground unresponsive. His staff did the right thing …

Emergency physicians: You are not alone

Edwin Leap, MD

Physician

August 15, 2016

Dear emergency medicine physicians: You aren’t alone. This is very important for you to realize. I mean, I know you aren’t ‘alone.’ You have spouses and children, parents, siblings, neighbors, dogs and cats. That’s all good. You need them. Also, every shift is chock-full of people and their maladies, which you heroically manage day in, day out. Patients are everywhere. Some are sick, and some are injured, and many are …

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Emergency physicians: You are not alone

A physician mother as the breadwinner. Here’s how she did it.

Marianne Haughey, MD

Physician

August 10, 2016

I was afraid. Really, I was more anxious. This wasn’t any of the typical new mother fears I had been warned about. If fact, I didn’t even see this one coming. I knew that it would be tough going back to work 3 months after my first daughter was born. I knew I would miss her terribly. I knew I had to figure out a pumping schedule with my colleagues …

Multiple choice questions are a terrible way to test doctors

Jeremy Gabrysch, MD

Physician

August 9, 2016

Most people are surprised to hear that the way doctors are recertified every ten years is through a multiple choice test. “Really?” they’ll say. “You take a multiple choice test? As a doctor?”

Unfortunately, after all these years that’s the most efficient way we can think of to evaluate professionals. But the method is so flawed. And your ability to answer questions on the multiple choice test isn’t necessarily linked with …

Access to guns is easy. Access to trauma care is becoming more difficult.

Eric Beam, MD

Physician

August 4, 2016

Now that the dust has settled in the wake of America’s most recent mass shooting, the odds seem high that history will repeat itself, and our legislature will again fail to enact any meaningful reform.

Like it or not, we as a country, through our elected representatives, have decided that we value unfettered access to deadly weapons over an individual’s right to feel safe in public spaces. Why …

A guide to surviving chronic disease

Alberto Hazan, MD and Jordana Haber, MD

Conditions and Diseases

August 3, 2016

For many people with chronic disease, the toughest thing is convincing themselves they’re not crazy. This is especially true for those with an illness with no clear etiology.

For millions of people around the world suffering from multiple sclerosis, lupus, fibromyalgia, chronic abdominal pain, ALS, rheumatoid arthritis, certain types of cancer, chronic fatigue syndrome, and hundreds of other illnesses, just making it through the day is overwhelming. Not only do many of …

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A guide to surviving chronic disease

A medical student’s first trauma

Shama Patel, MD

Medical Education

August 1, 2016

“Code fifty-two, emergency room. Code fifty-two, emergency room,” blared over the loud speaker in the hospital. Simultaneously a chorus of beepers went off, like crickets on a sticky summer day.

I glanced down at my pager that echoed the same message “CODE 52, EMERGENCY ROOM.” The same message flashed across the screen three more times as I ran quickly down the main hallway. Code 52 meant trauma. I was about to …

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A medical student’s first trauma

The ER physician approach to the crying baby

Alberto Hazan, MD and Jordana Haber, MD

Conditions and Diseases

July 30, 2016

When our daughter Florence was born, we were shocked that a tiny, seven-pound beauty could turn our household (and our entire lives) upside down. Why was it so difficult to deal with one human being, when we often took care of a department full of ill patients? How could someone so cute induce a state of perpetual anxiety, forcing us to question every single action we took?

It was disconcerting to …

Residency doesn’t prepare you for these 7 important topics

Robert Frantz, MD

Physician

July 26, 2016

There’s no doubt physicians entering practice today leave their residency programs with a tremendous amount of medical education and training; what seems like a lifetime’s worth of knowledge crammed into just a few, intense years of instruction.

Unfortunately, all the time residents spend on rotations, lecture, journal club, and myriad other obligations leaves little opportunity for getting oriented to the more mundane, yet absolutely critical components of practice. As a result, …

How maternity leave cost this physician

Alicia Welder, MD

Physician

July 22, 2016

When I had my first baby, I was a busy resident trying to complete my residency on time. I didn’t want to extend my residency even if it meant sacrificing time with my newborn. In order to get my 8-week leave, I banked days whenever I could. There was one period I worked 45 days straight (well, not straight, I did get the mandatory 24 hours off between once a week) so …

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How maternity leave cost this physician