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.

The myth of when HIPAA gets waived

Skeptical Scalpel, MD

Physician

July 12, 2016

On the morning of the tragic mass shooting in Orlando, a tweet by CNN stated, “The White House waived HIPAA regulations so that hospitals could talk with family members of shooting victims, says Orlando Mayor Buddy Dyer.”

Many, including me, retweeted this thinking that it was probably unprecedented.

Later that day, several Twitter followers informed me that HIPAA had been waived during Hurricane Katrina. Despite rumors to the contrary about 9/11, Katrina …

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The myth of when HIPAA gets waived

You’ll be surprised at how ERs are meeting their metrics

Aida Cerundolo, MD

Physician

July 11, 2016

During a busy ED shift, my computer signaled the complaint and location of my next patient: a woman in bed 10 flagged with “GI bleed.” I almost bolted to bed 10 to ensure this patient was stable, but then noticed orders pending, so my urgency eased.

“I see you already saw the patient in 10,” I began, addressing the triage physician.

“Yeah, she’s all set,” he replied, without turning from his computer. …

A case of abdominal pain in the ER. And a surprising cause.

Raj Waghmare, MD

Conditions and Diseases

July 6, 2016

(Triage note: 45-year-old male, vomiting for two days. Abdominal pain.)

Dr. Stephen Cluff is like Yoda. Judging by body hair, he’s more like Chewbacca. But he’s short, wise, and with his white hair and arthritic limp, he may as well have green skin, poor sentence structure, and a Muppet’s voice. If I’m stumped on a case, I’ll ask him. If I’m pissed off about department politics, I’ll call him for advice. If I want …

Patients are blindfolded to charges and cost

Aida Cerundolo, MD

Physician

July 5, 2016

As she adjusts her sunglasses, Mary squints to protect her sensitive eyes from the sun. Four years ago when lymphoma threatened her life, doctors gave her a 5 percent chance of survival.

“I really should be dead right now,” she states casually. A bone marrow transplant gave this patient a new lease on life, allowing for the treasured opportunity to mother her 8-year-old son. The transplant has been successful, but her …

Patient satisfaction must start with nursing satisfaction

Alberto Hazan, MD

Physician

June 28, 2016

Ever since the U.S. government decided to link Medicare reimbursement dollars to patient satisfaction scores, hospital administrators have been obsessed with improving the quality of care for patients visiting their emergency departments. While the motivation may be partly financial, the goal of improving the patient experience during emergency department and hospital visits is an admirable one.

Unfortunately, many of the tactics used by administrators have done little to achieve that goal. …

Physicians have a duty to respond to emergencies if they can

Niran S. Al-Agba, MD

Physician

June 27, 2016

“Someone else will lend a helping hand,” a physician told me once, when asked to help with an emergency in public. As a PALS instructor for more than a decade, I have always responded when possible. In the last decade, there have been three in-flight emergencies, two elderly individuals who passed out in church, and a host of other less serious maladies. A week ago, I discovered the best reason I …

The superhuman efforts of the trauma surgeons at Orlando Health

Jamie Coleman, MD

Physician

June 22, 2016

A 6-year-old boy with abnormal pupils and gasping for breath. A 26-year-old pregnant woman with a gunshot wound to her abdomen. A 54-year-old male with blood pouring from a wound in his thigh.

Now add 43 more patients.

Imagine you are the paramedic at this scene. Who do you take to the hospital first? Who do you have to choose to walk past and leave at the scene while you take your patient to …

We need to stop sugarcoating our cancer prognoses

James Wu, MD

Physician

June 21, 2016

Mrs. Liu, who was only 58 years old, had metastatic ovarian cancer. Despite radical surgery and chemotherapy, her disease persisted. Worse yet, her PET scan from a few months ago revealed that she had carcinomatosis — numerous deposits of cancer showered throughout her abdomen. This particular night, she starting having more nausea and couldn’t eat or drink anything without vomiting. So, she came to the ED. I was called into …

ER misuse in our instant gratification society

Kenneth Szwak, PA-C

Physician

June 20, 2016

Those of us who work in emergency medicine have all had these patients. They present with a complaint that started two years ago and for whatever reason now deem it an issue that needs immediate attention in the ER. I had a patient like this recently who not only had the issue for two years, but also had a primary care provider. Not only did the patient have a PCP, …

When doctors and patients secretly record each other

Skeptical Scalpel, MD

Physician

June 20, 2016

A JAMA Viewpoint suggests that doctors should be aware that patients may be surreptitiously recording their conversations. The author, a neurosurgeon, takes a very benign view of this issue and recommends that if a doctor suspects that patient is recording a conversation, “the physician can express assent, note constructive uses of such recordings, and educate the patient about the privacy rights of other patients so as to avoid any …

We stand at the brink. Together on the dance floor. We are Pulse.

James C. Salwitz, MD

Physician

June 14, 2016

Recently, a patient of mine died of cancer, whom I loved very much. She had a special way of enjoying life; a half, wise smile that after our many years together did not take me too seriously and reflected her deep inner strength. She taught me about joy; I will miss her always. Her husband, understanding my loss, said that it was alright, that I had done my best, that he …

Paramedics saved this woman’s life. They are the true heroes.

Raj Waghmare, MD

Physician

June 13, 2016

I’m pulling on my last elbow’s displaced wrist when a nurse pops in, and tells us a critical patient is two minutes away.

“Mind staying?” my colleague asks.

“Sure.”

Paramedics are hunched over the patient as she is wheeled quickly into the resuscitation bay. At the top of the bed, a mask is secured over her mouth and oxygen is pumped with loosely gloved hands. It isn’t helping — her skin is grey — like …

Sooner or later, you will need the ER. Will it be there?

Myles Riner, MD

Health Policy

June 8, 2016

Sooner or later, you will need the ER. I don’t care how healthy you are, how much you hate going to the hospital for care, how much you distrust doctors or modern medicine, how rich you are, or how deep in the woods you live, the odds are almost 100 percent that in your lifetime you will end up in the ER.

You may get lucky, and find yourself …

Are you the physician who yells?

Edwin Leap, MD

Physician

June 7, 2016

I’ve never been the doctor who yells. However, if you work in medicine, you’ve met him or her. I’ll call this physician “Dr. Barkus Yellby.” Dr. Yellby is angry. A lot. In the old days (and not so old days), he threw instruments in the OR when they weren’t what he wanted. Or if the charts and labs weren’t ready for rounds, he slammed things on the desk and berated …

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Are you the physician who yells?

Freestanding emergency departments: The model we need to study

Joshua Elder, MD, MPH

Health Policy

June 6, 2016

I recently took care of a woman in her 50s that came to our emergency department (ED) complaining of chest pain. The pain had started shortly before arriving in the ED but within minutes, we performed a battery of tests, treated her pain, and gave her an aspirin. Still concerned about heart disease being the cause of her pain, I observed her overnight in our EDs observation unit and completed …

Compassionate care is at it’s best when selflessly focused on helping others

Jeffrey McWilliams, MD

Physician

June 4, 2016

I’ve noticed, as I get older life seems to travel full circle no matter your path or destination. I find myself trying to teach my son Grant things that my father attempted to teach me not so long ago.

“Don’t do that, you’ll fall and hurt yourself, or try it this way, and the process will be much easier.”

There is that brief moment of acknowledgment often followed by scraped knees or …

With doctors losing respect, perhaps it’s time to expose medicine’s dark side

Ahmad Yousaf, MD

Physician

May 22, 2016

The following is paraphrased documentation, authored by a physician I know, regarding an intoxicated patient in the ER:

1 a.m.: Patient is telling nurse, “Before I leave, I need everyone’s name for my lawsuit. Tell the phlebotomist that if he’s good, he’ll get a cut.”

1:40 a.m.: Patient is making inappropriate sexual comments and is verbally aggressive with medical staff. He is advised to stay in bed.

2:02 a.m.: Patient (who had been sleeping comfortably) wakes up and …

Is it possible to be a Christian and practice emergency medicine?

Edwin Leap, MD

Physician

May 20, 2016

Many young physicians in training have asked me, quietly or by e-mail, “Is it possible to be a Christian and practice emergency medicine?” I think that they ask a good question, and likely for good reasons.

In their rotations, they have witnessed, first hand, life in the ER. They are uncertain, perhaps, because they see the frustration that boils over in the words and actions of otherwise compassionate and caring doctors …

I’d hate to be his patient

Daniel L. Meltzer, MD, MPH

Physician

May 17, 2016

I don’t know about you, but I’m up to my eyeballs in patient experience focus, metrics, and nomenclature. Of course, we all get it and are committed to taking great care of our patients, but, with all due respect, what about us? The caregivers, the clinicians, the physicians. Does anyone care about our experience?

I do. In fact, it’s pretty much what I spend most of my waking hours thinking about. …

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I’d hate to be his patient

A patient encounter that almost pushes this doctor over the edge

Raj Waghmare, MD

Physician

May 16, 2016

It’s the beginning of October, it’s Sunday, and it’s been an uneventful shift thus far. However, in exactly seventy minutes, a patient that I’ve just seen — one that I think has nothing more than an upset stomach — will collapse and begin a fight for her life.

I’m at the nursing station scribbling on a chart when a lanky man leans over me, a toddler in his arms. He’s looking at the …