These seem unrelated, but give me a chance. I was eating outside at a restaurant with my 5 month old, Max, and a car with a modified muffler hit the gas right in front of us. In Australia, you’d call the driver a “hoon.” The noise terrified my boy, and I felt something I’m not used to: protective rage. When Max stopped crying my mind went to struggling families, kids, …
Foreign policy through the lens of an emergency physician
It was 2 a.m. on a typically hectic Friday overnight shift in the emergency department.
A young woman, Kelly, checked into triage, accompanied by her older boyfriend Jim, who explained that Kelly had abdominal pain and some vaginal bleeding. Jim wanted her checked out and maybe some pain medicine to help her rest at home.
Kelly had no identification. She appeared younger than her stated age of 18. I also noticed track marks …
Doctors need to recognize the signs of human trafficking. Here’s how.
I was saddened to hear that one of my favorite libertarians, the wonderful journalist John Stossel, has taken ill. True to form, however, he’s taking it in stride (he nonchalantly quipped, “seems I have lung cancer”), and I want to take this opportunity to wish him very well indeed. I enjoy his reporting and writing, and have learned a great deal from Mr. Stossel over the years.
But that doesn’t mean he’s always …
What John Stossel gets right, and wrong, about health care
I remember seeing so many charts in my career on which the well-meaning emergency room physician wrote the following: “Follow up with your primary care doctor.” Or, if they didn’t have one, “Follow up in one week with a primary care doctor.” I laughed to myself. Usually, the people we say that to have either no insurance, inadequate insurance or inadequate motivation to even call the persons to whom we …
Let’s apply a little reality to the referrals from the ER
Monday morning. As I click through the usual beginning of the week barrage, I open an email from my ER chief. My heart drops into my stomach, where it begins to race. He’s forwarded a letter of concern from a specialist from a different hospital. It’s about a patient that I failed to help, and failed to diagnose, so she had to seek help elsewhere. As I read the details, I remember the case. I pick …
Respect your nurse. Your life may depend on it.
In 1991, I took a sub-internship in cardiology with a clinically-minded attending named Eddie Atwood. One day he stopped me in the hall: “You have a few minutes toward the end of the day?”
“Sure. What’d I do?” I just knew some sort of defining verdict headed toward my Dean’s letter, to be shown to all residencies and preserved in an archive of medical student iniquities, was surely coming.
“You students are …
How a patient gave this doctor his first coaching session
I settle into the bent-wicker chair on my lanai and try to relax. It’s a perfect island day, the temperature warm, the breeze cool, and I gaze out over the pool to the tops of the coastal mangroves. I’ve just come home from a shift at the local free clinic, and my mind is occupied by the work we did today. My fourth-year medical students encountered some difficult patients, and …
I thank my father for the gift of freeze-frame
I have a lot of ER stories that involve drug addiction and drug seeking behavior. I knew a patient who intentionally dislocated his shoulder three times in one day to receive pain medication. Another had a friend who stole an entire dirty needle box in order to rummage through it for injectable drugs.
I have been told by patients that pain pills were eaten by dogs, stolen by neighbors, lost in …
“You can’t create an addict in the ER.” Yes, you can.
It’s October, and it’s beautiful outside; warm, sunny with a lazy breeze. Colorful. Two hours into my ER shift, I meet Bridgette, a 77 year old who volunteers four days a week. She arrived by ambulance, but walks easily, and feels silly for being here.
She sits comfortably on the exam table and tells me her story: Two hours earlier, she was gardening at the seniors’ center when she had a sudden sharp pain in …
“How are you feeling?”
It’s a question we frequently ask patients — on rounds, in the clinic, post-operatively — and with all good intentions and gentility. But, do we ever stop to think: What is really the point of this question? What information are we trying to glean? I think for most of us, we’re asking the question with a cognitive bias towards the physical. How are they “physically” feeling: better, …
Ask patients how they feel, along with how they are feeling
He had loved her with all his being for more than six decades. In the last two years of their 61-year marriage, he had watched helplessly as dementia wrapped its noose around her, slowly tightening its grip on her mind and pulling her away from him.
When I met him, I knew the injury was irrecoverable. Her brain was consumed by hemorrhage that had filled the space (cerebral atrophy) left behind by progressive dementia …
A death that feels good to a surgeon’s soul
There you are in your father’s arms. He is practically running to keep up with the triage nurse. The nurse is walking quickly toward the room that we leave open for true emergencies and the sickest patients. Your father’s eyes are full of fear, and the nurse’s tone is worrisome.
I look down at you all snuggled up to your father’s chest. You are beautiful. So small and bright-eyed. You don’t …
Medicine is the most emotional profession. This story proves it.
I took a fantastic emergency medicine (EM) job when I finished residency. There was no question in my mind that it was the best job within a hundred mile radius, maybe more. When I first started, my expectations were met. My group held a contract to staff a busy but well-staffed suburban emergency department, and had held that contract for almost 20 years when I signed. The hospital was independent, …
How to destroy a great ER: A step by step guide
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Like many boys born in the 60s, my heroes were often frontiersmen. I grew up watching the Daniel Boone television series, with Fess Parker. (I can hear the theme song in my head as I type.) I watched the Disney production of Davy Crockett, and had a comic book of the same. I never missed a chance to watch John Wayne die on the walls of the Alamo (also as Davy …
The joy of practicing medicine in the frontier
I adored the physical exam in medical school. We were taught the exam by sections, and I devoured one after another. No matter how much I had learned about physiology, it was during our physical exam sessions that I finally started to feel like I was learning how to be a doctor. We were getting the tools we needed to really take care of patients. We would have the means …
Treat the physical exam with the respect it deserves
5 a.m. on a Friday morning, during a lull in my overnight shift, I got a text from my friend Julie (name changed).
“Steve had a massive heart attack.”
Me back: “OMG, what happened.”
Julie: “Not sure, he called my mom, he thought he was going to die. Now they are doing a CT scan.”
And so it went on. As I waded through the information, Julie thought she understood I realized that she …
Why I cherish my role as a medical translator
Currently, in American health care, experts are wringing their hands in confusion. I mean, people have insurance, right? And yet, health care is still expensive and dang it, people just keep going to the ER. Visits are climbing everywhere, and I can speak from personal experience when I say that we’re tasked with more and more complex and multi-varied duties in the emergency departments of the 21st century.
I’m not a …
The “go to the ER” mentality of American medicine
As emergency physicians, we write prescriptions for patients that we discharge home for all manner of presenting complaints. I used to believe that the overwhelming majority of these prescriptions would be filled by the patient after discharge.
It turns out I was wrong.
Research estimates that patients discharged from emergency departments (EDs) fail to pick up their high urgency prescriptions, like antibiotics, nearly 35 percent of the time.
This is problematic because failure …
Why don’t patients pick up their prescriptions?
This week, the community of women physicians was rocked by the death of one in our midst, an anesthesiologist, intensivist, medical school faculty member, and mother, in an apparent domestic violence homicide. Dr. Casey Drawert (yes, we will say her name) was a highly accomplished physician married to a “prominent businessman” adding to the media-stickiness of the story. Her success clashes with our deeply entrenched biases about the demographics of domestic violence victims.
Yet …
A female physician is murdered. A call to action to end intimate partner abuse.
We walk down the halls, time and time again, each encounter a new discovery, mystery, or typical presentation. As ED providers, we see new faces, entwined with “frequent flyers” that have become in a weird way part of the family. Our job is often loosely entangled with our identity and existence. It becomes hard to have dinner conversations without discussing therapies, changes in health care, Obamacare, or “unusual cases.” We …
I’m an emergency doctor and I’ve become human
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