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.

I may be the only advocate for my dying patient

Monica Williams-Murphy, MD

Physician

November 29, 2015

Medical school and medical training attempt to teach subjective humans how to think and practice medicine objectively. This may be one of the unique fallacies of modern medicine, but that’s a subject for a different blog.

Nevertheless, even in the highly emotional field of emergency medicine I’m usually pretty chill. That is, until someone’s dying, and then all of my equanimity can go flying out the window, for better or worse.

Such …

What I want to be when I grow up

Anjoli Anand, MD

Physician

November 28, 2015

June, 2003, and I am 18 years old, just a few days from graduating from high school. In his home in Bridgehampton, Kurt Vonnegut is sitting at his kitchen table railing against the injustices of the American health care system. When he finishes, he takes my hand and says, “Don’t worry, you’re going to make a fine doctor.”

November, 2015, and my feet are blocks of cement as I slowly make …

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What I want to be when I grow up

A medical student learns from the power of the bystander effect

Misha Armstrong

Medical Education

November 27, 2015

I have the privilege of being a first-year medical student. Awkwardly learning how to perform the physical exam, repeating the same questions to collect an HPI from standardized patients, unsure of how all of my mediocre skills will translate to the precision of the physicians I attempt to emulate. I have settled into the pace of lectures, and the rush of experiencing the human body has left me as I …

Our health care system makes physicians hypocrites by enabling addiction

Amy Faith Ho, MD

Physician

November 25, 2015

I do a strange thing as a physician almost daily. I go to alcoholics and have them promise me they’ll go home and continue drinking. Then I release them back into the wild to do just that.

I’m an emergency physician at an urban hospital, and I see alcoholics every single shift, brought in by the ambulance “found down” — that is, found passed out in public places or belligerent on …

What physicians call burnout, others call PTSD

Edwin Leap, MD

Physician

November 23, 2015

“Gunshot wound to chest, pulseless, 20 minute ETA.”

When that’s the EMS report, it gets your attention. Despite the wonderful theatrics of modern medical shows, and the best efforts of real-world, sweat-drenched paramedics, those of us who have done this long enough can translate that report. For the layperson it means: “Dead.”

I saw that last week. And the week before I saw another tragic, unexpected death in a man not much …

This is critical advice for doctors today: “You’ve gotta like your patients”

Thomas Paine, MD

Physician

November 19, 2015

Although I didn’t think much of the statement when I first heard it from my residency director, now, nearly twelve years later, I realize its value. I learned so much during those three years. I learned to prepare for success prior to every procedure I started to avoid clumsily searching for needed equipment mid-procedure. I learned what an eternity of time I gained during an intubation if I could be …

Emergency departments of the rich and famous

Edwin Leap, MD

Physician

November 13, 2015

The following excerpts will give you an idea of what life can be like while practicing emergency medicine in very beautiful, very coveted areas of the United States. I will not name towns or hospitals, as the situations are highly reproducible from place to place and season to season. We’ll just call it St. Resort hospital. If you doubt me, call up your friends who work in such locales, with …

You have no idea what it’s like working in the ER as a pregnant physician

Archana Reddy Shrestha, MD

Physician

November 9, 2015

When I was pregnant with my first child, I worked full time as a physician in the emergency department. I worked mostly 9-hour shifts, but some 12-hour shifts as well. Days, evenings, nights, holidays and weekends were divided up amongst the entire group of physicians. I worked my share of those shifts as well.

I have worked in the ER while pregnant twice now, and while I am proud to be …

It’s dangerous. It can kill. But physicians don’t want to talk about it.

Tehreem Rehman

Conditions and Diseases

November 8, 2015

“You need to come to the ED ASAP.”

A new patient was admitted at 2 a.m. and requested for a crisis counselor. Unlike with cases of sexual assault, survivors of domestic violence had to specifically request for the presence of an advocate when I was volunteering in NYC back in 2009. This woman, I’ll call her Sadie, had already taken the first courageous step to seek help.

I briskly walked past …

An emergency physician goes to the ER, and is shocked at the care she receives

Karen Shackelford, MD

Physician

November 2, 2015

I have lately been discussing the state of health care with a lot of doctors. I’m a doctor, and I’m also a consumer of health care services.

Imagine my surprise when I visited a local ER on a three day weekend, hoping to get some advice from someone who might be able to use the panoply of diagnostic tools available in the ED to help me mitigate the pain of a …

The discovery period regarding the existence of life

Kevin Haselhorst, MD

Physician

October 29, 2015

What do I need to know as I age? While scientists ponder the questions of water existing on Mars and if it can essentially sustain life, my duty it to assess if there is life left in Oliver — a nursing home patient transferred to the ER. Oliver was not oxygenating well but appeared to be resting comfortably. Reportedly, Oliver had fallen that day and EMS discovered a sizeable bruise …

We need to provide health insurance for undocumented people. Here’s why.

Abraar Karan, MD

Health Policy

October 22, 2015

The cost of medical service provision in the United States is one of the most palpable strains on the health care system, but we must not forget that cost is the sibling of quality and access — without considering the three as such, we will undoubtedly fail to navigate our country’s health care quandary. Low-quality care inevitably results in the need for more care in the form of readmissions, while …

Standing before them, I realize I made a terrible mistake

Philip Green, MD

Physician

October 21, 2015

An excerpt from Trauma Room Two.

Sometimes when I am bored, when it is all sore throats and dental pains, when I feel more like I am a social worker and a hand-holder than an emergency medicine physician, I play a game.

I do not look at the chart before …

What did a surgeon think of the television show, Code Black?

Skeptical Scalpel, MD

Physician

October 19, 2015

A new television series called Code Black debuted on CBS. The show’s name supposedly means the emergency department has too many patients and not enough staff. In my over 40 years in medicine, I’ve seen many busy, understaffed EDs but never heard anyone call it a Code Black.

There is the usual array of standard medical characters — the inexperienced new residents on their first day at work, the savvy nurses, …

Lab coats and scrubs don’t make the physician

Edwin Leap, MD

Physician

October 16, 2015

I was working at a small hospital when I heard the nurses talking about a new rule. The rule was that the only people who could wear lab coats would be physicians and administrators. It made me laugh a little. I’ve hated lab coats since medical school.

I currently sport what a family medicine resident told me was the ER mullet: khakis and polo shirt. (Who knew?) I find it much …

The day I went to work and met a real vampire

Archana Reddy Shrestha, MD

Conditions and Diseases

October 15, 2015

It all started out seeming like a pretty routine visit. My patient was in her early 30s and had come into the emergency department for weakness and was in no distress.

As I was talking with her about her symptoms she would flash the occasional smile. It was then I noticed that she had fangs. Not the kind that some people naturally have from misaligned teeth, but she had really long, …

An emergency in public: When should doctors help?

Chiduzie Madubata, MD

Physician

October 12, 2015

Recently, Pope Francis visited Philadelphia to finish out his five-day visit to the United States. Prior to his visit, many hospitals in the city were preparing for possible emergencies involving visitors from many countries around the globe, particularly elderly visitors. On-call teams were present in these hospitals, and contingency plans were in place in case people needed to be transported emergently to different hospitals despite the high level of security …

How pediatric critical care and a physician anesthesiologist saved a teen’s life

Linda Hertzberg, MD

Physician

October 11, 2015

It’s amazing when events that seem to be “miracles” happen, and even more magical to be a part of them, however peripherally.

My husband, David Merzel, MD, a physician anesthesiologist and pediatric intensive care specialist, and his patient, 17-year-old Chiann Wheeler, share the remarkable story of Chiann’s brush with death from sepsis, and how David’s quick diagnosis saved her life.

The story began one morning when then 15-year-old Chiann felt so sick …

Should there be limits to patient-centeredness?

Richard Young, MD

Physician

October 4, 2015

A colleague recently told me of a patient encounter he had in an emergency room. When he picked up the chart, it described the patient as a 62-year-old woman complaining of epistaxis, or a nosebleed.

He walked into the room and saw a perfectly well appearing 62-year-old woman. There was no blood on her clothes and none on her face. Her nose was not bleeding. When he asked her what could he do for her, she said …

Doctors, parents, and spouses all rolled up into one person

Wendi Kitsteiner

Physician

September 30, 2015

As my husband’s pick-up truck rolls up the driveway, a long ER shift behind him, my four kids come running from wherever they are currently playing on our farm. My seven-year-old son was reading in a rocker on the front porch. His six-year-old brother was watching the new baby chicks scramble around our brooder. My four-year-old daughter was helping feed our ducks. And my two year old was getting into …

Emergency Medicine

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