Emergency medicine

2,327 articles · Since 2004

Articles, page 49

A patient who was more than just the town drunk

December 11, 2015Dec 11, 2015

Valley Medical Center was an iconic hospital and a great place to learn the craft of emergency medicine. It was an old TB hospital that eventually became Fresno’s county hospital. Sitting at the corner of Cedar and Kings Canyon avenues VMC was nothing to look at. However, the combination of rampant poverty, violent gangs, and severe shortages of both doctors and nurses, made it an ideal place to do residency.

In …

Health policy

Fair payment and balance billing in the ER: What’s the solution?

Martin Ogle, MD

December 9, 2015Dec 9, 20157

As health care reform drives more insured patients into the system, access to care is more critical than ever. And in protecting patient access to care, fair payment is one of the most pressing issues facing emergency physicians today. Emergency…

Emergency medicine providers are in a unique position when it comes to providing patient care. Unlike physicians in private practice who can screen patients to make sure they’ll be paid for care, …

Physician voices

Survival of the fittest in the ER

Nadine Himelfarb, MD

December 7, 2015Dec 7, 2015

An observation that I and many of my emergency medicine colleagues have made about vacations: We need them. We need them for wellness, to recharge, to recover. Great saves, terrible tragedies, we witness it all and it can wear on you. Unfortunately, when vacation plans are made, it is not uncommon to find oneself working even more shifts before the break to offset our absence on the schedule, making the …

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Survival of the fittest in the ER

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Medical education

A medical student resents having to make smart choices. Here’s why.

Anonymous

December 3, 2015Dec 3, 201538

The human experience is an exercise in connection. Nothing is seen, heard, or felt in isolation. This is what can make womanhood in a large urban city so challenging. A catcall is not a single comment, heard on a single morning about the tightness of your jeans or the way your hair falls; but instead carries with it every unsolicited thing you’ve ever heard about your body, a shadow of …

Physician voices

I may be the only advocate for my dying patient

Monica Williams-Murphy, MD

November 29, 2015Nov 29, 20155

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…

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 …

Physician voices

What I want to be when I grow up

Anjoli Anand, MD

November 28, 2015Nov 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

Medical education

A medical student learns from the power of the bystander effect

Misha Armstrong

November 27, 2015Nov 27, 20155

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 …

Physician voices

Our health care system makes physicians hypocrites by enabling addiction

Amy Faith Ho, MD

November 25, 2015Nov 25, 20156

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…

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 …

Physician voices

What physicians call burnout, others call PTSD

Edwin Leap, MD

November 23, 2015Nov 23, 20152

"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…

“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 …

Physician voices

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

Thomas Paine, MD

November 19, 2015Nov 19, 20152

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 …

Physician voices

Emergency departments of the rich and famous

Edwin Leap, MD

November 13, 2015Nov 13, 20152

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 …

Physician voices

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

Archana Reddy Shrestha, MD

November 9, 2015Nov 9, 20153

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…

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

Conditions and diseases

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

Tehreem Rehman

November 8, 2015Nov 8, 201512

"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…

“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 …

Physician voices

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

Karen Shackelford, MD

November 2, 2015Nov 2, 201527

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…

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 …

Physician voices

The discovery period regarding the existence of life

Kevin Haselhorst, MD

October 29, 2015Oct 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…

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 …

Health policy

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

Abraar Karan, MD

October 22, 2015Oct 22, 201534

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 …

Physician voices

Standing before them, I realize I made a terrible mistake

Philip Green, MD

October 21, 2015Oct 21, 20152

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…

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 I go into a room. I walk in cold. I enter with no idea who is going to …

Physician voices

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

Skeptical Scalpel, MD

October 19, 2015Oct 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…

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

Physician voices

Lab coats and scrubs don’t make the physician

Edwin Leap, MD

October 16, 2015Oct 16, 20152

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

Conditions and diseases

The day I went to work and met a real vampire

Archana Reddy Shrestha, MD

October 15, 2015Oct 15, 20152

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…

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, …

Emergency medicine

Articles, page 49

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