No one ever wants to meet me. Well, at least inside of a hospital. If you are meeting me in a hospital, it is likely because you have been stabbed, shot, assaulted, or in a car accident. Although the only advice I have about avoiding the first three mechanisms of injury is to stay away from “two dudes” and not try to sell …
Driving advice from a trauma surgeon
Remember the Latin phrase “Primum non nocere”? It means “First, do no harm.” Most of us physicians committed to it when reciting the Hippocratic Oath, back when we were first embarking on our careers in medicine.
Sadly, today’s technology threatens this sacred physician-patient relationship. Electronic health records (EHRs), although much-needed, have created perverse, unintended consequences for the patient experience.
To be clear, EHRs are inherently good. They’re the backbone of better-coordinated care, …
The documentation solution your patients want you to adopt
When I was in residency, sexual assault exams were part of our training. We spent a lot of time learning how to ask the right questions, how to be gentle and empathetic, how to gather evidence appropriately and thoroughly.
While many hospitals now have SANE programs (Sexual Assault Nurse Examiner), I have never enjoyed the privilege of working with one of them. I have, for two decades, performed sexual assault exams on …
The relevance of drugs and alcohol in sexual assault
Walking around the ER in Tiny Community Hospital, I had a few realizations. In medicine, we hold onto some things very tightly. We love tradition; we love the known. We don’t always know why, but we choose “the devil we know,” almost every time, no matter how pointy his horns.
For instance: “No cell phones.” First of all, has anyone ever seen a cell phone interrupt anything we do? No? Neither have …
Stop clinging to tradition in medicine
I went into an all night pharmacy recently, after getting off of work at 10 p.m. I had to pick up a prescription for my endless, insomnia-inducing cough. Walking up to the counter, I was bathed in the smell of cigarette smoke, carried on the coats of patrons. Eight of us stood by the counter, outnumbering the staff by 100 percent. …
From a physician: God bless the night shift
We all went into medicine to save lives. Deep within even the most cynical of us, is still that pre-med hopeful that believes we can and should restart each non-beating heart, make the non-breathing breathe and fill with blood those who’ve bled, filling them back with life. We expect that a patient’s condition will improve while under our care, or at …
To the doctors who have lost patients. This is for you.
You live like this, sheltered, in a delicate world, and you believe you are living … And then some shock treatment takes place, a person, a book, a song and it awakens [you] and saves [you] from death.
– Anais Nin
On June 12, 2013, my driver and I were on our way to Sierpe, Costa Rica from Manuel Antonio when the road entered a palm tree plantation. About 50 meters in …
The spookiness about sudden death
This place sucks had become my mantra as I powered through every bloody, chaotic, understaffed shift.
Fresh out of residency, I had accepted a job in the ER of a community hospital which — though it had appeared calm, functional, and replete with helpful consultants during the 15-minute tour I took during my interview — had turned into exactly the opposite when I …
A doctor quits. Before doing the same, consider these 5 things.
Dear health IT staff,
I know that, on many levels, physicians must be the absolute banes of your existence. We are grumpy and resistant to change. And some of us are still confused by graphing calculators, much less complex modern computer systems. We call you because we forgot our passwords, then because we forgot the new passwords. We call because the system …
Dear health IT: Please understand our frustrations
Of the nearly 100 people I interviewed for my upcoming book, John Halmaka was one of the most fascinating. Halamka is CIO of Beth Israel Deaconess Medical Center and a national leader in health IT policy. He also runs a family farm, on which he raises ducks, alpacas and llamas. His penchant for black mock turtlenecks, along with his brilliance and quirkiness, raise inevitable comparisons to Steve Jobs. I interviewed him …
The marriage between technology and medicine: An interview with John Halamka
Influenza has arrived refusing to be ignored or be the ugly step-virus to Ebola any longer. This influenza season is officially an epidemic. The Washington Post’s Wonkblog reported earlier this month that December 2014 was “one of the worst flu months in years.” In fact, they found that it was “the worst December since the polling organization started tracking flu season in 2008.”
As of January 3rd, the CDC reported widespread …
The strain of the influenza epidemic on emergency departments
To critics who admonish emergency physicians like myself for our excessive use of CT scans, I’ll ask them to consider the leaf blower. I’m sipping my morning coffee on our front porch, a bright, idyllic autumn day in New England, the tranquility ripped apart by the landscapers across the street. For many jobs, a powerful leaf blower might prove superior to a rake or broom. But in my neighborhood known …
Are CT scans ordered too often? Well, consider the leaf blower.
“Blessed. I’m so blessed.”
She kept repeating this, from her seat on the examining table.
“I’m so blessed.” I unwrapped the bandage holding on the splint that had covered her arm for the three weeks since the bullet went in above her elbow and came out through her forearm, hitting no bone, touching no major artery.
“Blessed.”
Homeless. With diabetes that needed insulin, which needed a refrigerator, that she didn’t have.
Vulnerable. A few years earlier, …
Blessed to be alive after a gunshot wound
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The truth is, I know it’s easy to go to the Minute Clinic. I know the enticement of not needing an appointment, of being able to shop while you wait, of having the prescription ready to pick up by the end of your appointment. Who doesn’t like convenience and a friendly smile to add? Who doesn’t like the customer service offered …
Retail clinics sound good. But if you need follow-up care, good luck.
I truly love my job as an emergency physician.
I think it’s the best job there is in the house of medicine, melding the most ancient of medical traditions (abandoned by many modern practitioners) with the most cutting edge tools of medical technology. And really I never love it more so than at this time of year. I went into this field …
A holiday message from your emergency physician
One of the things that I love about my job as a hospitalist is the ease with which we can develop friendships with colleagues from other disciplines. Since I am an inpatient physician, it’s not surprising that some of my good friends are cardiologists, nurses, endocrinologists, physical therapists and, of course, other hospitalists. In fact, I met my neurosurgeon husband while co-managing his patients at the hospital. While thinking about …
Why can’t more hospitalists and emergency physicians be friends?
I was on call over a holiday weekend and Friday night at 10 o’clock I was paged by the emergency department about a nosebleed. A man in his 30s had a bloody nose Friday morning and over the course of the day had developed red spots all over his legs. The ED checked his blood and his platelet count was near zero.
Blood looks red because of the oxygen-carrying red blood cells, …
A hematologic emergency in the ER
A few years ago, the United States Navy launched a new recruiting and marketing campaign using the slogan: “America’s Navy: A global force for good.” The line was apparently a flop, and the Navy threw it overboard for “protecting America the world over,” but I liked it. I thought it captured a deep truth about the Navy, which is that it is undoubtedly a global force and that the force exists for …
Serving for the Navy: The global force for good
As part of the second-year clinical skills course, each member of my class is required to complete two 8-hour emergency department (ED) shifts. I had my first ED shift last week, and when I walked in, I introduced myself as a second-year medical student who needed to practice IV placements, EKGs, and any other procedures that happened to come my way. Three hours later, when I walked out of the …
From medical student to patient, in a matter of minutes
Despite the furious pace of the emergency department, he sat within his private bubble of calm on a hallway cot situated just outside the entrance of room 31. He sat upright, facing the opposite direction from which I approached, with the thinning brown hair of his broad occiput splayed across the upper edge of his pillow. From this approach, I paused for several seconds to appreciate this serene, surreal view …
An ER patient that stirs every emotion
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