Every ER has its call roster, that sacred list of oracles, laying out who we can call when our patients need some service that we cannot provide. If I need a cardiologist, or a neurosurgeon or even a dermatologist for some acute emergency condition, all I need to do is ring up the operator and tell them, “This is the ER …
Don’t pay specialists for being on call. Here’s why.
I appreciate the need for physicians and others to sleep. I’ve spent a great deal of my career awake in the wee hours. In some very real ways, emergency medicine as a specialty exists as a shield between patients and their sleeping (or otherwise engaged) physicians. But I fear we’re all wearing a little thin. Because the emergency room has become …
The American hospital as we know it is in peril
“My wife died uncomfortable and alone. She died thirsty!”
The man who spoke those words came in to the emergency room recently where I was working a shift. He was accompanied by his wife, a 70-year-old with high sugar, weakness, and nausea. The team worked to get her seen under the presumption that her diabetes needed control. Once she was brought back to …
She died thirsty! Ice chips matter when it comes to patient satisfaction.
It started with a mild case of nausea and got progressively worse. I became dizzy and shaky, but tried to ignore it. There was work to be done that afternoon. We were moving boxes into storage at my in-laws’ house in Michigan, and I needed to be strong. I carried boxes on unsteady feet, catching myself before bumping into walls. By early evening my legs were wobbly, and I felt …
A costly anomaly on a brain MRI
Each year as the holidays approach, countless medical families prepare for the dreaded release of the holiday schedule. Will the physician spouse be home this year? Will the non-physician spouse be packing up three kids under the age of five and traveling across the country alone to visit family they may only see once a year? It can be stressful. It …
Married to a physician: Holiday blessings in disguise
People ran to the church for refuge in Medieval times. It was considered a place of safety, a sanctuary from civil punishment. In the church, one could claim a right to justice, food, water and shelter. That role was recognized by church and government authorities alike; doubtless sometimes grudgingly as the wanted escaped harsh punishments.
These days, America’s emergency rooms have filled …
Holidays in the ER: What you’ll see is a lot of humanity
I was a fourth-year surgery resident, on the transplant team. It was a difficult rotation, because the doctor who ran it was sexist and got along better with you if you flirted with him. He made innumerable sexual wisecracks in the OR while we were working, and preferred to round with his arm around me as he made further innuendoes.
I wasn’t …
The time I almost got fired for saving a young woman’s life
When I was in college and decided I wanted to go to medical school, I kept a picture of a medical transport helicopter on my desk. It represented the excitement I wanted to experience one day. When I was in medical school, I loved nothing better than watching in the chaos of the trauma bay, helping as the blood spurted to …
Everyone cries when they bury their dead
I walk out of the patient room. My eyes stare at the computer screen. I’m behind, way behind. I roll my head on my neck. My neck feels tense, and I have a headache. It’s been a long week. I need a vacation. Hurry up, click-click-click this computer, I think to myself. Dammit, is this EMR really freezing up again?
I look …
Even if no life was saved, an ER physician makes a difference
Andy was new to me. He told me he had seen several doctors over the past few years for various pains in his right arm.
Some months ago, he had right shoulder pain that went away on its own, but for the past few weeks, he had pain in the middle of his upper arm. Last year he had tennis elbow and forearm pain for many months.
A slender, middle aged man, …
When the art of medicine gets lost in the business
Close to midnight and Tonya is somnolent, lying on an emergency department (ED) stretcher and not in her own bed at home. The change in location alters the fairy tale quality of the word somnolent from sleepy or drowsy to one that’s more sinister and worrisome. Especially when Tonya is dying of brain cancer, a single mother of thirty-four, a hospice patient now …
When you walk into the emergency room to see a trauma patient, do you remind yourself as you enter the doors, “Keep your game face on?”
When you finish a difficult surgery and make your way to the waiting area to review the prognosis with the family, do you tell yourself, “Take a deep breath. You can do this?”
When you steel yourself …
We owe it to our patients to put on our game faces
Imagine you walk into a restaurant named Luigi’s. From the décor and the smell of pasta sauce coming from the kitchen, you assume that this restaurant serves Italian food. You walk forward, your name is taken and you are then told to sit off to the side and wait until your name is called so that you can get a table. Time goes by, and no one gives you any …
Run your emergency department like a restaurant
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I talk a lot with different physicians about integrating NP/PA providers into their practice. I am frequently astonished by the level of reluctance, resistance and downright animosity from these physicians. Many times a doctor will have a medical “horror story” with the NP/PA playing the villain. One bad encounter or event seems to justify a complete rejection of the many positive …
5 ways to ease the integration of NPs and PAs
Among reams of coverage on the Ebola outbreak, Politico just published a characteristic story with the headline, “In the world of Ebola, no room for error.” The only problem is that is as soon as you introduce a human element to any system, there will be error.
That’s the reality that health care leaders across the United States are grappling with now in a simultaneous effort both to tighten the health …
The lessons hospitals and physicians can learn from Ebola
Ebola is frightening but not for the reason you may imagine.
A little over a year ago Asiana Flight 214 crashed while landing at San Francisco International Airport resulting in 181 injuries and 3 deaths. As an emergency medicine resident, this fast-forwarded my training as I took care of many of the patients arriving in our emergency department. I left that day inspired that I had the education and training to …
Ebola presents a new paradigm from the ER
As the helicopter emergency services (HEMS) industry enters its fifth decade, there is an 800-pound gorilla in the room and nobody is talking. The average EMT, fireman and emergency physician too often make the flawed assumption that when it comes to HEMS, the industry is a uniform, high quality, strictly regulated entity. They assume that all HEMS programs use state of …
Helicopter emergency services: A disparity between aviation and medical proficiency
What I found most disturbing about the man’s arm was not the deep, stellate laceration on the underside of his biceps.
It was the swastika tattoo next to it.
“Sir,” I said, “we’ll have you fixed up in no time. I’m going to numb up the wound, irrigate it, then repair the laceration with sutures and send you home on antibiotics and pain …
When treating neo-Nazis, should physicians have a choice?
Go into any hospital today and notice that between every great nurse and patient sits a computer terminal. The quantified health movement has created the great digital divide, between the patient and everyone else.
The nurse of old used to actually touch the patient. No more. Now, they wheel in a computer console, sit down and record the digital output of the wired up patient, every vital sign, every drug order or …
Quantified health and the great digital divide
In June 2014, the first patient with Ebola arrived at Liberia’s county hospital, Redemption. As tensions grew around the city of Monrovia, administrators at JFK Hospital began to devise plans for handling patients with suspected Ebola. Officials from the CDC then came and gave us lectures. They discussed prevention of spreading and what our plans would be in the event of a potential outbreak. Before that moment, there were no …
Working in an ER in Liberia: A physician shares his story
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