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.

The human cost of physician burnout is almost unfathomable

Brian Goldman, MD

Medical Education

September 7, 2014

Adapted from a keynote address given to the graduating medical class at the University of Toronto.

When I was asked to give the keynote to graduates of the class of ’14, it was an honor that nevertheless filled me with terror and a bit of wistfulness.

My sense of fear in giving advice to these amazing young doctors comes from not being sure I belong in the same company. They are whip smart, …

Doctors cannot speak about the reality of death and dying

Monica Williams-Murphy, MD

Physician

September 6, 2014

I live and work in the house medicine. You would think that those of us who have chosen this profession would actually know what dying looks like. Furthermore, one would hope that if the doctor could identify dying, he or she could share this with the patient and family (given that this is fairly significant medical information).

I never cease to be amazed that most doctors cannot speak straightforwardly and compassionately about …

A physician remembers his first patient of the new millennium

Gregory Bledsoe, MD

Physician

September 4, 2014

It was January 1, 2000, and I was an intern in emergency medicine at the University of Arkansas for Medical Sciences.

I had gone to sleep the night before listening to celebratory fireworks and congratulating myself for surviving Y2K. Now I was walking into the emergency department of our large, level 1 trauma center where I was furthering my medical training. Like most urban ERs, this one was a busy place …

This surprising request brought an emergency doctor to tears

Monica Williams-Murphy, MD

Physician

August 31, 2014

Most of the time I feel as though I am running in quicksand attempting to bring patients to a place of grace and dignity in dying. On occasion, there is someone who jerks me out of my quicksand and plants me squarely on stable shore and then proceeds to show me what grace and dignity in the face of death really look and feel like.

Please meet Mr. Jefferson.

Mr. Jefferson had long, lacy …

An American doctor’s experience with the NHS

Jennifer Gunter, MD

Physician

August 30, 2014

You know it’s going to be one of those days when one of the first tweets on vacation inquires about the closest hospital.

Victor, one of my 11-year-olds, had something in his eye courtesy of a big gust of wind outside of Westminster Abbey. He was complaining enough to let me flip his eyelid and irrigate his eye on the square in front of Big Ben. (I’m sure several people thought …

Recognize the potential victims of human trafficking

Alberto Hazan, MD

Conditions and Diseases

August 24, 2014

If you’ve ever worked in an emergency room, you’ve likely treated a victim of human trafficking.

We all have, often without knowing it.

With nearly thirty million people in modern-day slavery around the world, there are more slaves today than at any point in history.

Human trafficking is defined as “the recruitment, harboring, transportation, provision, or obtaining a person for labor or services, through the use of force, fraud, or coercion” for the …

Like it or not, urgent care centers are here to stay

John Schumann, MD

Physician

August 22, 2014

The New York Times had a front-page story about the growth of urgent care clinics nationwide.

These are the places that are often referred to as “minor emergency rooms,” or “doc-in-a-box” outfits. Their value proposition is simple: You don’t need an appointment. The costs are “reasonable,” and much more transparent than usual medical care at a doctor’s office, emergency room, or hospital. Best of all: They can treat a majority of acute conditions and …

Interdependent physician practice is here to stay

Angelo Falcone, MD

Health Policy

August 14, 2014

We hear a lot about the death of the independent physician practice. But perhaps the more important discussion is about the death of practicing medicine independently. That is, the days when individual physician groups could operate their businesses and treat patients independently and without regard to the surrounding network of other physicians, nursing facilities, health networks, social workers, case managers, and other support is over.

It doesn’t matter whether the physician …

Help patients by addressing the health of the community

Leana Wen, MD

Physician

August 14, 2014

When I was a medical student, I worked with an non-government organization (NGO) in Rwanda to provide medical care to women with HIV. Nearly all had witnessed their family members murdered during the genocide, and many became afflicted with HIV as a result of rape. Our initial focus was on getting antiretroviral therapy to these women, but we quickly realized that while it was important for them to have access …

Increasing hospital revenues through urgent care referrals

Trudy Lieberman

Patient

August 7, 2014

Not long ago, Tracy Hume, a freelance writer who lives in Greeley, Colorado, sent me an email posing this question: “Do ER-affiliated urgent care providers ever try to escalate patients to the ER when it is not medically necessary?”

It seems that over the July 4th weekend, Tracy’s teenage son was complaining of a headache, nausea and abdominal pain, and was vomiting. He doesn’t complain much, she said, so thinking that …

The first-year medical student and the 114-year-old patient

Elyse Linson, MPH

Medical Education

August 3, 2014

I thought the most important thing I had learned while working in the emergency department as a first-year medical student was to bop and weave. The impeccable foot skills I harnessed as a youth lacrosse player were put to great use- to stay out of the way. The quiet whisper of a nurse trying to slide behind me, and — BAM — back against the wall. I can hear the …

Scribes put humanity back into the practice of medicine

Jim Pagano, MD

Physician

August 2, 2014

In a recent posting Dr. Kaylan Baban mused about the ubiquity of scribes and some of the reasons behind this growing phenomenon. Among them were the usual suspects: increasing patient loads leading to decreased visit times with the provider, increasing non-clinical demands monopolizing time that would be better spent actually practicing medicine, and improved legibility of notes, which are now the patient’s property and are used for a …

Measuring the value of emergency department care

Robbin Dick, MD

Physician

August 1, 2014

Emergency department directors measure value in their departments with a number of metrics that are tracked religiously: door-to-provider times, ambulance drop-off times, left without being seen rates, length of stay for discharged patients, diversion hours, and 72-hour returns all come to mind.

These metrics clearly measure the performance of the emergency department, what to they do, if anything, to measure the value of care being provided? These metrics are often …

Getting personal with patients really matters

Imamu Tomlinson, MD, MBA

Physician

July 31, 2014

Ask almost any physician why they chose medicine, and they’ll answer, “I wanted to make a difference in the lives of patients.”

But in today’s high-pressure healthcare environment, it’s easy to get caught up in performance metrics and obsessed with efficiency. We tell ourselves, “It’s OK, as long as we’re delivering great clinical care, we’re delivering great care. After all, the massive heart attack was averted. The wound was stitched. What …

Practicing convenience medicine in the ER

Michael Perraut, MD

Physician

July 23, 2014

It’s easy to get frustrated in the ER. First, you’re at work. Second, most of your patients don’t want to be there. Third, many (if not most) of your patients don’t need to be there. Finally, by the time you see them, most of your patients are tired of being there.

It’s easy to become jaded when you trudge through this never-ending mire of patient after patient, and indeed ER docs …

Bad medical care: Is it better than none at all?

WhiteCoat, MD

Physician

July 21, 2014

In my past few shifts in the emergency department, I have seen the following patients who were seeking further care after being treated by other providers.

One was a child who had been seen twice at an urgent care clinic. He had a fever of 103 degrees and wasn’t eating. The first time he went to the urgent care center, he was diagnosed with an ear infection. He was started on …

Conducting research without the consent of the research subject

Ruth Macklin, PhD

Medical Education

July 16, 2014

A new study poses one of the most vexing ethical questions concerning research with human beings: When is it acceptable to conduct research without the consent of the research subject?

In emergency situations, patients often arrive at the hospital unconscious or with severely impaired decision-making capacity. Progress in medical practice depends on results from carefully designed research; yet in these emergency cases such patients are unable to fulfill one of the …

Why the ER is a mixed blessing for society

Edwin Leap, MD

Physician

July 15, 2014

We live in an incredible age. Life expectancies continue to rise. The environment in the U.S. is cleaner than it has ever been. The sum of the world’s knowledge is at the fingertips of any and every smartphone user, waiting to be accessed when they finish playing Candy Crush. The face of poverty in America is still terrible to behold; but it bears little resemblance to poverty down the long …

A medical student speaks up and saves a life

Andrew Ho, MD

Medical Education

July 12, 2014

Recently, I was on call for surgery at a hospital in New York City. At 2 a.m. in the morning, we were paged to a trauma in the ED. After we stabilized the patient and moved him for CT scans and x-rays, I noticed a small stretcher tucked away in the back part of the ED, a place typically reserved for overflow patients when we run out of rooms.

The patient …

Medicine is like blackjack: Physicians need to count cards

Thomas D. Guastavino, MD

Physician

July 11, 2014

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In the game of blackjack, players will attempt to increase their odds of winning by using the frowned upon method of counting cards. The basic principle is to add or subtract points to the cards dealt under the belief that the cards remaining in the deck are more or less likely to give the player a winning hand. Not a guarantee, of …

Emergency Medicine

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