As an emergency physician used to working in busy, urban ERs, I like to think that I’m not easily surprised. The other day, someone did something that really amazed me.
Our patient was a young woman who had a headache and requested medications to take it away. On an average ER shift, we see dozens of patients with similar complaints to hers. On busy days, the evaluation and treatment become rote: …
A simple act of kindness in the ER
All of the focus that CMS is putting on hospital readmissions via the Readmissions Reduction Program, and the financial penalties that readmissions can generate, is causing hospital administrators to look to the emergency department and emergency physicians to intervene and resolve the issues that interrupt recovery for post-hospitalization patients.
In today’s world of budget-constrained financing of government health care programs and narrow hospital margins, the question of how best to …
Reducing hospital readmissions from the emergency department
I get paid by Medicaid to see patients. How much?
Exactly $52.28 if it is an easy patient issue, like a cold, and $78.54 for a harder one, like a kidney stone. Who decides when the issue is easy and when it is hard? I do. But I have to follow some complex rules when deciding whether to bill a 99213 …
Conflicting state versus federal incentives confuse doctors
Nobody likes waking up in the middle of the night gasping for air. When you make a mistake in the emergency department, that’s exactly what happens.
They come in all sorts of shapes and colors:
Preventing nightmares: A guide for medical students and residents
I recently talked about how we might approach the idea of our own death. I wanted to start a discussion about how individuals engage with, think about and plan for the end of their life. In offering a medical perspective on what death is like, I hoped to stimulate self-reflection about this scary and foreign topic.
However, when we think about death, we don’t just think about our …
Have a conversation with your family about the end of life
In an article entitled, ”Why the ER admits too many patients,” Dr. Michael Kirsch tries to explain that emergency department admissions are inflated due to emergency physicians acting in their own self-interest. Many emergency physicians have read this and taken offense, feeling that his assertions point unfair blame on them for a significant portion of excesses in medical care and costs. I share this visceral reaction in part, but …
Emergency physicians are blamed for a broken health system
A few months ago, I walked into work on a late-night shift. One of the nurse practitioners came up to me and said, “There’s someone you need to see right away.”
The patient was a woman of about 60, and it was clear that she was critically ill. According to her husband, she’d been diagnosed with cancer six months ago. It had metastasized throughout her body. Her oncology team made several …
Empowering patients: Emergency department palliative care
A few months ago, the father of a primary care physician came into the emergency department with syncope. He was 102 years old. His age was more than double his heart rate. That may or may not be bad but it certainly is often a reason for more testing. The senior resident seeing the patient ordered an EKG, a battery of labs, a head scan, and anticipated admitting the patient …
We need more clinical time outs
I have long been a fan of the Case Records of the Massachusetts General Hospital, which is published weekly in the New England Journal of Medicine. For many years, I made a point of recommending them to medical students and internal medicine residents as a model of concise yet comprehensive case presentations.
No wasted words, no missing information, and none of the filler that trainees often added when they presented cases, such …
Be personable and make a huge difference in a patient’s recovery
It is unethical not to be compassionate when you are a physician. Treating people or their families poorly isn’t helpful to anyone in a stressful situation. But a big problem exists there – ethics is not taught in medical school. Then again, neither is compassion. So where do you learn them? Can you learn compassion, or is it something you just have?
Or don’t have?
She could have been anyone’s grandmother. White …
Watching people die is sometimes the compassionate thing to do
Overwhelmingly, doctors’ reimbursement has been the target of government programs and insurance companies. The idea underlying this movement has been, pay doctors less and curtail their incentive to see patients and the cost of medical care will decrease. As a result of this faulty reasoning, we have ushered in the era of unhappy doctors, those retiring early, and those asking for extra payments to justify the hours needed to give …
To cut health care costs, pay doctors more
Her wary eyes, magnified from her thick-lensed spectacles, watched my every move as I pulled room 21’s curtain to the side and entered her room. In her early eighties, it was apparent to me that my entrance into her life was more important than the abdominal pain that brought her to our emergency department. In the corner sat a slight man with wispy gray hair poking out from the border …
How bingo kept a patient going
He was a 24-year-old African American man with no history of medical or eye problems. On an ordinary Thursday evening at 8 p.m., he arrived into the emergency department complaining of a sudden loss of vision in both eyes.
“He couldn’t see a thing on our chart. Vitals are fine, pupils are equal and reactive, and the rest of the neuro exam is unremarkable,” the emergency room attending briefly explained. “Can …
I won’t come back to the ER for glasses again
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I would like to explain why Michael Kirsch’s article, “Why the ER admits too many patients,” is wrong, in all the myriad ways, in his contention that emergency physicians (EPs) admit too many patients because of improper motivations. Note that I am not going to argue that EPs don’t admit too many patients — that’s a legitimate discussion to have and there may be some merit …
The truth about admissions from the emergency department
Every player in the medical arena has found itself challenged by conflicts where one’s self-interest competes can skew what should be pure advice. This issue is not restricted to the medical universe. Every one of us has to navigate through similar circumstances throughout the journey of life. If an attorney, for example, is paid by the hour, then there is an incentive for the legal task to take longer than …
Why the ER admits too many patients
There’s a war being waged on one of America’s most revered institutions, the emergency room. The ER, or emergency department (ED for the sake of this post) has been the subject of at least a dozen prime-time TV shows.
What’s not to love about a place where both Doogie Houser and George Clooney worked?
Every new parent in the world knows three different ways to get to the closest ED. It’s the …
Stop the war being waged in the emergency department
I wish I could share the photo of my 4mm boomerang shaped kidney stone. I labored for 2 months, back in early 2009 to pass it, the second stone in 5 years.
During my ordeal with these stones, I had the following health care encounters, tests, medicines, lab and imaging tests.
The high cost of kidney stones
“If you insure them, they will come.”
Those words might as well be the mantra of hospitals across the country, because they can expect an onslaught of customers thanks to the expansion of health insurance under Obamacare. A recent study published in Science showed increased emergency room use among people in Oregon who became eligible for Medicaid, compared to others who, literally by the luck of the draw, were not chosen to …
Protocol-driven observational units can reduce ER crowding
The clock read 9:30pm and in front of me was dozens of notes, PowerPoint slides, and practice exams to review before 8am. The all-too-familiar finals week all-nighter beckoned, and though I’ve had my fair share of experiences with studying until the sun rose, I decided to forgo the typical mug of coffee and take some over-the-counter caffeine pills instead. My friend proclaimed that they would help more than any energy …
An $8,000 hospital bill added to my already growing debt
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Mission must have always been in my blood, but it took me a while to discover it. I considered going on a mission trip to Bungoma, Kenya, in 2009, but the timing coincided with one of the major conferences at the New York State Society of …
A mission trip to Kenya: Challenge, success and heartbreak
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