Who watches the watchers? It’s an old Roman saying from the poet Juvenal, and it had to do with infidelity. But over the years it has been applied to politics as well. It means, “How do I know that the people guarding me are worthy?” It has also been translated, “Who guards the guards?”
But it seems to me that it applies to medicine quite appropriately. Who watches those watching physicians? We …
Who watches those watching physicians?
She looked like a whipped puppy that had had a garden hose turned on it and slunk off to a far corner of the yard to dry out in the sun.
She sat there, wizened but hard, thin and wiry, dressed in standard issue blue emergency room scrubs, thin tanned face, long stringy, wet prematurely gray hair falling limply around her shoulders. She looked down at the floor, but when her …
Out of the many he has seen, he will do his best to help just this one
Today, a patient attacked me. A nurse got kicked. Another punched. I was gouged to the point that blood was drawn. The patient was neither intoxicated nor psychotic. Rather, she was a meek 92-year-old grandmother, and she was terrified. It took five of us to hold her down, as she summoned the strength of a woman fighting for her life.
Linda is an elderly woman with moderate dementia. She is blind …
It was recently Nurses Week in early May and there were a lot of adulations being offered on social media and throughout hospitals regarding the appreciation we have for those among us who have chosen to be on the “front lines” of caring for us when ill or injured.
As an emergency physician I could speak about the many times a nurse has grabbed me and pulled me into a room …
Being a nurse is the noblest profession
Another backboarded body rolls in. I slip from my perch at the computer and greet the emergency medical technician.
“Seizure. Lasted a few minutes, done by the time we got there. Fell and cut his face. Vitals stable. Sugar fine. Oriented but postictal. Didn’t take his meds.”
Approximately my age, the backboarded man’s chin bears a ribbon of red laces.
“Dammit,” he says. A glance at the cardiorespiratory monitor shows me suitable hemodynamics, …
Playing a game of Russian roulette with his life
An American poet and political activist, Muriel Rukeyser, said the universe is made of stories, not of atoms. I believe her.
As a seasoned storywriter and storyteller, I walked gingerly into the adult emergency services for my first shift as a volunteer at a legendary New York City public hospital. I sported a crisply ironed red polo with “emergency department volunteer” embroidered in white stitch.
Armed with a pocket notebook and a …
A dire need for narrators in medicine
One of my most treasured stories as an ED physician belongs to a lovely couple who valued quality of life. It was a routine day in the ED when an elderly woman rolled through the ambulance doors on a cold, narrow stretcher, unaccompanied by family. She was placed in bed 5, which is where we met. She was frail and her memory was poor. The EMS run sheet reported “change …
Quality of life: We say it, but do we mean it?
Medical scribes are a burgeoning field with many institutions and practices exploring their use while the many commercial enterprises who lease out scribes are pushing for their widespread acceptance. There is no accepted definition of what scribes do or what their background or training should be. There is no mechanism for licensure of them in any state. They are poorly defined medical assistants. The field is in its infancy and …
Do medical scribes threaten patient privacy?
The day I graduated from medical school and walked across that stage with my diploma in hand, I was sure that I had achieved the highest honor in the land. I could not help envisioning myself in a long, crisp white coat, walking down the long hallways of the hospital, with my name badge perfectly displayed that read: “doctor.”
I was certain in my mind that I had finally made it. …
Dr. Mom: No instructions included
A Southerner at heart, I find myself in love with places. We are forever pining on about our family homes, our small town barbecue restaurant, the sound of some lake where catfish splash in the night, or the woods where our favorite treestand sits. Sometimes our afflictions for place become the stuff of novels; Scarlett O’Hara is always associated with her beloved Tara just as Faulkner is ever infused into …
Hospitals are part of who we are
Physician colleagues and their hospitals have been the targets of direct attacks during the past three years in Syria. According to UN war crimes investigators, Syrian forces have deliberately targeted hospitals, attacked field hospitals, and prevented patients from receiving medical care.
A United Nations Commission of Inquiry independent panel published its findings to draw attention to what it called “an enduring and underreported trend” in the conflict. The report …
Doctors on the front lines of the Syrian conflict
After a relaxing weekend with my daughter, son-in-law and 2-year-old grandson, my wife and I made our way to the Atlanta airport to begin our trip home. The end of a trip — even a short weekend — is always sad. I never look forward to the travel home and usually want to snap my fingers and skip the travel.
My wife and I have trouble packing light and so, when …
Make a personal connection in the ER
I heard this on the radio recently: Mom takes her new baby to the emergency department on a weekend because she thinks her daughter might have a urinary tract infection. She’s right, but regulations say the baby has to stay in the hospital for two days to ensure the infection clears. Afterwards, the mom is surprised by and concerned about a $7,000 hospital bill for the baby’s care.
The …
Are the benefits of price transparency overstated?
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The Centers for Medicare and Medicaid Services released a massive amount of information regarding how much money it paid out to individual doctors. For the policy nerds out there, here is the original data. For everyone else, here is a simple way to look up how much your own doctor made. I decided to search for myself in the database …
How much Medicare pays doctors requires context
During a recent lunch with my daughter, a senior at the University of Maryland, she shared her frustration with a question she often receives: “So, what are your plans for next year?” She commented that while her life experiences through present day have been memorable, each stage has been predictable. Now, for the first time, she has more questions than answers. This ambivalence — this fear of what’s ahead — …
The palliative care discussion starts in the emergency department
The guy was a curmudgeon. That’s all you could say about him. His blood pressure and diabetes were dreadful, and he insisted there wasn’t anything he could do about it. The meds were too expensive; the diet was far too limiting; he had no pleasures in life other than food.
He lived alone, hated his job, saw few people, had no friends — so he told me at every visit. His visits …
How an email list changed a man’s life forever
A large number of pediatric practices these days use after-hours call centers for parents who have questions about a sick child. I’ve been looking around to find some data about how common this is, but my sense is that the majority of pediatricians use them. There is no question these call centers make live easier for the doctor; having somebody screen the calls, answer easy questions, and only call you …
Do call centers send too many children to the emergency department?
I was recently sent a link to this article entitled “Smile! You’ve Got Cancer” written by Barbara Ehrenreich. I encourage everyone to read it. The article lives up to its striking title and more. And I couldn’t help but respond with my perspective. So that you know where I’m coming from, my most personal encounter with cancer is that my grandmother died from cancer. I also treat people with acute …
The dreadful cost of denying how you really feel
They used to tell us, as physicians, that “if it isn’t on the chart, it didn’t happen.” We could protest all day, to billing companies, insurers or attorneys, “I did that. It’s assumed. I always do the same thing every time.” But they would retort, “nope, it’s not in the chart.” So we learned to detail everything, every time, every movement. Every consideration and justification. The idea being, our ‘thought process’ …
If it’s not in the computer, you didn’t order it
In my near-decade of practicing emergency medicine I have yet to receive a letter from a hospital congratulating me on how few CT scans I’ve ordered. Nor have I ever received a special award for diverting a potential admission to an outpatient referral instead. Rather, the push has always been the opposite. Fee-for-service models encourage the opposite behavior, and trying to do the most evidenced-based or cost-effective thing is not …
Emergency departments should embrace clinically integrated networks
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