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…
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 …
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…
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 …
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…
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.
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…
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 …
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…
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: …
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…
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 …
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…
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 …
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: The sixty-year-old man diagnosed with…
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:
The sixty-year-old man diagnosed with a strained lower back muscle who comes back with a ruptured abdominal aortic aneurysm.
The fifty-four-year-old Hispanic female with generalized malaise who goes into cardiac arrest from a missed myocardial infarction.
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…
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 …
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…
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 …
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…
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 …
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…
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 …
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…
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 …
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.…
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?
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…
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 …
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…
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 …
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…
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 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 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 …
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…
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 …
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…
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 …
