Emergency medicine

2,327 articles · Since 2004

Articles, page 60

The vicious cycle of emergency department use

February 8, 2014Feb 8, 201431

Inappropriate use of emergency departments (EDs) → congested EDs → over-worked staff members → frustrated staff members → speculation of more non-emergent ED usage → expectation to provide high customer satisfaction scores → decreased actual customer satisfaction → decreased reimbursement…

Whose idea was any of this? None of it makes sense to me. The idea of providing reimbursement to healthcare agencies based on customer satisfaction scores is …

Conditions and diseases

Options for the injured older adult in the emergency room

Eric Widera, MD

February 7, 2014Feb 7, 20142

A 92-year-old woman with a history of stroke comes to an emergency department and is found to have fractures of her cervical spine. Neurosurgery sees her but doesn't think she needs surgery. The emergency department physician tries to admit her…

A 92-year-old woman with a history of stroke comes to an emergency department and is found to have fractures of her cervical spine. Neurosurgery sees her but doesn’t think she needs surgery. The emergency department physician tries to admit her to the hospital as she has a new functional disability due to the fall but the hospitalist refuses as the patient doesn’t meet criteria for inpatient admission.

And there she sits …

Physician voices

Test overuse: Why does it happen and what can we do about it?

Kevin R. Campbell, MD

February 7, 2014Feb 7, 201421

In medicine today diagnostic testing and advanced imaging is readily available and widely utilized in most every clinical setting. Many physicians have given up the stethoscope and physical exam in favor of an echocardiogram and a CT scan. Fear of missing something pervades every emergency department and has resulted in hundreds of thousands of unnecessary testing costing billions of dollars in healthcare expenditures.

Of course, the driving causes of increased testing …

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Did a New York Times column unfairly attack ER doctors?

WhiteCoat, MD

February 6, 2014Feb 6, 20144

Cardiologists are causing patients to get cancer. It’s true. Cardiologists routinely perform angiograms on patients who have no heart disease whatsoever. As shown in this Harvard newsletter, each angiogram exposes the patients to about 7 mSv of radiation. Add in…

Cardiologists are causing patients to get cancer.

It’s true.

Cardiologists routinely perform angiograms on patients who have no heart disease whatsoever.

As shown in this Harvard newsletter, each angiogram exposes the patients to about 7 mSv of radiation. Add in the myocardial perfusion imaging at another 25 mSv of radiation and you have enough radiation to cause cancer in an otherwise healthy individual.

And cardiologists routinely subject patients with normal …

Physician voices

Thank an EMT for their courage, their dedication and their spirit

Julian Orenstein, MD

February 6, 2014Feb 6, 2014

When, a couple times each year, dozens of our county teenagers train to become EMTs, they know they are taking on a challenging, heavy responsibility. But probably none of them are ready for the kind of horrible death our community experienced a week ago, when a 15-year-old-girl walking home from school in Rockville was struck and killed in a crash involving two cars that news reports say may have been …

Medical education

Shotgun medicine: An arrow is often better

Jennifer Adaeze Anyaegbunam

February 5, 2014Feb 5, 20143

During my internal medicine rotation, the medical students had the opportunity to attend intern morning report, an interactive teaching session where attending physicians walk the interns through a patient’s story, starting from the moment they hit the door of the…

After discussing the patient’s symptoms, complaints and past medical history, the attendings always ask the group to think carefully about the …

Conditions and diseases

An embolus in one but trauma in many at 30,000 feet

Melissa Stone

February 2, 2014Feb 2, 20144

A middle-aged obese female with a past medical history of diabetes and congestive heart failure is in cardiac arrest after several hours of immobility on an airplane. What is the cause of her condition? If this were a USMLE exam,…

If this were a USMLE exam, my thoughts would race to Virchow’s triad: stasis, endothelial injury, hypercoagulability. But this wasn’t an exam. This was a few rows behind me on an airplane.

I sat only …

Health policy

What the Oregon Health Study has told us so far

Cedric Dark, MD, MPH

February 1, 2014Feb 1, 201411

Recently, another installment was published from the research team of the Oregon Health Insurance Experiment. The major finding -- Medicaid coverage results in a 40% increase in emergency department (ER) use. Many of the health care pundits quickly sifted through…

Recently, another installment was published from the research team of the Oregon Health Insurance Experiment. The major finding — Medicaid coverage results in a 40% increase in emergency department (ER) use. Many of the health care pundits quickly sifted through the scientific results to support their opinions.

You can read some of them here:

Sarah Kliff reports the facts: Expanding Medicaid doesn’t reduce ER trips. It increases them. Scott Gottlieb claims that …

Physician voices

The toxicity of Medicaid

Edwin Leap, MD

January 28, 2014Jan 28, 2014158

I have noticed over the years that physicians who write about medicine, particularly for the general public, are limited to very specific discussions. For instance, it is perfectly acceptable to write about the plight of the poor and uninsured. It is always reasonable to advocate for a single payer system. It is perfectly acceptable to discuss how one downsized in order to make less and “give back” more. And it …

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The toxicity of Medicaid

Health policy

How the Affordable Care Act will affect emergency department payments

Cedric Dark, MD, MPH

January 25, 2014Jan 25, 2014

A recent article in the Annals of Emergency Medicine analyzed the revenue increases due to emergency physicians for services delivered to currently uninsured individuals when they begin to receive coverage (via either Medicaid or private plans) under the Affordable Care…

A recent article in the Annals of Emergency Medicine analyzed the revenue increases due to emergency physicians for services delivered to currently uninsured individuals when they begin to receive coverage (via either Medicaid or private plans) under the Affordable Care Act.

The authors analyzed payments for outpatient emergency department (ED) visits using the Medical Expenditure Panel Survey from 2005-2010. They looked into characteristics of charges and payments for the following groups: …

Health policy

Learning about Obamacare from a car accident

Bob Doherty

January 24, 2014Jan 24, 201433

Just a little over a week into 2014, my new year started off with a bang -- literally -- as I got into an automobile accident that involved my car sideswiping another vehicle and then crashing my car into a…

Just a little over a week into 2014, my new year started off with a bang — literally — as I got into an automobile accident that involved my car sideswiping another vehicle and then crashing my car into a tree at 30 MPH. The car was totaled, but fortunately, I (mostly) walked away from the accident with only a fractured sternum and bruising.

Just a little over a week from …

Physician voices

Learning from patients on a speaking tour

Leana Wen, MD

January 21, 2014Jan 21, 20143

One year ago, my book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, was published. My goal in this last year has been to travel around the country and talk about the book and its message of…

One year ago, my book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, was published. My goal in this last year has been to travel around the country and talk about the book and its message of advocating to improve your health. I planned a 48-city itinerary where I’d crisscross the U.S. from Massachusetts to California and back. I’d speak at bookstores, libraries, nursing homes, universities, and community …

Health policy

Why the Oregon Medicaid study ultimately won’t matter

Angelo Falcone, MD

January 19, 2014Jan 19, 20144

2014 has dawned, and with it more than 2.1 million people have new health insurance under the Affordable Care Act. This, as they say, is where the rubber meets the road. But a new study out of Oregon is challenging a key argument for extending health insurance to millions: that doing so will reduce costly emergency room visits.

The study in question showed that when health insurance was extended to Oregon residents …

Physician voices

A patient trapped in his own body

Edward Thompson, MD

January 14, 2014Jan 14, 201419

Donald is large. Very large. At more than 600 pounds, he is a mountain of flesh with a small opening at the top through which he speaks. "My stomach hurts," he says, his voice surprisingly high and childlike. It is…

Donald is large. Very large.

At more than 600 pounds, he is a mountain of flesh with a small opening at the top through which he speaks.

“My stomach hurts,” he says, his voice surprisingly high and childlike.

It is 10:00pm in the emergency room, and I am already swamped with patients I’m trying to move through the ER before my shift is over.

Asked if he’s ever felt this kind of pain before, …

Read more…

A patient trapped in his own body

Health policy

Why does Medicaid increase emergency department use?

Dr. Saurabh Jha

January 11, 2014Jan 11, 201451

The interpretation of results of a policy study lies in the political inclination of the beholder. If one likes the results they are “ground breaking.” If they are not in line with our world view there are “nuances” of hypothesis…

The interpretation of results of a policy study lies in the political inclination of the beholder.

If one likes the results they are “ground breaking.” If they are not in line with our world view there are “nuances” of hypothesis testing that detractors have overlooked, it’s too “premature” to draw conclusions and “further research” is needed. Statisticians, like lawyers, can be recruited to argue any point of view to meaningless insignificance.

This …

Physician voices

Rural medicine reminds physicians of their value

Edwin Leap, MD

January 10, 2014Jan 10, 20143

Recently, while on a locums assignment in a very small, rural hospital, I cared for a gentleman with chest pain. His discomfort seemed classic for an MI, but his EKG did not. So I treated him as normal with aspirin and nitrates, and waited for his cardiac markers to come back from the lab. In the interim, his chest pain worsened. Sure enough, he developed an anterior MI. The tombstones …

Health policy

Price transparency alone won’t solve our health system’s ills

Renee Hsia, MD

January 8, 2014Jan 8, 201418

His right testicle had jumped into his abdomen after he lost control of his motorcycle on the highway. My 43-year-old patient, whom I’ll call Richard, in otherwise healthy condition, was brought to the ER with severe pain. Fortunately, his testicle…

I am an attending physician in the emergency department and trauma center at San Francisco General Hospital. I …

Physician voices

My cancer shows how our world is ruled by love

Elana Miller, MD

January 6, 2014Jan 6, 20144

I recently wrote about how our world is ruled by love, and circumstances conspired to show me just how true that really is. Love is when I go to the ER at UCLA, where I work, for a cough and…

I recently wrote about how our world is ruled by love, and circumstances conspired to show me just how true that really is.

Love is when I go to the ER at UCLA, where I work, for a cough and feeling that “something isn’t right,” and even though my complaints are mild, I’m brought right in and treated respectfully.

Love is when the chest x-ray comes …

Physician voices

We don’t really get to die of old age

Edwin Leap, MD

December 31, 2013Dec 31, 201313

Whether they are young or old, we do not want our loved ones to die. Period. Even if we live with faith in our eventual, eternal reunion with them, we know that their passage will leave a void. I completely…

But I want to take a few lines to try and make things clearer, or easier, for those who have family members who are very aged and infirm. You see, …

Read more…

We don’t really get to die of old age

Physician voices

When children are abused by foster parents

S. Terez Malka, MD

December 26, 2013Dec 26, 20135

I click open the x-ray viewer. After 4 years in emergency pediatrics, I am not really surprised that a tibia fracture underlies the bruised ankle I unexpectedly encountered on physical exam. Yet I audibly gasp as the chest x-ray loads. The torso in question belongs to a chubby little cherub of a 3-month-old in room 11, brought in for red eyes. I begin to count the fractured ribs — 1, …

Emergency medicine

Articles, page 60

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