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.

When evaluating mental health patients, go beyond snap decisions

Greg Smith, MD

Conditions and Diseases

August 20, 2013

It is tempting to use our sense of sight to make snap judgments about people, places and things.

Think about it. When you walk into a restaurant, if you see a sparkling clean dining room, you probably assume that the kitchen looks the same and that the food will be prepared in a clean, safe environment. When you see a well-dressed pilot and crew walking onto an airplane that has been …

How much information should doctors give to patients?

James Hubbard, MD

Physician

August 17, 2013

In my over three decades of family practice, I have come to the conclusion that we, as doctors, should provide non-medical people with as much medical information as we can. Not as much as we think they should have, or information just related to the problem at hand, but as much as we can provide. Period.

I started practicing when many still debated whether we should tell a patient if he …

Patients: Insist on being an equal and active partner in your care

Leana Wen, MD

Physician

August 16, 2013

It was the beginning of my third year of medical school. I had just started my first clinical rotation. My very first patient was Ray, a middle-aged man with pancreatitis.

I presented his case to the team. “What are Ranson’s criteria?” the attending physician asked.

My mind went blank. “Uh, I’m not sure,” I said.

“Next time, you’d better be sure,” the attending said. He turned to my colleague, who promptly gave the …

Fix Google Maps before patients start dying

Chris Boyer

Health Technology

August 15, 2013

fix-incorrect-marker

It happened to me again.

This morning I got another email from one of our physician practices:

“Our early morning patient was late today because she Googled our office and it gave her the wrong directions/location. Help!”

This is not a one-time thing. Over the last seven months that I’ve been in my new position (and the four years prior at my old position), I …

Hallways are no places for psychiatric evaluations

Greg Smith, MD

Physician

August 13, 2013

A commenter recently asked the other day about staging patients, especially mental health patients, in the hallways. This is sometimes done, along with triage and initial assessments, because of the very real lack of appropriate space in a busy, full emergency room. What do I mean by this?

Well, as any of you know who have ever been to the ED for anything at all, once you get through the front …

When a doctor offers to speak the language of medicine for you

Miranda Fielding, MD

Physician

August 9, 2013

These days they have navigators for everything. When we got lost back in the day, we used to consult a map, or lacking a map, we would pull in to the nearest “filling station” (what we used to call gas pumps) and ask for directions from the friendly young man who would appear to wash our windshield, check the oil and the tire pressures, and of course, pump the gas. …

Guantanamo: End forced nasogastric tube gagging

Nuriel Moghavem and Marty Makary, MD

Physician

August 4, 2013

Guantanamo detainees on a hunger strike are now being strapped into chairs and gagged as doctors push a feeding tube through their nose into the back of their throat and into their stomach as often as twice a day. It’s a disturbing new practice, but one we must examine in full as we consider whether Guantanamo reflects American values.

Anyone who has had a nasogastric tube placed through their throat …

Locums tenens physicians change the face of medicine for the better

Edwin Leap, MD

Physician

August 2, 2013

I remember a time when many physicians, especially residents in various specialties, would moonlight in small emergency departments. They viewed it as a convenient way to supplement their low salaries. Some of them were excellent doctors. Sadly, quite a few were not qualified and caused more harm than good.

I did the same thing, although I was a second- and third-year emergency medicine resident at the time. Indeed, the money came …

Treating the psychiatric patient in the ED: 3 changes I’d like to see

Greg Smith, MD

Physician

July 29, 2013

“Most EDs do not have separate secure areas in which psychiatric patients can be held. They typically don’t have a psychiatrist immediately available to evaluate the patient and provide guidance on management, and they do not have extra nursing staff to monitor often unpredictable patients.”

This was a comment on one of my blog posts.

Well, we have been talking about the way psychiatric patients get to the ED …

What medicine has taught me about children

Edwin Leap, MD

Physician

July 13, 2013

I’ve learned a few things about children over the years. While most have come from raising children, the rest have come from caring for them as patients. Knowing children, knowing their hearts and their ways, gives me great joy. I like to think that as I know them better, I become more like them, and while my time on earth may not be any longer for it, it may be …

Is your hospital leader committed to patient-centered care?

Robbin Dick, MD

Health Policy

July 11, 2013

Nearly every hospital leader in America will tell you their hospital is all about patient-centered care. Of course, we know this isn’t true in many cases, especially when it comes to hospital capacity management. Though many institutions will deny to its last dying breath that they have any priorities that supercede patient care, nearly all do.

They usually go like this: first priority is high margin surgical cases; second priority is …

True pain and suffering: There is no place for manipulation

Greg Smith, MD

Physician

July 11, 2013

“Well then, if you won’t prescribe the Xanax for me, I guess I’ll just have to get it off the street.”

“If you send me home, I promise you’ll be reading about me in the obituaries tomorrow.”

“I’m in terrible pain. You have to treat me. You have to give me narcotics. If you don’t, I’ll call the state medical board and report you.”

I hate to be manipulated.

Hate. It.

There is a certain …

A ruptured eardrum turns out to be something much more

BirdStrike, MD

Physician

July 9, 2013

My shift is over, and I’m ready to head out the emergency department door. When I walked in 12 hours ago, the department had 20 waiting patients. I look up at the monitor and after 12 hours of trying to wrestle the department under control, not only is it not under control, now we’re 25 patients deep in the weeds. My partner Dr. Jim looks at me and says, “Get …

Reflections after 4 years of emergency medicine training

Leana Wen, MD

Physician

July 3, 2013

On July 1st, four years ago, I walked through Massachusetts General and Brigham and Women’s Hospitals with an odd mixture of fear, relief, and excitement. Now, as I leave the hospital after my last shift of emergency medicine residency training, I am filled with a similar hodgepodge of emotions and reflections.

1. “You were terrified of being a doctor!” I mentioned this article to the attending who oversaw my first shift as …

For psychiatric patients in the ED, waiting is the hardest part

Greg Smith, MD

Physician

July 3, 2013

There was the time I was hugging a trashcan in the lobby of the community hospital ED just a few blocks from my house. Not because I have a molded plastic fetish or because I like the smell of trash, mind you. I had an itinerant renal calculus, otherwise known as a kidney stone that was moving through my urinary system.

It. Hurt. Like. Hell.

I. Wanted. To. Die.

I was throwing up …

Violence against women: Save her life and treat her injuries first

Mona Singh

Patient

June 26, 2013

According to a WHO report, more than a third of women experience sexual or physical violence around the world. At such pandemic proportions, violence against women is a serious global health and public policy problem.

In addition to increasing a women’s vulnerability to depression, alcohol use disorders, pregnancy-related complications, and STIs, including HIV, intimate partner violence is a significant cause of death and injury:

42% of women experience injuries from physical or …
Read more…

Violence against women: Save her life and treat her injuries first

Should doctors be available to patients around the clock?

Kevin R. Campbell, MD

Physician

June 25, 2013

Nothing exemplifies more the complete lack of understanding of the issues surrounding our healthcare system than an article that appeared in the New York Times recently.

Author Jane Brody’s piece attempts to address issues with the astronomical costs and misuses of emergency department (ED) visits in the US today. While I agree that ED visits for routine issues are a waste of resources and money, her suggestion that physicians should …

Being indigent is not a crime, but being an uncaring doctor should be

Greg Smith, MD

Physician

June 24, 2013

Okay, so this morning I want you to think about something with me. I want you to be honest, as honest as you can, as I will be with you too. Deal? We can’t move forward until you agree.

Right.

What do you feel when you’re driving along, you come to the next busy intersection, stop for the red light, and see that homeless guy? You know the very one I’m talking …

Every doctor can learn from a medical coder

Jessica Jou

Medical Education

June 23, 2013

Mrs. B was washing dishes in the kitchen when she heard a thump where her twelve-month-old son was asleep. She ran to him and found her son had fallen from a chair (code: e884.2). He was crying (code: 780.92) and visibly shaken, but did not have overt signs of bleeding, bruising, or trauma. She picked him up and immediately brought him to the emergency room.

There, he was triaged by the …

Emergency Medicine

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