Emergency medicine

2,327 articles · Since 2004

Articles, page 63

The knowledge that one wasn’t alone in an uphill fight

September 3, 2013Sep 3, 2013

I smelled the patient, unfortunately, even before walking into his room to introduce myself. From the hallway, his odor of lingering stale smoke flared my nostrils, instigating childhood recollections of the wood-burning furnace at my grandmother’s home. From a distance, the scent of smoke was just that — charred-burnt air, its weight clinging to my nostrils. As I approached the patient, however, the scent of smoke smoldered my wishful memories …

Physician voices

14 ways to drive your doctor crazy during a physical exam

WhiteCoat, MD

August 31, 2013Aug 31, 201312

1. When your doctor looks into your eyes with a flashlight, shut your eyes tightly so he can’t see your pupils. Later, when your doctors asks you to shut your eyes tightly to test your eyelid strength, look at him like he’s speaking in tongues and keep your eyes open. If he whips out his flashlight to look at your pupils …

Health policy

Do we need less art in medicine?

Vipul Kella, MD

August 28, 2013Aug 28, 201318

After eating at my favorite restaurant last week, I started to think why I enjoyed it so much. I have been eating at the same place regularly for years, but never stopped to think about what makes it special. After thinking about it for a bit, I came up with one word: consistency. I know that every time I eat there I can expect the same dish prepared the exact …

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Do we need less art in medicine?

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Calling a consult: Disrespect from specialists hurts patients

Heidi Roman, MD

August 26, 2013Aug 26, 20133

A while back I was working in pediatric urgent care and had occasion to do something I have done many times since starting out in medicine. I called a consult. The reason, like many consults, was an abnormality on a study that required a specialist’s opinion. I paged the resident on call for this particular specialty.

When they called back I was treated, right from the get-go, to some serious attitude. This was a legitimate …

Conditions and diseases

When evaluating mental health patients, go beyond snap decisions

Greg Smith, MD

August 20, 2013Aug 20, 20135

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…

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 …

Physician voices

How much information should doctors give to patients?

James Hubbard, MD

August 17, 2013Aug 17, 201316

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…

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

Physician voices

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

Leana Wen, MD

August 16, 2013Aug 16, 201317

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…

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 …

Health technology

Fix Google Maps before patients start dying

Chris Boyer

August 15, 2013Aug 15, 20139

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…

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 …

Physician voices

Hallways are no places for psychiatric evaluations

Greg Smith, MD

August 13, 2013Aug 13, 20138

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…

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

Physician voices

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

Miranda Fielding, MD

August 9, 2013Aug 9, 20138

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. …

Physician voices

Guantanamo: End forced nasogastric tube gagging

Marty Makary, MD, MPH & Nuriel Moghavem

August 4, 2013Aug 4, 20139

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 …

Physician voices

Locums tenens physicians change the face of medicine for the better

Edwin Leap, MD

August 2, 2013Aug 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…

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

Physician voices

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

Greg Smith, MD

July 29, 2013Jul 29, 201312

"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…

“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 …

Physician voices

What medicine has taught me about children

Edwin Leap, MD

July 13, 2013Jul 13, 20132

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 …

Health policy

Is your hospital leader committed to patient-centered care?

Robbin Dick, MD

July 11, 2013Jul 11, 20133

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…

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

Physician voices

True pain and suffering: There is no place for manipulation

Greg Smith, MD

July 11, 2013Jul 11, 201329

“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…

“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 …

Physician voices

A ruptured eardrum turns out to be something much more

BirdStrike, MD

July 9, 2013Jul 9, 20136

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 …

Physician voices

Reflections after 4 years of emergency medicine training

Leana Wen, MD

July 3, 2013Jul 3, 20133

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,…

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

Physician voices

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

Greg Smith, MD

July 3, 2013Jul 3, 20136

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 …

Emergency medicine

Articles, page 63

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