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Emergency medicine

2,327 articles · Since 2004

Articles, page 64

Patient voices

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

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…

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

…

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

Physician voices

Should doctors be available to patients around the clock?

16

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…

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 …

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Should doctors be available to patients around the clock?

Physician voices

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

25

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.…

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 …

Read more…

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

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Medical education

Every doctor can learn from a medical coder

16

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…

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 …

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Every doctor can learn from a medical coder

Conditions and diseases

MKSAP: A 56-year-old woman with a severe generalized headache

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 56-year-old woman is evaluated in the emergency department for sudden onset of a severe generalized headache that began 36 hours ago and has…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 56-year-old woman is evaluated in the emergency department for sudden onset of a severe generalized headache that began 36 hours ago and has not responded to over-the-counter medications. The patient has a history of hypertension treated with lifestyle modifications. She has a 30-pack-year smoking history.

On physical examination, blood pressure is 148/68 mm Hg, …

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MKSAP: A 56-year-old woman with a severe generalized headache

Health policy

The ER is a cost effective place to receive acute care

6

There is a persistent narrative about emergency rooms. This narrative says that emergency rooms are overly expensive places to receive healthcare, that they are a cost drain on the hospitals they are attached to, and that they are a key…

There is a persistent narrative about emergency rooms. This narrative says that emergency rooms are overly expensive places to receive healthcare, that they are a cost drain on the hospitals they are attached to, and that they are a key driver of rising healthcare costs.

A RAND study released recently challenges most of that narrative, and lends support to a view that most of us emergency physicians have long held: that …

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The ER is a cost effective place to receive acute care

Physician voices

A hospital transfer may not always be a good thing

6

Injury to the brain continues to be a unique thing in medicine. These injuries are scary and unfamiliar to many health care providers. There is a finality to them. Their consequences are hidden a little bit; the asystole is easy…

Injury to the brain continues to be a unique thing in medicine. These injuries are scary and unfamiliar to many health care providers. There is a finality to them. Their consequences are hidden a little bit; the asystole is easy to figure in the emergency room but the suppression and brain death isn’t something so easily recognized.

They’re what you might imagine, along with polytrauma, as poster child conditions for tertiarization …

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A hospital transfer may not always be a good thing

Physician voices

Being called to assist with an in-flight medical emergency

8

Most doctors have a story about being called to assist with an in-flight medical emergency. I have yet to earn one for myself, but my favorite story - passed down from resident to resident - goes something like this: An…

Most doctors have a story about being called to assist with an in-flight medical emergency. I have yet to earn one for myself, but my favorite story – passed down from resident to resident – goes something like this: An airline attendant called for a veterinarian’s help. When no one answered, they settled for a doctor and an anesthesiology resident stepped up. He learned that a passenger traveling with her …

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Being called to assist with an in-flight medical emergency

Physician voices

Psychiatric patients don’t fit the usual medical mold in the ED

9

The ED is a hectic place. Sore throats. Heart attacks. Dog bites. Broken bones. Strokes. Major trauma. If you work in an ED, you see it all. And then some. Is it any wonder then, with the potential for literally…

The ED is a hectic place.

Sore throats. Heart attacks. Dog bites. Broken bones. Strokes. Major trauma. If you work in an ED, you see it all. And then some.

Is it any wonder then, with the potential for literally thousands of medical and surgical problems to stumble through the doors of an ED, that hospitals and the bodies that accredit them demand strict, regimented, standard, reproducible emergency assessments …

Read more…

Psychiatric patients don’t fit the usual medical mold in the ED

Health policy

Are ER services really the cost villains?

7

Maligned over the last decade as places to avoid because of the price of the care they delivered, a study by the RAND Corporation goes a long way toward improving the image of hospital emergency rooms (ERs). The ER price…

Maligned over the last decade as places to avoid because of the price of the care they delivered, a study by the RAND Corporation goes a long way toward improving the image of hospital emergency rooms (ERs). The ER price tag was too high for the insurance companies that paid the bills, so many of them tried to discourage ER use by designing policies with high coinsurance and copayments …

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Are ER services really the cost villains?

Physician voices

Fear is a primal emotion in medicine

3

An excerpt from What Doctors Feel: How Emotions Affect the Practice of Medicine. Excerpted with permission by Beacon Press. The stat cardiac-arrest page came through on my beeper at exactly the same moment as the hospital-wide PA system announced, “Code…

An excerpt from What Doctors Feel: How Emotions Affect the Practice of Medicine. Excerpted with permission by Beacon Press.

The stat cardiac-arrest page came through on my beeper at exactly the same moment as the hospital-wide PA system announced, “Code 411, cardiac arrest, MICU.” The operator chanted the mantra over and over with studied deliberativeness, as though there were even a snowball’s chance in hell that I hadn’t heard …

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Fear is a primal emotion in medicine

Patient voices

We need an Apple Genius Bar for patients

20

Have you ever been to a Genius Bar at an Apple store? The last time I was there -- checking out a pesky problem on my iPhone -- I couldn't help but wonder: why can't we have something like that…

meet_genius

Have you ever been to a Genius Bar at an Apple store?

The last time I was there — checking out a pesky problem on my iPhone — I couldn’t help but wonder: why can’t we have something like that to deal with our common health issues?

Genius Bars are located in Apple Stores in  easy-to-access shopping areas, like malls. The Genius Bars are …

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We need an Apple Genius Bar for patients

Physician voices

Being a psych patient in the emergency department

8

So you’re in the emergency department, probably in a small, windowless room, dressed in paper (or, if you’re lucky, crazy green cotton cloth) scrubs. You’re lying in a bed with a plastic mattress and scratchy sheets staring across the room…

So you’re in the emergency department, probably in a small, windowless room, dressed in paper (or, if you’re lucky, crazy green cotton cloth) scrubs. You’re lying in a bed with a plastic mattress and scratchy sheets staring across the room at the door that has a small chicken-wire reinforced tempered glass windowlette in it and is ajar just enough to let you see the shiny black shoe of the security …

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Being a psych patient in the emergency department

Social media in medicine

Why you shouldn’t give medical advice on Twitter

9

A few weeks ago I was following an online discussion conducted by a widely followed health site. During the discussion, they had a physician who was giving out wellness advice to users via Twitter. That physician had one tweet in…

A few weeks ago I was following an online discussion conducted by a widely followed health site.

During the discussion, they had a physician who was giving out wellness advice to users via Twitter.

That physician had one tweet in particular that terrified me.

Medical-twitter14-338x600

Medical-twitter23

As the above screenshot shows, one tweet mentioned that when in doubt regarding …

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Why you shouldn’t give medical advice on Twitter

Health policy

How the medical profession is being forced to game the system

18

I attended a medical staff meeting recently. These are required meetings and attendance is taken, as was done when we were in kindergarten. While some folks are interested in these meetings’ content, many are not and simply sign the attendance…

I attended a medical staff meeting recently. These are required meetings and attendance is taken, as was done when we were in kindergarten. While some folks are interested in these meetings’ content, many are not and simply sign the attendance sheet and then slither out in a stealth fashion. Sly doctors grab their pagers and then leave hurriedly pretending that they were summoned to an urgent medical situation, when they …

Read more…

How the medical profession is being forced to game the system

Physician voices

Saving the patient a trip to the ER is harder than it looks

16

I read the New York Times. I read the health section as much as I can to keep track of what the paper is saying about health-related issues. I read Jane Brody. I like Jane Brody. I’m not sure what…

I read the New York Times.  I read the health section as much as I can to keep track of what the paper is saying about health-related issues.  I read Jane Brody.  I like Jane Brody.  I’m not sure what Ms. Brody is, but I don’t think she’s a clinician.

In her article “Avoiding Emergency Rooms,” she makes some suggestions on how people should get care if they need …

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Saving the patient a trip to the ER is harder than it looks

Health technology

Bedside ultrasound tips for the general internist

7

I first picked up an ultrasound transducer 17 months ago, at an emergency medicine ultrasound course at Harvard University. I had just barely heard about using ultrasound as a clinical tool and was vaguely interested. The course was 3 days…

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I first picked up an ultrasound transducer 17 months ago, at an emergency medicine ultrasound course at Harvard University. I had just barely heard about using ultrasound as a clinical tool and was vaguely interested. The course was 3 days long and cost a little under $700 and changed my life forever and made me a better doctor.

Emergency physicians have embraced the …

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Bedside ultrasound tips for the general internist

Physician voices

Inspired after seeing my 5-year-old patient

6

Off I go to work a few shifts at a desperately understaffed rural hospital in a state far away. The rental car GPS leads me to the ED address and it’s not there. All that is there is what looks…

Off I go to work a few shifts at a desperately understaffed rural hospital in a state far away.  The rental car GPS leads me to the ED address and it’s not there.  All that is there is what looks like a small supermarket with a funeral home next door.  I see a security guard in the parking lot.  He has a lump in his cheek and a badge that says “Sam.”  …

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Inspired after seeing my 5-year-old patient

Health policy

Transitional care programs are ripe for innovation

Right now hospitals around the country are being asked to reckon with some stark realities regarding readmissions. $17 billion a year is spent on readmissions for Medicare patients alone, and 75% of those readmissions are considered to be preventable. Of…

Right now hospitals around the country are being asked to reckon with some stark realities regarding readmissions. $17 billion a year is spent on readmissions for Medicare patients alone, and 75% of those readmissions are considered to be preventable. Of all Medicare patients who are admitted to a hospital, 18 percent will be readmitted in 30 days and of those, 50 percent will not have seen a primary care physician …

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Transitional care programs are ripe for innovation

Physician voices

It’s time to treat mental illness in the ER with dignity

55

We doctors who specialize in psychiatry have a sacred trust. We are given the opportunity to talk to people who are hurting every day, people who trust that we will listen to them, try to understand them, not laugh at…

We doctors who specialize in psychiatry have a sacred trust. We are given the opportunity to talk to people who are hurting every day, people who trust that we will listen to them, try to understand them, not laugh at them, and not think that they are stupid, crazy, or horrible. A tall order, granted, given that we hear stories that sometimes border on the unimaginable, bizarre and otherworldly. This …

Read more…

It’s time to treat mental illness in the ER with dignity

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