Although I rarely get sick with the numerous strains of “bugs” that seem to go around our community this time of year, the week prior to my return to work for my next scheduled string of four shifts was spent mainly in bed, coughing and aching and whining about how miserable I felt. Fully recovered, though, I was excited to return to the emergency department to do my fair share …
A memorable introduction to the family
“We’re doing everything we can,” I said as I put my hand on the sobbing woman’s shoulder. “We’re going to keep trying for about 10 more minutes, but I don’t know if we’re going to be successful with this.”
These are the moments that are truly difficult in my job. Telling people their loved ones have passed away, or preparing them for what seems inevitable.
“You can do it!” the woman said …
Should family members be present when performing CPR?
A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be.
–Wayne Gretzky
Recently, I attended an end-of-year review with one of our hospital partner’s executive team. We reviewed our performance for the past year, and discussed mutually strategic goals and how to improve upon our excellent service. As part of the conversation turned …
Make small bets during the era of health reform
I happened to read an article in the Columbus (Ohio) Dispatch where Ohio coroners are complaining because some doctors, including emergency physicians, are refusing to sign death certificates listing a patient’s cause of death. The coroners are concerned because they are being “burdened” with hundreds of extra cases every year that they must handle. And if other doctors don’t sign off on the cause of death, sometimes it takes two …
Why coroners should fill out death certificates
I just finished reading Neil Gaiman’s fascinating novel, Gods of America. I first learned about his work by watching the movie Stardust, then reading the novel.
One of the themes of Gods of America is that the deities of the old world came to America in the hearts of their followers, but over time lose their followers and thus their power. A war is arranged between the …
We worship at the feet of pain and pills
Let me tell you about this fabulous new test – it’s far better than the old tests, I’ve got a decade’s worth of research publications to show you, plus it’s a floor wax and a dessert topping.
Who am I? Why, I’m simply an academic clinician, advocating for this test because it’s the next great thing to help us tailor treatments to patients. Does it matter that I’m on the unofficial …
The filtering of medical evidence has clearly failed
My kid and I are outside in the front yard blowing bubbles, enjoying the blue skies and 70 degree weather when she says, “Cool Daddy! Look, there’s a police car coming down the street. Oh, cool! I think he’s coming to see us!”
Uh, oh, I think to myself. Despite my kid’s excitement, I know that rarely does anything good come delivered by a policeman. My wife is inside, my one …
Why a malpractice win for doctors feels like a great loss
I began the medical school application process 10 years ago. I was 23, single and most of my role models worked full time. I had no idea that a part-time medical career lay in my future. Quite a bit has changed since the days of hoping and praying and crossing my fingers for a medical school acceptance letter. In the past 10 years I have, at varying times, declared …
I’m a part time physician, and I’m not sorry
Everyone knows that life in the ER is fast-faced, extremely busy, and ever-challenging. When things get crazy, it becomes habit for busy physicians to see patients as “the chest pain in room 6” or “the broken wrist in the hallway.” We turn people with their amazing lives and fascinating stories into a nameless number and a “chief complaint”.
It’s a practice that’s easy to justify—after all, taking a long …
Embrace the gift that our patients are giving us
Sometimes as human beings, despite all the layers we consciously build upon the shell of our souls to shelter us, define us, and project an image to others of what we hope we are, our basic inherent quality of goodness emerges on its own free will. A kind word, a gentle touch, a hint of a smile, an understanding patience–these are all things that escape uncontrollably in moments where our …
Visiting the ER on a day when others needed a heartfelt hug
When you are sorrowful look again in your heart, and you shall see that in truth you are weeping for that which has been your delight.
-Kahlil Gibran
Dear Debbie,
You cared for my mom briefly in the ICU. You might not remember me, but I remember you. My mother, a healthy 54-year-old woman came down with the flu on Christmas. Within a …
In one of the darkest days of my life, you cared for my mom
Our nurses will soon have “scripting” guidelines for their interactions with patients. This is apparently widespread in many industries. The idea being, patients will be more satisfied with their care if certain key phrases are repeated to them; phrases which might, possibly, just maybe find their way onto satisfaction surveys. Wink, wink!
Whether I will have to engage in this tawdry bit of theater remains to be seen. But bless the …
Scripting with patients is a silly game
The Saturday after Sandy hit, I was the medical student in a Cambridge, Massachusetts emergency room. Around the time my shift started, Andrew, a man about my age, couldn’t bear the pain in his nose any longer. The ED nurse still talks about the “huge booger” bulging from his nose. A few days before coming to the ED, he’d left behind his flooded, powerless Brooklyn apartment seeking refuge in his …
When doctors don’t know the cost of medical care
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I recently received this email message from one of my residents who has moonlighted in a local commercial urgent care center. This message is reprinted with his permission just as I received it, except I removed the brand name.
Hey Dr. Young, I’m looking for some basic mentoring advice. I’ve been moonlighting at ZZZ Urgent Care for about a year. Not my favorite work, but oh well. I don’t routinely prescribe antibiotics …
Working in an urgent care center: An assault on the soul
It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity.
The woman lying on the gurney was motionless. Her chest moved up and down with a timid but halting regularity. The calmness of her face was in sharp contrast to the panicked despair of the …
When end of life approaches: 2 pathways of care
As trauma surgeons we often have to disassociate ourselves from the stories that surround our patients so that we can focus on their life-threatening injuries. It’s also how I personally cope with the devastating injuries to the patient and the aftermath left for the family. Sometimes, though, I am caught off guard and my defenses aren’t strong enough.
A middle-aged man was brought in one evening after being hit while riding …
When doctors dissociate themselves from the stories of their patients
I’m not old enough, in emergency medicine years, to identify with the struggle of those calling for the end of the term “ER.” The argument was about the “R” vs. the “D”: “It’s not a room!” It’s a department!” was the war cry. Then perceptions changed, battles were won, and along came the very popular TV show, “ER.” The war hawks quieted …
Emergency medicine: What is it exactly today?
My first night shift in a stretch of 7 was almost over. It was 6:15am and I had to keep moving otherwise the minute I would stop, my eyelids would drop like two ton shades and I’d fall asleep. That never makes for a good drive home after a night shift.
“Got time to see one more?” asked Jenny the nurse.
“Do I have …
The baby had a seizure: Why was the mother smiling?
An excerpt from When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.
One Friday, Jerry got the scare of his life.
Jerry is a 48-year old mechanic who is in good health. His parents are healthy, and he recently got a “clean bill …
What happens if the doctor isn’t sure?
Right now, the technology exists to completely transform healthcare.
A doctor should be able to walk into the room where a patient is waiting for them and get everything they need to make an informed decision about that patient’s care.
Location-based technology should sense the doctor approaching and already know which patient is waiting for them. A computer or a tablet in the room should have access to thousands of data points …
Technology is being held back from transforming healthcare
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