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Emergency medicine

2,327 articles · Since 2004

Articles, page 66

Physician voices

After the Boston Marathon, we are just like the rest of the world

17

A few years ago my best friend ran the Boston Marathon. She came back glowing, proud that she’d qualified, amazed by the crowds and energized by the feeling of community. Never once did she think that she could have died…

A few years ago my best friend ran the Boston Marathon. She came back glowing, proud that she’d qualified, amazed by the crowds and energized by the feeling of community. Never once did she think that she could have died from a bomb exploding at the finish line.

America seems to be facing tragedy after tragedy. From the Aurora shootings, to Sandy Hook Elementary, to the Boston Marathon bombings, each time …

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After the Boston Marathon, we are just like the rest of the world

Boston rises in the wake of tragedy

2

“Daddy, a bomb blew up in Boston!” That was how my 4-year old greeted me when I came home this evening. Of course, I already knew about the horrific attacks during the Boston Marathon, first on Twitter, then realizing the…

“Daddy, a bomb blew up in Boston!”

That was how my 4-year old greeted me when I came home this evening.

Of course, I already knew about the horrific attacks during the Boston Marathon, first on Twitter, then realizing the gravity of the event as mainstream media caught up.

I practice in Nashua, NH, which is about 45 minutes north of Boston.  But …

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Boston rises in the wake of tragedy

Physician voices

The rise of ultimatums in medicine: Do they work?

30

Has anyone else noticed the growing presence of ultimatums in medicine today? The New England Journal of Medicine published a discussion of the ethics of not hiring smokers. My hospital adopted this policy six months ago, and they are not…

Has anyone else noticed the growing presence of ultimatums in medicine today?

The New England Journal of Medicine published a discussion of the ethics of not hiring smokers.  My hospital adopted this policy six months ago, and they are not alone.   There is a tobacco blood test that new employees have to pass.  If they fail, they can look for a job elsewhere.  I do not know the exact details, but …

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The rise of ultimatums in medicine: Do they work?

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Patient voices

With health reform, flexibility is important

Flexibility is important these days, perhaps more than ever before. I'm reminded of this almost every time I order lunch at a fast food joint: "I'd like a double cheeseburger, please, with ketchup only." "You mean 'only ketchup,' don't you?"…

Flexibility is important these days, perhaps more than ever before. I’m reminded of this almost every time I order lunch at a fast food joint: “I’d like a double cheeseburger, please, with ketchup only.” “You mean ‘only ketchup,’ don’t you?” “Okay, a double cheeseburger with only ketchup.” “Right, got it, coming up!”

So many changes on the medical care horizon and everyone speaking a slightly different language — it’s bound to …

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With health reform, flexibility is important

Physician voices

A memorable introduction to the family

6

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…

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 …

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A memorable introduction to the family

Physician voices

Should family members be present when performing CPR?

6

“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…

“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 …

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Should family members be present when performing CPR?

Health policy

Make small bets during the era of health reform

3

–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…

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 …

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Make small bets during the era of health reform

Physician voices

Why coroners should fill out death certificates

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…

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 …

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Why coroners should fill out death certificates

Physician voices

We worship at the feet of pain and pills

57

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…

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 …

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We worship at the feet of pain and pills

Physician voices

The filtering of medical evidence has clearly failed

7

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?…

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 …

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The filtering of medical evidence has clearly failed

Physician voices

Why a malpractice win for doctors feels like a great loss

9

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…

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 …

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Why a malpractice win for doctors feels like a great loss

Physician voices

I’m a part time physician, and I’m not sorry

35

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…

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 …

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I’m a part time physician, and I’m not sorry

Physician voices

Embrace the gift that our patients are giving us

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.”…

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 …

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Embrace the gift that our patients are giving us

Physician voices

Visiting the ER on a day when others needed a heartfelt hug

2

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…

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 …

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Visiting the ER on a day when others needed a heartfelt hug

Patient voices

In one of the darkest days of my life, you cared for my mom

52

-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 week, she had…

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 …

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In one of the darkest days of my life, you cared for my mom

Physician voices

Scripting with patients is a silly game

22

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…

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 …

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Scripting with patients is a silly game

Physician voices

When doctors don’t know the cost of medical care

7

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…

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 …

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When doctors don’t know the cost of medical care

Physician voices

Working in an urgent care center: An assault on the soul

43

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…

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

…

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Working in an urgent care center: An assault on the soul

Physician voices

When end of life approaches: 2 pathways of care

2

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…

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 …

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When end of life approaches: 2 pathways of care

Physician voices

When doctors dissociate themselves from the stories of their patients

4

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…

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 …

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When doctors dissociate themselves from the stories of their patients

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