Defined as someone “having the faculties impaired by alcohol, those of us who work in an acute healthcare facility are witness to many illustrious examples of drunk patients coming through our doors.
Underaged kids passed out at a house party? Yup. Raging alcoholics who are brought into the ER at least once a week? Sure. Elderly women who secretly binges on wine …
The role of alcohol in health costs
As physicians, we know that no matter what care we provide, Medicare and private payers are going to do what they can to reduce payouts. For the health of the nation, healthcare spending simply cannot continue on its current trajectory. Reform measures such as accountable care organizations, bundled payments and penalties for potentially preventable complications and readmissions may help reduce expenditures, …
Protect yourself against fraudulent EHR documentation
I wanted to expand on something I wrote recently, which relates to my other sort-of-recent post on upcoding. I wrote, about scribes and compliance:
Knowing that the scribe cannot document a complete ROS unless I actually did that ROS, I am more compulsive about making sure I hit all ten systems. (Even when it’s not clinically relevant. Such is the Kafkaesque world we live in.) And I …
Medicare made the rules and now punishes doctors for following them
I was working in the ER this weekend when one of my nurses asked me a simple question: “How would you fix the health care system?” Obviously, this is a complex problem requiring complex solutions, but in an environment where at any minute a heart attack or a stroke could disrupt a conversation I prepared a sound bite for an answer.
“Do …
Fix our health system: Be like Switzerland
One of medicine’s ethical traditions is to relieve suffering whenever possible. I believe in this, and try to treat all of my patients as I myself would want to be treated under similar circumstances.
My dilemma is, even after practicing medicine for over 30 years, the definition of a “suffering patient” has become a moving target.
On the one hand, I hear arguments primarily from governmental agencies that presume to “advocate for …
The insanity of pain management in the ER
When you set out on an unfamiliar journey, you will need a map to get to your desired destination. You may pass landmarks, but not know exactly where you are unless you are able to identify these landmarks on your map. The same is true for the journey of life, and specifically, the path at the end of life.
You may know …
At the end of life, never underestimate the power of a map
When Newtown children returned to area elementary schools less than a week after the massacre at Sandy Hook Elementary, the cameras were watching, a reality that may slow healing in the Connecticut community.
Although there’s no literature that’s specific to the effects of a media frenzy after a school shooting on children’s psychological recovery, there’s plenty of other applicable evidence, according …
Why the media will slow the healing of Sandy Hook
“I kissed my daughter as she left for school today and realized it might be the last time I would ever see her.”
-New Jersey mom, three days after the Sandy Hook, CT shootings
On December 14, 2012, twenty school children died of the Gun Disease, shot making gingerbread houses. As guns beget guns, firearm injury and death spread like a virus. Doctors, the healthcare system, have failed to protect the most …
Stop the proliferation of guns by ending the fear
On Friday morning I was seeing a patient, chatting about the holidays. She had given me a gingerbread house making kit for my kids — which she had done annually since I had become her doctor.
“You are doing so well,” I declared, “Have a very Merry Christmas!”
“You too!” she said as we hugged and she left the examination room.
At 12pm …
As an oncologist, I thought I had the words to console the survivors
Is the medical profession doing enough about gun violence?
Are any of us? This is the question that we all must ask ourselves, in the wake of the incalculably sad massacre of little school children in Newtown, Connecticut.
I have struggled for days now to find the right words—how can I, or anyone else for that matter, find the words to describe the indescribable shared grief we have about the indescribable horror …
Are the healing professions doing enough to curb gun violence?
I remember the first gunshot wound I treated in the emergency department at Jacobi Hospital in the South Bronx 35 years ago. Only one of two I saw that month in the second busiest trauma ER in the country. Gang fight. Troubled youths. In the middle of the night. Hand guns.
We couldn’t save him. I was devastated. My chief resident, an aspiring trauma surgeon, took me aside and matter of …
Did I shoot them? Am I bleeding? And does all bleeding stop?
Since the massacre of innocent school children and those that gave their lives educating and trying to protect them this past Friday at Newtown Connecticut’s Sandy Hook Elementary School, I’ve struggled to make sense of this calamity as much as much as anyone.
As a physician who has worked to save the lives of sick and injured children, and as a father of children the same age as those massacred in …
The only words that explain Sandy Hook: Pure evil
The Newtown school shooting. It’s a tragedy that a mass shooting requires a qualifier, but this is America so we need to be specific as not to be confused with Aurora, Columbine, Arizona, or Virginia Tech. Colorado massacres require a site specific qualifier.
There are 2 common elements with all these massacres: mental illness and guns (not hunting rifles, but firearms designed to cause maximin human carnage in the shortest amount …
Both mental health and guns deserve our attention
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“Hi, I’m Edwin, and I own firearms!”
Right now, in the shadow of the horrors of the Sandy Hook shooting, it feels as if every gun-owner is on edge. Some are apologizing, distancing themselves from gun advocacy groups. Some are saying all the right words, “well, my target gun is locked in a safe.” Like telling your Baptist Preacher grandpa, “my whisky is in a cabinet and is only for medicinal …
A gun owner responds to Sandy Hook
While Hurricane Sandy’s fury wreaked havoc on the Northeast and caused massive destruction, one thing is for sure: Sandy’s wrath is no match for nurses’ strength.
Nurses’ role in the media is often overlooked because it often focuses on the heroic activities of the doctors. Health care isn’t a competition between nurses and doctors. Doctors and nurses are colleagues. Health …
Sandy’s wrath is no match for nurses’ strength
The events in Newtown, Connecticut will hopefully jump start a national conversation. That’s about the only solace I can take from the senseless murder of 20 schoolchildren in a classroom.
This conversation ought to transcend minutiae like the specifics of gun laws and gun show loopholes (although there will be a time for redressing these inanities). I don’t want to hear about …
Who’s responsible for Newtown? We all are, to some degree
I grew up in Connecticut. It was in a town just like Newtown. It was safe and it was quiet.
I am a father and a grandfather. My life is surrounded with children.
This weekend has been tough. You try to read or write something, but the mind wanders. Then you feel sadness. The more you think about the specifics, the sadder it gets. Your heart aches.
Our nation feels it. I recently …
I wonder about the mental effects of amplified noise
Please read the next few lines closely. This is not about the Constitution. Not about the “right to bear arms” or banning guns. Not about you answering this with some canned speech either way. Nor is it about having the answers. What it is about is the fact that even in small town America our neighbors have now learned what the big cities have known for a long time. It …
Do we make gun ownership a fifth vital sign?
The shootings at Sandy Hook Elementary School in Newtown, Connecticut have been traumatizing for the entire nation. While we have unfortunately become used to hearing about school shootings and other public mass shootings in the U.S., the brutal murder of 20 innocent elementary school children (all ages 6 and 7) is just too much to bear.
In fact, the moment …
How a psychologist explained Sandy Hook to his children
I will say this up front: Newtown, Connecticut will not be the last time tragedy strikes. For good or bad, in this age of social media including twitter, it is easier to track the coverage of this story and people’s opinions about it. I have been thinking about this constantly today, and talking with my friends and neighbors about what happened this morning.
Outlining the problems setting up this tragedy …
Newtown, CT will not be the last time tragedy strikes
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