For the majority of physicians in the U.S., taking their skills abroad and providing care via medical missions in undeveloped countries is usually not an option. For me, that was always an option. I am an OB-GYN who works as a locum tenens, a traveling physician who temporarily fulfills the duties of another. This has provided me the flexibility to have …
Locum tenens prepared me to volunteer in undeveloped countries
It’s Saturday night at an emergency department (ED) in Boston, MA, and I am faced with a medical student’s dream dilemma: which one of the many interesting cases should I observe? Should I watch trauma surgeons operate on the 17-year-old gunshot victim or work with the ED docs to assess whether a 59-year-old woman is having an acute stroke? That is exactly what I adored about emergency medicine as a …
How my ER rotation turned me into a primary care doctor
It’s 3:30 am and my clock alarm is singing some song that I used to like. I roll over to turn it off all the while thinking to myself: “I am waking up to stand for the next 12 hours straight holding a retractor. No one is going to care that I am there, and if I am even acknowledged …
To the health professionals during hurricane Sandy: Thank you
Of all the complex, costly, and downright intimidating issues in U.S. healthcare today, Super Storm Sandy tops my list as the scariest.
Even though hospitals from the Carolinas to Maine deployed their emergency plans and had extra providers on site to deal with the expected influx of patients, those in the hardest hit areas couldn’t withstand such a powerful storm surge.
Like many …
Hurricane Sandy’s profound impact on population health
The 2012 Presidential election is over. Obamacare is the law of the land and is certain to remain so. There was tremendous uncertainty not knowing whether the law would be repealed, revised or remain. Many of us opposed the bill, and there certainly are negatives. Like it or not, it is time to “get over it,” and not a second later than now. …
How Obamacare will create a new normal for medicine
I was skeptical about the iPad Mini. I’ve used my Retina display iPad (3rd generation) for the past six months and been satisfied with the experience.
I’ve used it in the hospital setting during rounds, and even while talking to patients in the ER. I’m able to easily pull up Epic’s EMR using the Citrix app, and I can easily store the iPad …
Why the iPad Mini is the tablet physicians have been waiting for
I have a lovely pen. It’s a Mont Blanc Meisterstück fountain pen. My group bought it for me on my tenth anniversary as a partner in our emergency medicine practice.
It’s a luxury I would never have paid for myself, though I have loved and used fountain pens since I was in college. Ironically, about the time I got it, the window …
My experience with a scribe in the emergency department
Most modern American are familiar with the classic political novel, Atlas Shrugged. Love or hate it, the novel had a great impact on political thinking in the West. If you haven’t read it, or aren’t familiar, one of the fundamental questions author Ayn Rand asks is this: what if the producers and innovators of society simply stopped trying? What if they …
If Atlas shrugs off healthcare, it will be a dark day
The crowded emergency department (ED): It has become a symbol for our fragmented, inefficient health care system.
In the wake of Hurricane Sandy, the visual has become more familiar than we’d like – the young and the old slumped forward on rigid plastic chairs in the waiting room, occupied stretchers lined up in tandem in the hallway. Some of these patients are sick enough to warrant a hospital admission but languish …
ED boarders: A new focus to mitigate overcrowding
Emergency care providers (emergency physicians and specialists on-call for the ER) are at a significant disadvantage when it comes to trying to get paid fairly for services rendered to enrollees of commercial health plans. Most other health care providers are able to: 1) screen prospective patients to make sure they will get paid appropriately for the care, 2) elect not to care for a plan’s enrollees, or participate in a …
How insurers take advantage of the EMTALA mandate
To hospital administration,
I am writing this letter to inform you that when I take my mandated influenza vaccine I will be doing so under protest and with the understanding that failure to do so could result in loss of my ability to earn income for myself and my family. Unfortunately, I do not qualify for any of the exemptions allowed by our facility. Since I am not religious, I have …
A physician takes his flu vaccine under protest
I pulled the stifling surgical mask off my face as I left my last patient’s room. I had just finished suturing a complicated facial laceration and was bone-tired from the evening. Glancing at the clock, I saw that mercifully, my shift was over.
Collapsing into my chair to finish up my charting, I was slightly annoyed when my nurse held a clip-board in front of my face, “Here is your next …
A rare case when needs of the dying should be secondary
I work at several hospitals and each uses a different electronic medical record system. When I switch from hospital one to another, I obviously have my favorite EMR systems and my not so favorite EMR systems. In the previous post, I was using the EMPOWER charting system, which I liked for its simplicity, but disliked because of the layouts of the charting interface and some of the macros it contained.
After …
More than half of my ER shift was spent on entering data
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The other night, a patient gave me a piece of his mind. Mr. Q was a middle-aged man debilitated by days of nausea, vomiting and intractable belly pain. That morning, his wife finally convinced him to get medical attention and drove him to our emergency department. On arrival, he sat in a cubicle in the waiting room and explained his story to a triage doctor: how he was doing well …
Repeated story syndrome: Finding the right balance for patients
In a recent post, you met Catherine, a young woman who came down with a stomach bug but was ushered through numerous blood tests and a CT scan, only to be even more confused than ever. You saw how shared decision-making needs to begin with the process of establishing a partnership for shared diagnosis, because diagnosis is the first and most critical step to your medical care.
Here …
5 steps to establish a partnership for shared diagnosis
I had an interesting twitter chat the other day with one of my colleagues, a young ER grad studying healthcare policy by the name of Seth Trueger. The Twitter conversation wound up involving about a dozen ER docs and nurses. You can review an edited summary over at Storify.
The point in contention is an interesting one: we know the nation’s ERs are overwhelmed and overcrowded. That’s old news. We also …
The volume of low acuity patients in the ER is not a myth
I was driving home from a night shift and the scorching sound of Texas guitars flamed out of my car speakers. The group ZZ Top was old, but the song was new. It went like this, “25 lighters on my dresser, yessir. You know I gotsta get paid.”
Mostly, I was shocked that any members of the band ZZ Top were still alive, …
An unexpected tip after treating a gang member in the ER
The New York Times recently had an important and provocative piece, “Overtreatment Is Taking a Harmful Toll.”
The title is a bit misleading. The article focuses more on overtesting. We test too much and we treat too much.
The article, while mostly accurate, does not really explain the reasons for the problem. Unless we can accept and understand the underlying reasons for these problems, we cannot successful correct these problems.
Let …
Reasons why doctors overtreat and overtest
Bill M. is a 22-year old college student who has had asthma and diabetes since he was a child. He comes in with trouble breathing because he has no primary care doctor and is out of his inhalers. While he’s in the ER, he also says that his diabetes hasn’t been followed for years, and now his blood sugars are out of control and he has new problems with his …
How the primary care shortage affects the ER
A guest post by the American College of Chest Physicians, exclusive to KevinMD.com.
In light of Hurricane Sandy’s impact upon the east coast, and subsequent effect on the area’s healthcare delivery systems, many physicians and healthcare professionals are likely considering how they would respond if disaster were to strike their community. From the decision making process and preparation for evacuation to evacuation …
What if Hurricane Sandy came to your city?
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