Emergency medicine

2,327 articles · Since 2004

Articles, page 70

An unexpected tip after treating a gang member in the ER

November 7, 2012Nov 7, 20127

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…

Mostly, I was shocked that any members of the band ZZ Top were still alive, …

Physician voices

Reasons why doctors overtreat and overtest

Robert Centor, MD

November 7, 2012Nov 7, 201212

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,…

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 …

Physician voices

How the primary care shortage affects the ER

Leana Wen, MD

November 6, 2012Nov 6, 20123

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 …

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Physician voices

What if Hurricane Sandy came to your city?

ACCP

November 6, 2012Nov 6, 2012

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…

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 …

Physician voices

More information does not equal better care

Richard Young, MD

November 1, 2012Nov 1, 20122

A very insightful editorial appeared recently in the Archives of Internal Medicine.The article gave several examples of overdiagnosis in medicine, but I thought the authors did a particularly good job explaining the false hope of CT scanning to detect pulmonary…

A very insightful editorial appeared recently in the Archives of Internal Medicine.The article gave several examples of overdiagnosis in medicine, but I thought the authors did a particularly good job explaining the false hope of CT scanning to detect pulmonary emboli. Emboli occur most often when a blood clot in the veins of the legs breaks off, travels through the right side of the heart, and gets stuck …

Health policy

ER utilization shouldn’t be a measuring stick for health care reform

Chris Rangel, MD

November 1, 2012Nov 1, 20129

Mitt Romney’s “let them eat cake” comments on 60 Minutes serves to illustrate how badly both sides of a political debate can confuse an issue. In 2010 he criticized emergency room care as a potential loophole used by people to…

Mitt Romney’s “let them eat cake” comments on 60 Minutes serves to illustrate how badly both sides of a political debate can confuse an issue. In 2010 he criticized emergency room care as a potential loophole used by people to get “entirely free care” while avoiding having to pay for health insurance and in his book No Apology, the Governor outlined the idea behind Massachusetts health care …

Physician voices

Emergency physicians who love their guns

Edwin Leap, MD

November 1, 2012Nov 1, 2012

When I was a resident physician, I had the coolest classmates ever. We worked together, laughed together, learned together and many of us stay in touch to this day. Our practices have crossed the gamut of emergency medicine, with some in academics, some in private practice, some administrators, two involved in auto-racing medicine, one a bush-pilot/fishing guide and one an amateur mountaineer.

But one of the things that united us, one …

Physician voices

Is customer satisfaction in healthcare a gateway to corruption?

Edwin Leap, MD

October 24, 2012Oct 24, 20125

Customer satisfaction is quite the rage these days. Many stores and restaurants, many professional offices, hand out surveys, or ask customers to log onto their survey site on the Internet. As a reward, one may win everything from a free…

I’d be interested to know how customer satisfaction played out in my home. “Kids, now you’ve had a week of school-work. Please fill out the attached survey …

Patient voices

Preparing for your doctor’s visit: 10 things to always bring

Leana Wen, MD

October 23, 2012Oct 23, 20127

Most patients I see are surprised to find out that there’s something they should have brought to their doctor’s visit. Granted, I’m an emergency physician, and many of my patients come to me in emergency situations that they can’t plan for. However, most people have some heads-up for going to their doctor. Certainly if you’re going to your annual check-up or a routine appointment, you should bring these items with …

Physician voices

I have seen faith present its various faces many times

StorytellERdoc, MD

October 22, 2012Oct 22, 20124

Faith. A simple word with complicated meaning. It is a seed buried deep within our spiritual cores, ready to be nourished and blossom with the sprinklings of tragedy. It is a belief that things will work out, despite our lack of vision for fate’s secretive reasons of the bumpy journey we must endure. It is an inherent hope that has either sustained us or has failed us miserably. Yes, to …

Physician voices

My worst nightmare was not coming true, someone else’s was

BirdStrike, MD

October 19, 2012Oct 19, 20124

Some cases burn into your brain like a hot branding iron, for whatever reason, and never really leave. This was one of those cases. One hectic morning before my shift, my wife and I rushed around the house trying to…

Some cases burn into your brain like a hot branding iron, for whatever reason, and never really leave. This was one of those cases.

One hectic morning before my shift, my wife and I rushed around the house trying to get our kids ready for school. On this day, my daughter was to go on a field trip where the teachers would walk the kids through the city to the local …

Physician voices

To the patients who resent greedy doctors

BirdStrike, MD

October 16, 2012Oct 16, 201231

- Johnathan Blaze It is generally agreed upon that the more one values a good or service, the more he or she is willing to pay for it. Most will agree that shoes are important. They keep your feet from…

Good, it’s about time that these greedy doctors get smacked down for being the financial rapists that they are. Medicine in this country is the biggest, most destructive SCAM going on today. Doctors think they are entitled to RIDICULOUS amounts of money for simple routine procedures.
– Johnathan Blaze

It is generally agreed upon that the more one values a good or service, the …

Health policy

Reduce health waste through deregulation and free market principles

WhiteCoat, MD

October 14, 2012Oct 14, 20125

Emergency Physicians Monthly has an important debate between ACEP President David Seaberg and EP Monthly founder Mark Plaster about the “Choosing Wisely” program. Choosing Wisely is being pushed by the ABIM Foundation as a way to get specialty societies to…

Emergency Physicians Monthly has an important debate between ACEP President David Seaberg and EP Monthly founder Mark Plaster about the “Choosing Wisely” program.

Choosing Wisely is being pushed by the ABIM Foundation as a way to get specialty societies to label certain tests as “unnecessary” or of questionable benefit.

I side with Dr. Seaberg in this argument.

I disagree with the concept some people advance …

Physician voices

My flirtation with the ER has made me more sympathetic to patients

Leana Wen, MD

October 10, 2012Oct 10, 20124

As emergency physicians who are trained in acute resuscitation and thrive in high-stress situations, we tend to roll our eyes at the less acute complaints our patients come in with. “Back pain for three months? Headache for a week? Why…

Patients, too, complain about this. “Can’t they see it’s not a real emergency and go see their primary care doctor? This must be costing our healthcare system …

Physician voices

Cause of death: Defensive medicine

BirdStrike, MD

October 5, 2012Oct 5, 201211

1. A 40-year-old female sees her family physician for burning chest pain after she eats hot peppers. She had it only once while exercising. Her family physician sends her to the emergency department and she gets admitted for chest pain. Rather than going home with treatment for her GERD, she ends up dead. This never should have happened, but the family never learns what really killed her.

2. A 33-year-old father of …

Read more…

Cause of death: Defensive medicine

Physician voices

When patient histories start to blur

Greg Smith, MD

October 3, 2012Oct 3, 20122

I am guilty of neglect. I’ll admit it. I’ll own it. I’ll embrace it. When I am doing a consult now for one of many hospital emergency rooms, I am sent a pretty standard package of history, nurses notes, doctor’s…

I am guilty of neglect.

I’ll admit it. I’ll own it. I’ll embrace it.

When I am doing a consult now for one of many hospital emergency rooms, I am sent a pretty standard package of history, nurses notes, doctor’s assessment, physical exam report, lab results and other information that I review prior to actually seeing the patient on the screen and doing my own assessment. Now, on a day like today, …

Read more…

When patient histories start to blur

Physician voices

Speak the truth, document the truth: To do otherwise is malpractice

Edwin Leap, MD

October 1, 2012Oct 1, 201210

I remember a short lecture I received in my medical officer's course when I joined the Air National Guard around 1988. The room was full of young medical students, physicians, nurses, and other health care folks who were beginning their…

I remember a short lecture I received in my medical officer’s course when I joined the Air National Guard around 1988. The room was full of young medical students, physicians, nurses, and other health care folks who were beginning their service. The topic was appropriate documentation in the medical record.

Among the notable examples of what not to do was this gem, written by a medical officer about another officer’s wife: …

Physician voices

Why punishing medical mistakes won’t make patients safer

Edmund Kwok, MD

September 25, 2012Sep 25, 20126

An interesting story came across my desk recently. Apparently, some states in the U.S. have moved towards a punitive model in trying deal with medical errors and adverse outcomes – this particular story describes how Utah will no longer fund healthcare providers and hospitals for dealing with illnesses that resulted from avoidable errors and infections.

On the surface, it kind of makes sense – one should be punished for making a …

Physician voices

Doctors are practicing irrational medicine at the end of life

Monica Williams-Murphy, MD

September 22, 2012Sep 22, 20128

I just took care of a precious little lady, Ms. King (not her real name), who reminded me that, too often, we doctors are practicing irrational medicine at the end of life. We are like cows walking mindlessly in the same paths; only because we have always done things the same way, never questioning ourselves. What I mean is that we are often too focused on using our routine pills …

Physician voices

When patients stray from the common sense approach to health care

James C. Salwitz, MD

September 12, 2012Sep 12, 20127

It turns out that the practice of medicine is just common sense. If someone has fallen and their hip hurts, it is probably related. If someone does not have an infection, do not give an antibiotic. Exercise and good food…

Usually, patients understand this basic idea. The best chance of becoming and staying healthy is the simplest …

Emergency medicine

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