Emergency medicine

2,327 articles · Since 2004

Articles, page 71

The well woman visit: An easy way to obtain preventive services

September 12, 2012Sep 12, 20122

As an emergency physician, I tend to work on the other side of preventive care services. I see what happens when women don’t know about safer sex and birth control, and end up with complications from sexually transmitted infections. I…

As an emergency physician, I tend to work on the other side of preventive care services. I see what happens when women don’t know about safer sex and birth control, and end up with complications from sexually transmitted infections. I see what happens when women do not get routine screening for cervical cancer and struggle with life-threatening cancer. I see what happens with out-of-control hypertension and diabetes, and the heart attacks and strokes that …

Physician voices

After the ER visit, the financial nightmare begins

Christopher Chang, MD

September 5, 2012Sep 5, 20127

Imagine this scenario. A young child is playing in the yard when her pet dog bites her face. Bleeding, the child is rushed to the ER and the doctor offers to suture up the child's face. A parent will probably…

Imagine this scenario. A young child is playing in the yard when her pet dog bites her face. Bleeding, the child is rushed to the ER and the doctor offers to suture up the child’s face.

A parent will probably ask for a plastic surgeon to suture the face instead of the emergency room doctor.

As such, the plastic surgeon is called in and sutures up the face beautifully.

The child and family …

Physician voices

What health care can learn from the military

John Lee, MD

August 26, 2012Aug 26, 20126

While the typical physician is now accepting of the IT changes that are intruding into their work environment, he often does not understand the reasons or the strategic underpinnings for the push for the digitalization of health care. Being a typical modern consumer, he understands smartphones, online shopping, and email, but doesn’t understand concepts such as clinical data repositories, data warehouses, decision support and business intelligence. Analogies can help, but …

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Artificial death extension: It means that I actually care

Monica Williams-Murphy, MD

August 25, 2012Aug 25, 20129

The names of things often greatly affect our perception. In end of life lexicon, there is a movement underway to change the name of the medical order DNR (do not resuscitate) to AND (allow natural death). No change in the…

DNR: “They withholding a medical intervention” (evoking negative feelings).

AND: “They are giving care that …

Physician voices

Are emergency department pediatric transfers always necessary?

Christopher Johnson, MD

August 24, 2012Aug 24, 2012

There are about 27 million visits by children to America’s emergency departments each year. About a quarter of those are to rural EDs or ones at some distance from a dedicated children’s facility, such as a children’s hospital. Over the last decade or so it’s become clear that, for critically ill children, early transfer to an advanced pediatric facility improves outcomes. The children do better if they can be transferred …

Physician voices

Mandating care in the ER but not payment: Why that’s a problem

Thomas Pane, MD, MBA

August 16, 2012Aug 16, 20129

A recent case from Dayton, OH highlights the tangled mess of emergency department specialty coverage, federal law, and out-of-network insurance benefits. When these interact, patients, doctors, insurers and hospitals can be left frustrated and perplexed. Here’s a brief summary. A…

Here’s a brief summary.

A 6-year old boy suffered a fingertip injury and the emergency staff called the covering plastic surgeon, who repaired the injury. The surgeon, who does not participate with insurance, submitted a bill for …

Health policy

Why must medical care be provided for free?

Edwin Leap, MD

August 16, 2012Aug 16, 201238

Our septic tank backed up recently. When I say backed up, I mean, into the basement. And when I say into the basement, I mean, out of the bathroom and onto the carpet. And under the walls. The stars were aligned, and I had to go to work. My wife borrowed a Shop-Vac and rented a steam cleaner. I was assigned to call the septic-tank guy. The kids helped clean …

Physician voices

Is the death of Rory Staunton really the result of a simple mistake?

Skeptical Scalpel, MD

August 8, 2012Aug 8, 20122

If you pay attention at all to news about medicine, you must have heard about the tragic death of a 12-year old boy who was seen and discharged from the emergency department of the prestigious New York University Medical Center. He had developed sepsis from what appears to have been a small cut and the diagnosis was missed. When he eventually returned to the ED and was admitted, it …

Physician voices

Improving medical care needs to involve the doctor

Leana Wen, MD

August 2, 2012Aug 2, 20128

A few days ago, I received a question that stopped me in my tracks. I was giving a talk to a local church group on the importance of patient advocacy, and most everyone was nodding. Yes, doctors don't always listen…

Then someone raised her name. Her name is Susan, and she is the owner of a mom-and-pop grocery in …

Physician voices

Doctors experience trauma to their hearts and stress to their souls

Edwin Leap, MD

July 23, 2012Jul 23, 20127

I was talking to some new friends over lunch recently, at the nationally renowned Hominy Cafe, in Charleston, SC. Any place with a fried green tomato BLT, and shrimp and grits for breakfast, has my vote! To the point: my…

To the point: my question to these esteemed emergency medicine educators was this: “Do you ever have irrational fears about the people you love, because of …

Conditions and diseases

MKSAP: 79-year-old man with vertigo

mksap

July 21, 2012Jul 21, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 79-year-old man is evaluated in the emergency department for vertigo that began suddenly about 1 hour ago, associated with severe nausea and vomiting.…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 79-year-old man is evaluated in the emergency department for vertigo that began suddenly about 1 hour ago, associated with severe nausea and vomiting. He noticed that he could not seem to sit up straight and could not walk without assistance. The patient denies confusion, motor weakness, hearing loss, dysarthria, diplopia, fever, or paresthesias. …

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MKSAP: 79-year-old man with vertigo

Physician voices

5 questions to change your end-of-life path

Monica Williams-Murphy, MD

July 1, 2012Jul 1, 20125

I had just put him on a ventilator. Mr. Barnes (not his real name) had come in by ambulance sweating, barely responsive, gasping for air. The paramedics said he was from the local rehabilitation hospital and had just been sent there 2 weeks ago after a protracted hospitalization for a stroke which had left him partially paralyzed. Then they showed me medical orders indicating that he was “full code,” medical …

Physician voices

Burdening families with CPR decisions in the face of futility is cruel

Monica Williams-Murphy, MD

June 13, 2012Jun 13, 201217

Those who know and work with me have heard me state without hesitation that it’s morally wrong to do CPR on 90-year old great grandmas. So, it was with great relief that I read the “Do Not Offer CPR” option in a recent JAMA article urging a revision of our present approach to the use of CPR for those who are unarguably at the end of life.

This is a change …

Health policy

The influence of fatigue on claim quality

Adam C. Powell, PhD

June 6, 2012Jun 6, 2012

While there is an extensive literature on how tired, overworked physicians provide lower quality medical care, one thing that has been ignored by advocates of quality improvement is that overwork financially harms hospitals as well. Just as tired physicians sometimes fail to attend to certain clinical details, they are also more likely to commit errors when writing the notes which ultimately are used during the coding process. If hospitals consider …

Physician voices

When self-evident truth in medicine is systematically ignored

Edwin Leap, MD

June 3, 2012Jun 3, 201216

Some things in medicine are obvious. Despite the endless worship of ‘evidence-based’ medicine, and the constant barrage of studies on every conceivable topic, we do certain things because we know they just seem right. I take as evidence the fact that we daily try to save lives, devoting research time, untold gazillions of dollars and heroic clinical effort to our continued goal of staving off death. Why is this? Do …

Physician voices

Protecting patients by solving the problem of defensive medicine

Ellis Weeker, MD

June 2, 2012Jun 2, 20124

In the United States many people feel it is their God given right to sue anyone, anytime for anything. Whether you are successful or not may be another story. So what are the cost implications for healthcare in the United States? Few other developed countries rely upon this method for resolving malpractice issues. What is the cost-benefit equation? To protect themselves, American physicians practice what is called defensive medicine designed …

Medical education

Patients are more than multiple choice questions

Rick Pescatore, DO

May 27, 2012May 27, 2012

It felt good to stuff the stethoscope back into my pocket and slip into the emergency department last night. The constant ringing of phones, beeping of cardiac monitors, and distant wail of inbound EMS units was a welcome cacophony compared to the isolated silence of the library study rooms. Sweeping the curtain back as we stepped into the first patient room, the hours of frustration with biochemical pathways and embryological derivatives …

Physician voices

What medicine can learn from the Titanic

Rushil Patel

May 26, 2012May 26, 2012

April 15th marked the 100th anniversary of the sinking of the Titanic, yet the mystique surrounding its demise has not faded. When the colossal vessel first collided with the iceberg, eyewitness accounts described an eerie sense of serenity that pervaded the ship. Passenger J.J. Astor even remarked, “We are safer here than in that little boat,” before later drowning.

To prefer drowning over safety strike us as irrational, but this behavior …

Medical education

Medicine involves a tension between isolation and connection

Reflex Hammer

May 19, 2012May 19, 20129

I was skeptical when a doctor casually mentioned that 2% of all pregnancies are ectopic pregnancies (in which the fertilized egg is implanted somewhere other than the uterus, usually the fallopian tube). Without treatment, a common outcome is fallopian tube rupture, which jeopardizes the life of the mother. It is a serious medical concern. I shot a confused look at a fellow first-year medical student. Two percent? It seemed way …

Physician voices

Keep the care in the health care

Myles Riner, MD

May 18, 2012May 18, 20123

I believe the greatest challenge in medicine today is keeping the "care" in healthcare. One of the most frustrating aspects of practicing medicine for me had to do with how difficult it had become to incorporate caring into my practice.…

I believe the greatest challenge in medicine today is keeping the “care” in healthcare. One of the most frustrating aspects of practicing medicine for me had to do with how difficult it had become to incorporate caring into my practice. I am not necessarily talking about the kind of caring associated with having a long-term, close and mutually appreciated association with my patients: if that had motivated me, I would …

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Keep the care in the health care

Emergency medicine

Articles, page 71

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