Emergency physicians, nurses, and residents writing on KevinMD from the emergency department: acute care, the realities of the ER, boarding and overcrowding, violence against staff, and medicine practiced under pressure. Most contributors work in emergency departments. For what emergency physicians and nurses have said about being assaulted at work and told it was part of the job, see Violence against health care workers: what physicians and nurses say, in their own words. For what emergency physicians wrote in the first weeks and months of the pandemic, see COVID-19: what physicians wrote as it happened. For what emergency physicians and pain patients have said about opioid prescribing, see Opioids: what physicians and pain patients say, in their own words. For what physicians in the highest-burnout specialty have said about burnout since 2009, see Physician burnout: what physicians say, in their own words.

Is medical technology making doctors less relevant?

Conditions and Diseases
September 23, 2009

It happens over and over. I call a surgeon about a patient with abdominal pain.

‘Well, what’s the white count?’

‘Normal.’

‘Did you get a CT Scan?’

‘Yes, and it was normal. But they just look uncomfortable.’

‘Sounds like nothing for me to do. Call the hospitalist.’

It happens in other specialties. Cardiologists who aren’t interested in a patient with a normal stress test, pediatricians unimpressed with negative chest x-rays and normal labs. ENT’s unconcerned if …

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Is medical technology making doctors less relevant?

How will the H1N1 vaccine be distributed to patients?

Conditions and Diseases
September 21, 2009

by Michael Smith, North American Correspondent, MedPage Today

A minimum of 3.4 million doses of vaccine against H1N1 pandemic flu will be available in the first week of October, the CDC said.

medpage-today Those doses — all in the form of a live attenuated nasal spray vaccine — may be supplemented by some injectable vaccine, according to Jay Butler, MD, the …

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How will the H1N1 vaccine be distributed to patients?

Violence in the emergency department and how to promote ER safety

Physician
September 12, 2009

by Patricia B. Allen, MBA, RN

What would you differently tomorrow if you had a violent episode in your emergency department today?

Violence in the ED is a growing and alarming phenomenon. A recent survey conducted by the Emergency Nurses Association (ENA) revealed that 25 percent of the RN respondents report experiencing physical violence more than 20 times in the past three years and 20 percent of the respondents revealed encountering …

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Violence in the emergency department and how to promote ER safety

The drama of using tPA in stroke within the three-hour window

Conditions and Diseases
September 6, 2009

Before telling this story, I’m going to have to lay some background for my non-medical readers.

The most obscene word in English, in my opinion, has three letters and is an acronym. It’s tPA (it stands for Tissue Plasminogen Activator).

This drug gets a lot of press as a “clotbuster.” It has the potential to break down clots and reverse a stroke. That potential, however, has a dark side. By breaking down …

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The drama of using tPA in stroke within the three-hour window

Are relationships being lost in medicine, and are hospitalists partly responsible?

Physician
August 29, 2009

An emergency physician, like me, may be the worst possible person to discuss relationships with patients. I mean, one of the reasons I chose this specialty was that I didn’t want long-term relationships with my patients. I see, now, that God has a great sense of humor.

See, the county I landed in after residency is small enough that I do know many of my patients, and I do see them …

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Are relationships being lost in medicine, and are hospitalists partly responsible?

Vicodin and Percocet banned and taken off the market, or is a black box warning more likely?

Medications
June 30, 2009

The FDA has declared war on acetaminophen, with Vicodin and Percocet being collateral damage.  You can bet Dr. Gregory House is sweatin’ pretty hard over this news.

In the last few days, acetaminophen, otherwise known as the brand name Tylenol, has been squarely in the FDA advisory panel’s crosshairs. In general, it’s a very safe medication, but there is …

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Vicodin and Percocet banned and taken off the market, or is a black box warning more likely?

Did Demerol cause Michael Jackson’s cardiac arrest and death?

Conditions and Diseases
June 26, 2009

Michael Jackson’s death continues to consume the news cycle.

There is currently no clear explanation. Some have speculated that it may be related to the narcotic pain drug, Demerol. According to this report from the UK’s The Sun, “An Emergency Room source at UCLA hospital said Jackson aides told medics he had collapsed after an injection of potent Demerol …

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Did Demerol cause Michael Jackson’s cardiac arrest and death?

5 top medical comments, June 14th 2009

Patient
June 14, 2009

Here are some of the more interesting comments readers have left recently.

1. Carla Kakutani on how Massachusetts’ health reform won’t relieve ER overcrowding:
Insurance does not equal access (although it’s better than nothing). Nothing changes until every stakeholder recognizes they have to control costs and allow a rebuilding of primary care in the US. That includes doctors and patients, along with everybody’s favorite villains, the insurance companies and big pharma. …

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5 top medical comments, June 14th 2009

6 top medical comments, May 10th, 2009

Physician
May 10, 2009

Here are some of the more interesting comments readers have left recently.

1. Anonymous on whether emergency physicians best served to staff urgent care centers:
As an ED doc, I understand the problem. We are taught to always rule out the emergencies, and I am constantly worrying about the worst case scenario, and likely will order more tests since they are at my disposal, which is …

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6 top medical comments, May 10th, 2009

Can you really kill a man by gluing his anus shut?

Potpourri
May 9, 2009

A recently reported method of torturing gay men in Iraq sounds horrifying.

Andrew Sullivan points to an article that spares no graphic details: “. . . anti-gay Shiite death squads are sealing their anuses with a powerful glue, then inducing diarrhea, which leads to a painful and agonizing death.”

But, can someone really die from this novel form of torture?

Emergency physician Shadowfax has his doubts. …

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Can you really kill a man by gluing his anus shut?

How the primary care doctor shortage threatens Obama’s health reform plan

Physician
April 27, 2009

Top story in The New York Times.

Excellent.

There’s hope that maybe, just maybe, we’re getting through to the decision makers in Washington.

The article itself is old news to regular readers of this blog, and regurgitates many of the arguments impeding health reform, as well as the problems in solving them.

“Obama administration officials, alarmed at doctor shortages, are looking for ways to increase …

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How the primary care doctor shortage threatens Obama’s health reform plan

Edwin Leap: Who pays when politicians commit malpractice?

Physician
April 2, 2009

My kids love to play Monopoly. They delight in acquiring properties, making money and crushing their siblings. They play with passion and savagery. That is, until recently. A couple of weeks ago I walked past the Monopoly board, spread on the floor between my children and their dear friend Tyler.

“˜How’s it going guys?’

“˜Great game, but we all ran out of money. So, we just put some more money on the …

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Edwin Leap: Who pays when politicians commit malpractice?

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Did the Canadian health system fail Natasha Richardson?

Physician
March 20, 2009

Would Natasha Richardson be alive today if she had gone skiing in the United States instead?

I don’t think it would have made a difference.

To recap the tragedy, Ms. Richardson died from an epidural bleed, after she fell while skiing. Her presentation was somewhat classic, with the well-described “lucid” period before she deteriorated.

According to Canada’s Globe and Mail, “ambulance workers were not …

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Did the Canadian health system fail Natasha Richardson?

Is Natasha Richardson brain dead? Was an epidural bleed, or “talk and die” syndrome, to blame after her ski accident?

Physician
March 18, 2009

Tragic news this morning regarding actress Natasha Richardson, who reportedly, suffered a head injury during a ski lesson in Canada.

According to reports, she fell on a beginner’s ski hill, and did not hit anyone or anything during the fall. There was no obvious sign of injury, and in fact, she was “was walking around and feeling fine for an hour after her accident.”

Things then …

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Is Natasha Richardson brain dead? Was an epidural bleed, or “talk and die” syndrome, to blame after her ski accident?

Op-ed: More coverage requires more doctors

Health Policy
February 25, 2009

The following op-ed was published on February 25th, 2009 in The New York Times’ Room for Debate blog.

With the number of the uninsured having risen to 48 million Americans, clearly the need for reform is dire. But President Obama made no mention of who exactly will take care of these patients, even if they get insurance under a successful health reform initiative.

As a primary care physician in southern New …

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Op-ed: More coverage requires more doctors

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