As an emergency physician used to working in busy, urban ERs, I like to think that I’m not easily surprised. The other day, someone did something that really amazed me. Our patient was a young woman who had a headache and requested medications to take it away. On an average ER shift, we see dozens of patients with similar complaints to hers. On busy days, the evaluation and treatment become rote: ...

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Imagine this:  You are sick.  You are the sickest you’ve ever been.  You want to die.  You almost did die.  You want to bury your head in your cozy bed for the next two years. But you’re not in your bed.  This bed has plastic for covers and sandpaper for sheets.  You need to throw up every thirty minutes but you have to share a bathroom with someone you don’t know, ...

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For days, I have been trying to get long-term patient, Stan, on the phone; his blood work came back abnormal, and we need to repeat it.  I called the number in our file a bunch of times. The odd thing is that sometimes it rings without stopping, sometimes it is answered by a machine, which immediately beeps and disconnects, and at least once it sounded as if the receiver was ...

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Disruptive innovation is competitive strategy for an age seized by terror. - Jill Lepore, author of The Disruption Machine: What the Theory of Innovation Gets Wrong "What do you want me to do with all the stuff in this box?" my wife asked this weekend. I looked inside and saw my former self: one of BNC and pin connectors, wires, a notebook with sin, cos, theta, and a host of other equations -- a ...

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When school boards fancy themselves health care providers I met Madelyn for the first time last month in clinic. Six months prior, she was an otherwise healthy 14-year-old girl. One afternoon, Madelyn’s phys ed teacher led a gym class aimed at completing fitness and health assessments on all of the children in the grade. One at a time, each child was asked to step up and onto a scale ...

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There’s no good age to die. Way too many of the patients I’ve seen over the past two years are harrowingly close to my own age. I think it’s less startling to hear that an older person has cancer than when a young person is diagnosed, but I have yet to identify the age when this transition happens. Maybe it’s an unspoken understanding that older people die and younger people shouldn’t, but ...

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Let me show you four simple steps, requiring just 15 seconds, that will turn a patient thank you into a two-way healing encounter of the highest order. It is incredibly easy for a thank you from a patient to slip by during a busy day in the office. We can get so caught up in the blizzard of clinical tasks we fail to hear what the patient is trying to communicate. We don’t ...

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Nobody likes waking up in the middle of the night gasping for air. When you make a mistake in the emergency department, that’s exactly what happens. They come in all sorts of shapes and colors:

  • The sixty-year-old man diagnosed with a strained lower back muscle who comes back with a ruptured abdominal aortic aneurysm.
  • The fifty-four-year-old Hispanic female with generalized malaise who goes into cardiac arrest from a missed myocardial infarction.
  • The two-year-old with ...

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When the Joint Commission is at the hospital, leave Here’s a doctor’s health tip for patients that I’ll bet you haven’t heard before. If you’re a patient who walks into a hospital for an elective procedure of any kind -- surgery, or a diagnostic test -- and you find out that Joint Commission reviewers are on site, reschedule your procedure and leave. Come back another day, after the reviewers have left. Why? ...

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Should doctors be paid overtime for taking call? Taking call is the worst thing about being a doctor. There, I said it. But wait! What about medical malpractice lawsuits? What about dealing with patients’ suffering or dying either from their illness, or far worse, relating to decisions you made or procedures your performed? Certainly these are far worse events than being on call. Granted. However, these awful events are part of ...

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