The non-medical reader may wonder what I am complaining about.  Of course, many of you have to be credentialed in your fields as well, whether law or accounting, law enforcement or public service, education, nursing or a trade.  But those of you in medicine know how difficult it can be to become credentialed as a physician, either by a state for purposes of a license, or by a hospital in order ...

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When I was in residency, sexual assault exams were part of our training.  We spent a lot of time learning how to ask the right questions, how to be gentle and empathetic, how to gather evidence appropriately and thoroughly. While many hospitals now have SANE programs (Sexual Assault Nurse Examiner), I have never enjoyed the privilege of working with one of them.  I have, for two decades, performed sexual assault exams on ...

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Walking around the ER in Tiny Community Hospital, I had a few realizations.  In medicine, we hold onto some things very tightly.  We love tradition; we love the known.  We don’t always know why, but we choose "the devil we know," almost every time, no matter how pointy his horns. For instance:  "No cell phones."  First of all, has anyone ever seen a cell phone interrupt anything we do?  No?  Neither have ...

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shutterstock_27236638 I went into an all night pharmacy recently, after getting off of work at 10 p.m. I had to pick up a prescription for my endless, insomnia-inducing cough. Walking up to the counter, I was bathed in the smell of cigarette smoke, carried on the coats of patrons. Eight of us stood by the counter, outnumbering the staff by 100 percent. ...

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shutterstock_140188489 Dear health IT staff, I know that, on many levels, physicians must be the absolute banes of your existence.  We are grumpy and resistant to change. And some of us are still confused by graphing calculators, much less complex modern computer systems.  We call you because we forgot our passwords, then because we forgot the new passwords.  We call because the system ...

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shutterstock_223911598 I have issues with the customer satisfaction paradigm, but it’s not generally hard to make patients happy. Sometimes, though, it can be nearly impossible. It all depends on our own inner life as physicians and human beings. The key to medicine, to being a beloved physician, is to love our patients. This can be a tall order. Human beings are remarkably difficult ...

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shutterstock_208236568 I tried to order an echocardiogram yesterday at work.  But it turns out, they only do them on Monday, Wednesday and Friday.  Fair enough.  It’s not an unknown phenomenon.  Some places, surgeons are only available on Tuesdays and Thursdays, cardiologists on the second Wednesday of months with an R. After hours, most hospitals now struggle to have ultrasound at all, unless, of ...

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shutterstock_116633578 Tonight I will sleep in bed, all night, with my wife. The hours will pass in pleasant dreams, wrapped in a blanket, warm beside my darling. We are on vacation, and our teenage children will be sleeping in their beds as well; after they have watched enough bizarre videos on YouTube and eaten all the chips in the house. But as I ...

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shutterstock_73550245 I appreciate the need for physicians and others to sleep.  I’ve spent a great deal of my career awake in the wee hours.  In some very real ways, emergency medicine as a specialty exists as a shield between patients and their sleeping (or otherwise engaged) physicians.  But I fear we’re all wearing a little thin.  Because the emergency room has become ...

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shutterstock_229011745People ran to the church for refuge in Medieval times. It was considered a place of safety, a sanctuary from civil punishment. In the church, one could claim a right to justice, food, water and shelter. That role was recognized by church and government authorities alike; doubtless sometimes grudgingly as the wanted escaped harsh punishments. These days, America's emergency rooms have filled ...

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