The American hospital as we know it is in peril 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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Holidays in the ER: What youll see is a lot of humanityPeople 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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They didnt do anything! The inverted homeopathy of the ER. How often do we have this interaction: "My wife was here yesterday for belly pain.  That doctor didn’t do nothing! Told me she just needed to get over it. I am not happy and something needs to be done about this!" (Frequently spoken by spouse.) Records are reviewed.  Treatment:  Included numerous doses of morphine and phenergan, as well as fluids and Zofran.  Frequent warm blankets were ...

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Everyone cries when they bury their dead When I was in college and decided I wanted to go to medical school, I kept a picture of a medical transport helicopter on my desk. It represented the excitement I wanted to experience one day. When I was in medical school, I loved nothing better than watching in the chaos of the trauma bay, helping as the blood spurted to ...

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The religion of emergency medicine: Its time for a reformation Emergency medicine, like every specialty, is its own religion. And on many levels, it tracks right along with the progression of religions from their ancient origins to their modern incarnations. Our unique profession grew out of a pressing need for physicians who could provide immediate and life-saving care to the sick and injured, at all hours of the day or night. The ...

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Money has always been and will always be a big part of medicine Medicine is not about money, except when it is. When I was in my residency training, pharmaceutical reps still roamed the land. Vast herds of gorgeous young women in tight skirts and stilettos traveled through doctor's offices, clinics, hospitals and residencies all over creation. Their appearance was always a thing of joy, especially for sleepy, hungry physicians-in-training. Someone would run to the ...

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Whatever our individual belief systems, here is a cause that can unite us. Whatever our party affiliations, this can cause us to "reach across the aisle." Whether or not we are religious, or believe in this life only or the next, this is a cause we can agree on, here and now. Conservative or liberal, right or left, theist or atheist, libertarian or green, male, female, gay, straight, we must ...

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The striking parallels between warfare and emergency departments Preface: I love to write about many things. People, pets, children, family, nature. But over and over I come back to a theme: my colleagues in our specialty and the forces arrayed against us. I’m not trying to be the toxic voice, the endless complainer. But if people like me don’t beat the drum, then nothing will ever change for the ...

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An ER missed Ebola.  Heres how it could happen to you. How did the emergency department staff of a Texas hospital see, and discharge, a patient infected with Ebola? Despite the fact that blame spreads through hospitals faster than hemorrhagic fever viruses, I’m not interested in pinning down a single person, or a single thing, which may have allowed that to happen. I am very interested, however, in offering a few insights ...

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The ER demonstrates the inverted priorities of American society We fling open the doors of America’s emergency departments to help those who can’t afford health care.  We have legislated this protection: No person can be turned away for financial reasons.  This is very compassionate, and represents the higher angels of our culture.  Alas, it also is emblematic of the stupider demons of government.  You see, the ER demonstrates the inverted priorities ...

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