Edwin Leap, MD

Edwin Leap is an emergency physician who writes at the Substack, Life and Limb, and is the author of the Practice Test and Life in Emergistan.

The emergency department crisis: Why patient boarding is dangerous

Edwin Leap, MD

Physician

March 28, 2025

Last night when I came to work most of the beds in our 31-bed emergency department (ED) were full. There were more than 20 patients either in the waiting room proper or in the chairs that serve as “rooms” behind the triage area.

Much of the problem was the fact that we were boarding patients who were waiting on inpatient beds, psychiatric admissions, or transfer to higher levels of care elsewhere. …

Hospitals at a breaking point: Lack of staff and resources leave ERs in chaos

Edwin Leap, MD

Physician

February 2, 2023

I recently worked an evening shift in the emergency department the day before New Year’s Eve. Patients arrived in waves, by car and by ambulance. They seemed to check into the triage area every few minutes. When I left at midnight, there were 23 patients awaiting admission in the ER waiting for four, six, 12 or more hours — some for a full day.

Simultaneously, there were about 20 waiting to …

Trapped in a cauldron of suffering, medical staff are weary

Edwin Leap, MD

Physician

October 9, 2021

Sometimes I really look forward to something new. An alien race arriving on earth would be a nice start. I think we could all use a change in the news cycle. Because I am very tired of thinking about, talking about, and especially treating COVID-19.

In all of my years of medical practice, I have never seen anything that taxed the system and caused so much mayhem, while simultaneously producing such …

Vaccine hesitancy is complex

Edwin Leap, MD

Physician

August 8, 2021

Given the devastation wrought by the COVID-19 pandemic, many are asking why people would be hesitant to be vaccinated against it. That’s the question that bounces around the skulls of countless physicians, public health experts, journalists, politicians, and others. But before trying to answer the question, it might be reasonable to ask why people do, or fail to do, other things that negatively affect their health.

Why does a patient with …

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Vaccine hesitancy is complex

Why do people keep going to church?

Edwin Leap, MD

Physician

January 23, 2021

Physicians in general are a pretty intelligent group of professionals. However, we sometimes make the mistake of thinking that we must also know a lot about almost everything because we know a lot about one particular thing. However, given the exploding pace of advancing knowledge, that idea is hubristic. But it isn’t just science and technology where we fall short.

During the COVID pandemic, one of the things most contentious has …

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Why do people keep going to church?

This physician is tired, and he’s not alone

Edwin Leap, MD

Physician

October 18, 2020

I have a lot of energy. I have been going and going and going for so long.

And today, it hit me.

I’m tired.

I began this pursuit of medicine in 1983 when I decided to be a zoology major. I worked and went to medical school. And I went to medical school and worked. Then I worked and went to three years of emergency medicine residency and worked hard for those three …

COVID-19 and the college experience

Edwin Leap, MD

Conditions and Diseases

October 3, 2020

Everyone seems to be walking about in disbelief. College educators and administrators are shocked. Public health officials are incredulous. Politicians are confused, and news reporters are busily shaking their heads at the numbers. Physicians, my colleagues across the country, are beside themselves. And all of this head-scratching and hand-wringing is because students went back to their colleges and universities and behaved like, you know, students at college and universities.

And then …

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COVID-19 and the college experience

The downsides of going to the ER for primary care

Edwin Leap, MD

Physician

September 24, 2020

Despite the fact that many people have difficulty finding a family physician, there remain many options for medical care. From emergency departments to urgent care clinics to clinics based in retail stores and pharmacies, there are several different ways to see a physician, physician assistant, or nurse practitioner.

This is can be useful when one has no family physician, or can’t get an appointment. It can be difficult and downright dangerous …

We can’t expect large medical centers to absorb every case

Edwin Leap, MD

Physician

September 22, 2020

My small community ED has a fairly high acuity. As such, I was recently trying to transfer a couple of patients, one of whom was an NSTEMI, pain-free but with a rising troponin. In the process of trying to arrange things, I learned that our main regional referral center was holding a staggering 150 patients in their own ED, all waiting for inpatient beds.

I’ve spent the majority of my career …

Truth dies in silence. Sadly, so do people.

Edwin Leap, MD

Conditions and Diseases

April 9, 2020

I have been writing columns for physicians for twenty years. And year after year, I have had physicians say this: “I’m glad you said what you did. If I said it, I’d be fired.” There are variations on the theme, but they’re much the same. Twenty years, and far more than 20 years, during which the alleged health care leaders in America have been routinely muzzled because they aren’t supposed …

In these dark times of a pandemic, look to history for hope

Edwin Leap, MD

Conditions and Diseases

April 1, 2020

This is a frightening time. The coronavirus is called “novel” because it is new, and what is new is often terrifying.

We don’t know enough about our new microscopic enemy. Scientists, clinicians, and policymakers are all working tirelessly with limited data and learning along the way. Consider that many diseases that we regularly face have been observed, reported, studied, and treated for decades; some for centuries (although with less success than now). Novel coronavirus …

COVID-19 will expose EMTALA and the physician shortage

Edwin Leap, MD

Conditions and Diseases

February 29, 2020

Coronavirus, a.k.a. COVID-19, is lurking on the edges of the United States. What it will do here has yet to be seen. I was initially very concerned since I work on the front lines in community emergency medicine. For the last week or so, I have felt a little better after reading several articles. I suspect it will not have a high lethality among otherwise healthy individuals. But I’m no …

Not only do the worst need love, the best are made better by offering it

Edwin Leap, MD

Physician

February 14, 2020

I once saw an older gentleman who was mentally impaired from birth. A hard enough blow, he had slowly, inexorably drifted into dementia. He cut his head in a fall, suffering the ravages of gravity as so many do every day, every night.

He was Caucasian. His full-time care-giver was African-American. That young man was the only person who could calm the angry, profane mood swings of his increasingly difficult, neurologically …

Watching is incredibly important. I know this as a physician.

Edwin Leap, MD

Physician

January 17, 2020

I sometimes work as a church security volunteer. And when I do it, I get to simply stand and watch. Watch for someone sick or injured (we have defibrillators and wound care equipment). Watch for someone coming to cause harm. Watch in order to call the police. Watch to keep the children safe.

And it occurs to me, when I do it, that watching is incredibly important. I know this as …

Taking food and drink away from doctors and nurses is just cruel

Edwin Leap, MD

Physician

December 10, 2019

It’s hard to explain what we do. And so maybe, it’s hard for others to sympathize with our situations. I mean, physicians, mid-levels, and nurses in emergency departments are tied to computers in often cramped work-spaces, even as they are required to be at the bedside almost constantly for the latest emergency or (in other cases) the latest bit of pseudo-emergency drama.

If you haven’t worked there, or haven’t for a …

What can I do differently in the ER?

Edwin Leap, MD

Physician

November 2, 2019

In the emergency department, we see them all the time. The person with a medical problem too serious to ignore, but not quite bad enough to require admission. The patient referred to the specialist who comes back to the ER. “I couldn’t afford the cash upfront.” The new cancer in the uninsured. The pneumonia without a doctor. The homeless not eligible for Medicaid.

The senior barely able to stand, but whose …

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What can I do differently in the ER?

Why this doctor was so uncomfortable arguing with another physician

Edwin Leap, MD

Physician

October 3, 2019

I hate confrontation. It’s just the way I was raised. I’m not saying it’s right, or healthy, it just happened. My parents and I almost never confronted one another; even when it would have been healthier. That, of course, is water under the bridge and not in any way a condemnation of my folks who were kind and loving and indulgent parents.

But this tendency caused me to suppress emotions. Whether …

What has emergency medicine wrought? Helplessness.

Edwin Leap, MD

Physician

September 26, 2019

It seems that all day, every day, I care for patients who simply won’t take care of themselves. And I sometimes think that we in emergency medicine have caused more harm than we expected.

Now let me first say, I also take care of those who can’t care for themselves. There are those who, through age, infirmity, or poverty, simply have no means. The patient with a chronic condition who can’t …

The medical profession needs more shadowing opportunities

Edwin Leap, MD

Medical Education

September 8, 2019

Job shadowing is a long-standing tradition. High schools often have dedicated shadowing days, during which students can come and spend time with people working in careers that the students find interesting. While a few hours isn’t really enough to know if you like, love or hate a job, it’s a start.

In health care, it can be especially important to spend time shadowing. In fact, PA schools want applicants to have …

ER staff deserve a safe place to do their jobs

Edwin Leap, MD

Physician

August 14, 2019

Many years ago, it was called the emergency room. Now we call it the emergency department. However, unlike so many departments in the world, the emergency department has almost too many purposes, duties, and mandates to number.

However, in the process of being the under-funded safety net for American health care, it has also become a place of remarkable danger where medical and nursing staff, support personnel and even patients face …

Edwin Leap, MD

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