We live in an incredible age. Life expectancies continue to rise. The environment in the U.S. is cleaner than it has ever been. The sum of the world’s knowledge is at the fingertips of any and every smartphone user, waiting to be accessed when they finish playing Candy Crush. The face of poverty in America is still terrible to behold; but it bears little resemblance to poverty down the long ...

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We practice distracted medicine everyday I have a shiny new Bluetooth device.  So now, as I zip around town, I can speak without my hands touching my phone. It’s relevant because our county is passing a ban on cell phone use, unless it is hands-free. This is a national trend, of course, and the catch phrase is "distracted driving." Everyone knows that distracted driving is bad. ...

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Who watches the watchers?  It’s an old Roman saying from the poet Juvenal, and it had to do with infidelity. But over the years it has been applied to politics as well.  It means, "How do I know that the people guarding me are worthy?"  It has also been translated, "Who guards the guards?" But it seems to me that it applies to medicine quite appropriately.  Who watches those watching physicians?  We ...

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I was working overnight in Tiny Memorial Hospital, located in scenic rural America.  My call room there was a converted patient room.  As such, my bed was a hospital bed.  Lying there one night, I rolled to the side and raised the head of the bed using the button on the rail.  The blanket was standard hospital fare: stiff and thin.  And the television remote, fully two pounds and connected ...

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A Southerner at heart, I find myself in love with places.  We are forever pining on about our family homes, our small town barbecue restaurant, the sound of some lake where catfish splash in the night, or the woods where our favorite treestand sits.  Sometimes our afflictions for place become the stuff of novels; Scarlett O’Hara is always associated with her beloved Tara just as Faulkner is ever infused into ...

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Think for a second about the most treasured drug or device in your medical bag.  Or about the procedure you find most appealing, the disease or injury you most enjoy treating.  Personally, I really enjoy doing lumbar punctures, opening abscesses, placing IO lines and applying splints.  And because I’m an emergency physician, I am duty bound to say that I love to intubate ... and I do. I also enjoy doing ...

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They used to tell us, as physicians, that "if it isn’t on the chart, it didn’t happen."  We could protest all day, to billing companies, insurers or attorneys, "I did that.  It’s assumed.  I always do the same thing every time."  But they would retort, "nope, it’s not in the chart."  So we learned to detail everything, every time, every movement.  Every consideration and justification.  The idea being, our ‘thought process’ ...

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You have to earn your cynicism.  That’s my rule.  Young pre-med and medical students, even some residents don’t have the same right to cyncism as the rest of us who have labored in emergency departments for years, for decades.  The same goes for nurses fresh on the job from training, and ward secretaries who so recently were high school kids. It always troubles me when these people start working in our ...

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When I was a resident in emergency medicine, at what was then simply Methodist Hospital of Indiana, I was blessed with the opportunity to fly with Lifeline. While I am originally from West Virginia, where rural means mountainous, I came to love the beautiful, stark emptiness of Indiana as seen from the sky.  And over time, I came to truly appreciate the small, rural hospitals that called us for help ...

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I wonder, sometimes, are physicians valued professionals, or merely problems to be solved?  Are we skilled clinicians vital to the well-being of our patients?  Or are we merely assetts to be managed?  It occurs to me as I walk around hospitals these days, and see the overgrowth of people with clip-boards, people with undue authority over our lives and practices, people trained in business and management but untrained in either ...

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