I would like to explain why Michael Kirsch's article, "Why the ER admits too many patients," is wrong, in all the myriad ways, in his contention that emergency physicians (EPs) admit too many patients because of improper motivations. Note that I am not going to argue that EPs don't admit too many patients -- that's a legitimate discussion to have and there may be some merit to the ...

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Recently, there was a bit of hue and cry regarding Mayor Bloomberg's report on the matter of prescription drug abuse and restrictions on new prescriptions for painkillers through the emergency department. Initially, I was concerned. I completely agree with the comment from the linked article: “Here is my problem with legislative medicine,” said Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians ... “It prevents me from being ...

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Dealing with psychological stress of being a doctor Chatting with some med students, a good question was raised: how do we, as doctors, deal with the emotional baggage we encounter in our profession? It's high stress, we see disturbing things, and sometimes we make mistakes that can result in harm to patients. The pressure and responsibility can be very hard to handle. These stresses, if unmanaged or poorly managed, can ...

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Medical malpractice: Equating standard of care to best practice I review a lot of cases in my professional life. Some of them are just ones that our QA group comes across in our practice. Some are cases related to our liability policy. Some are cases I'm sent for review, or educational cases I present. We see a lot of cases which could have been done better, or in which the ...

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I wanted to expand on something I wrote recently, which relates to my other sort-of-recent post on upcoding. I wrote, about scribes and compliance:

Knowing that the scribe cannot document a complete ROS unless I actually did that ROS, I am more compulsive about making sure I hit all ten systems. (Even when it's not clinically relevant. Such is the Kafkaesque world we live in.) And I ...

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My experience with a scribe in the emergency department I have a lovely pen. It's a Mont Blanc Meisterstück fountain pen. My group bought it for me on my tenth anniversary as a partner in our emergency medicine practice. It's a luxury I would never have paid for myself, though I have loved and used fountain pens since I was in college. Ironically, about the time I got it, the window ...

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I had an interesting twitter chat the other day with one of my colleagues, a young ER grad studying healthcare policy by the name of Seth Trueger. The Twitter conversation wound up involving about a dozen ER docs and nurses. You can review an edited summary over at Storify. The point in contention is an interesting one: we know the nation's ERs are overwhelmed and overcrowded. That's old news. ...

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There was an interesting and important article in the New York Times the other day about the gradual increase in the average E/M coding levels used by doctors over the last few years. For the non-docs, med students and ER trainees out there, here is a brief summary of the way physician billing works in the ER. During and after the patient encounter, the physician creates a medical record. ...

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From Outside Online, an article about how physicians are increasingly hesitant to provide volunteer medical coverage at athletic events: "Last year, 13 Americans died during running races, and another eight while competing in triathlons. While those numbers might seem troubling, the deaths are attributable mostly to the booming popularity of endurance sports—13 million Americans enter running races each year, and 2.3 million compete in triathlons. But the rising participation and the ...

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On the theme of knowing when and when not to follow the diktats of emergency medicine, one of the greatest challenges for a practicing ER doc is chest pain. Missed MI is still the biggest driver of malpractice costs, and last I hear, ER docs still send home something like 2% of patients who are having MI or unstable angina. Not good. So over the last decade we've gotten all ...

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