Andy was new to me. He told me he had seen several doctors over the past few years for various pains in his right arm. Some months ago, he had right shoulder pain that went away on its own, but for the past few weeks, he had pain in the middle of his upper arm. Last year he had tennis elbow and forearm pain for many months. A slender, middle aged man, ...

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Close to midnight and Tonya is somnolent, lying on an emergency department (ED) stretcher and not in her own bed at home. The change in location alters the fairy tale quality of the word somnolent from sleepy or drowsy to one that's more sinister and worrisome. Especially when Tonya is dying of brain cancer, a single mother of thirty-four, a hospice patient now situated in the ED; a space powered by a ...

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We owe it to our patients to put on our game faces When you walk into the emergency room to see a trauma patient, do you remind yourself as you enter the doors, “Keep your game face on?” When you finish a difficult surgery and make your way to the waiting area to review the prognosis with the family, do you tell yourself, “Take a deep breath. You can do this?” When you steel yourself ...

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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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Imagine you walk into a restaurant named Luigi’s. From the décor and the smell of pasta sauce coming from the kitchen, you assume that this restaurant serves Italian food. You walk forward, your name is taken and you are then told to sit off to the side and wait until your name is called so that you can get a table. Time goes by, and no one gives you any ...

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5 ways to ease the integration of NPs and PAs I talk a lot with different physicians about integrating NP/PA providers into their practice.  I am frequently astonished by the level of reluctance, resistance and downright animosity from these physicians.  Many times a doctor will have a medical “horror story” with the NP/PA  playing  the  villain.  One bad encounter or event seems to  justify a complete rejection of the many positive ...

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Among reams of coverage on the Ebola outbreak, Politico just published a characteristic story with the headline, “In the world of Ebola, no room for error.” The only problem is that is as soon as you introduce a human element to any system, there will be error. That’s the reality that health care leaders across the United States are grappling with now in a simultaneous effort both to tighten the health ...

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Ebola is frightening but not for the reason you may imagine. A little over a year ago Asiana Flight 214 crashed while landing at San Francisco International Airport resulting in 181 injuries and 3 deaths.  As an emergency medicine resident, this fast-forwarded my training as I took care of many of the patients arriving in our emergency department.  I left that day inspired that I had the education and training to ...

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Helicopter emergency services: A disparity between aviation and medical proficiency As the helicopter emergency services (HEMS) industry enters its fifth decade, there is an 800-pound gorilla in the room and nobody is talking.  The average EMT, fireman and emergency physician too often make the flawed assumption that when it comes to HEMS, the industry is a uniform, high quality, strictly regulated entity.  They assume that all HEMS programs use state of ...

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When treating neo Nazis, should physicians have a choice?What I found most disturbing about the man’s arm was not the deep, stellate laceration on the underside of his biceps. It was the swastika tattoo next to it. “Sir,” I said, “we’ll have you fixed up in no time. I’m going to numb up the wound, irrigate it, then repair the laceration with sutures and send you home on antibiotics and pain ...

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