It’s easy to get frustrated in the ER. First, you’re at work. Second, most of your patients don’t want to be there. Third, many (if not most) of your patients don’t need to be there. Finally, by the time you see them, most of your patients are tired of being there. It’s easy to become jaded when you trudge through this never-ending mire of patient after patient, and indeed ER docs ...

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Top stories in health and medicine, July 22, 2014From MedPage Today:

  1. Error: You Have No Payments from Pharma. The federal government has a word for physicians who don't have financial relationships with pharmaceutical and medical device manufacturers: "Error."
  2. Do the Eyes Really Have it in Diabetes? Novartis and Google garnered much media attention last week when they announced their partnership ...

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In my past few shifts in the emergency department, I have seen the following patients who were seeking further care after being treated by other providers. One was a child who had been seen twice at an urgent care clinic. He had a fever of 103 degrees and wasn’t eating. The first time he went to the urgent care center, he was diagnosed with an ear infection. He was started on ...

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A new study poses one of the most vexing ethical questions concerning research with human beings: When is it acceptable to conduct research without the consent of the research subject? In emergency situations, patients often arrive at the hospital unconscious or with severely impaired decision-making capacity. Progress in medical practice depends on results from carefully designed research; yet in these emergency cases such patients are unable to fulfill one of the ...

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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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Recently, I was on call for surgery at a hospital in New York City. At 2 a.m. in the morning, we were paged to a trauma in the ED. After we stabilized the patient and moved him for CT scans and x-rays, I noticed a small stretcher tucked away in the back part of the ED, a place typically reserved for overflow patients when we run out of rooms. The patient ...

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Medicine is like blackjack: Physicians need to count cards In the game of blackjack, players will attempt to increase their odds of winning by using the frowned upon method of counting cards. Then basic principle is to add or subtract points to the cards dealt under the believe that the cards remaining in the deck are more or less likely to give the player a winning hand. Not a guarantee, ...

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As an emergency physician used to working in busy, urban ERs, I like to think that I’m not easily surprised. The other day, someone did something that really amazed me. Our patient was a young woman who had a headache and requested medications to take it away. On an average ER shift, we see dozens of patients with similar complaints to hers. On busy days, the evaluation and treatment become rote: ...

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All of the focus that CMS is putting on hospital readmissions via the Readmissions Reduction Program, and the financial penalties that readmissions can generate, is causing hospital administrators to look to the emergency department and emergency physicians to intervene and resolve the issues that interrupt recovery for post-hospitalization patients. In today’s world of budget-constrained financing of government health care programs and narrow hospital margins, the question of how best to ...

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Conflicting state versus federal incentives confuse doctors I get paid by Medicaid to see patients. How much? Exactly $52.28 if it is an easy patient issue, like a cold, and $78.54 for a harder one, like a kidney stone. Who decides when the issue is easy and when it is hard? I do. But I have to follow some complex rules when deciding whether to bill a 99213 ...

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