A small case with big implications almost escaped my notice this week.  The Boston Globe reported a case in which a family sued after a 23-year-old man died after being diagnosed with a lung infection. According to the Globe, the young man went to one of the Boston Emergency Rooms complaining of cough, fever, and chest pains.  Ok, stop right there all you armchair diagnosticians.  What does this man most ...

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Over the past few months, Beth Israel Deaconess Medical Center (BIDMC) has been exploring the use of wearable computing. In the emergency department we’ve been evaluating an early unit of Google Glass, a high tech pair of glasses that includes a video camera, video screen, speaker, microphone, touch pad, and motion sensor. We have been able to access our internal web-based ED dashboard on Glass, in a secure manner that ensures all ...

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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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I was a work today and I was given this message, “ —–'s husband called and wants you to call back right away!  He sounded very upset.  His wife died.” Uh oh, I thought to myself, this is never good.  It was a patient I remembered well, that I had seen repeatedly for a chronic problem, and who always came with her husband.  We seemed to get along well.  I didn’t ...

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“Never sign anything without me reading it first.” Cautionary words from my husband, an attorney, whose ability to read and interpret the fine print has saved my life, so to speak, on more than one occasion. That all-in-the-family attitude toward a profession is something almost every doctor also knows well. Through me, my husband, relatives, friends, and sometimes acquaintances can get what I call a “healthcare quickie,” a free, two-minute sideline. They can ...

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It was like watching the news footage of shoppers trampling each other to get through the doors of a Filene's Basement sale or witnessing people standing outside all night for the new iPhone even though it isn't a sale and it will be made in mass production for months or years to come.  I am talking about seeing people line up in the dark of pre-dawn to get their fingers ...

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Safety net emergency departments are frequently blamed for being the source of rising health care costs. After all, they care for the millions of underserved and un-insured Americans forced by a variety of circumstances to visit ERs for their primary care and low-acuity concerns. With the Affordable Care Act (ACA) reforms initiated in January, demand for emergency services will rise significantly. Medicaid already covers over 50 million individuals – most of ...

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Schuur and colleagues in JAMA Internal Medicine listed five low value services in the emergency department (ED). Although compilation was not solicited by the American College of Emergency Physicians as part of the Choosing Wisely program, it has its ethos. The list was developed by a technical expert panel after multiple iterations. The list is not only wise but derived from sound methodology. Most importantly, the recommendations are ...

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The other day at an interdisciplinary rounds meeting at the hospital, one of our nurses who is also an emergency medical technician mentioned that in Britain injured patients receive tranexamic acid before arriving at the hospital because it reduces death from bleeding. "What's that?" I said. I kind of barely remembered hearing this medication's name associated with the treatment of a rare disease, but not treatment of trauma. So I was guessing ...

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As a medical scribe working with a large, well-known scribe company, unnamed to protect my job, it makes me proud reading all the articles published about how much having a scribe benefits a physician, especially in the emergency department. I enjoy my job immensely and I am grateful for the opportunity to learn and engage in patient care. However, as a pre-medical student working next to several other doctor-hopefuls in ...

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