A patient of mine recently came to see me in a follow-up appointment after an emergency department visit. He had been working out at the gym, on a hot day, after he had skipped breakfast, and after his usual routine he felt extremely lightheaded. Everyone told him he looked "white as a sheet", and a physician who was at the gym told him he must go to the emergency department. In ...

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My 74-year old obese, poorly controlled diabetic patient with high blood pressure, high cholesterol, coronary artery disease, asthma, obstructive sleep apnea has been difficult to motivate to improve his lifestyle and his health. He is bright, sweet and caring but just not very disciplined. At each office visit, we review his medications, review his dietary habits and go through the check list of check-ups for diabetic complications including regular ophthalmology exams ...

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I told you so.  I also told the POTUS in my open letter, but he did not read it. Who could honestly believe the nation would support dumping coverage for 22 million people?  As David Leonhard wrote recently op-ed in the New York Times: “They [Republicans and President Trump] had only one big weakness, in fact: They weren’t dealing in reality.”  When faced with reality, it is interesting what a few good ...

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My sister calls my name three times before I hear her. I am so distracted by the palm trees and the ocean view that I don’t feel her put the car in park. I look up at the “Physician Parking Only” sign straight ahead. “Hurry up and get out. We’re running late, and I don’t want to have to stay after my shift ends,” she says. “Don’t you always stay like two ...

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Even after all this time, the phone calls aren't always easy to make. “Hi, Mrs. Smith, this is Dr. Kass at camp, don’t worry, everything is OK.” I usually get that out in one breath, then immediately transition to concrete details. "It's a finger. It might be broken." It doesn't matter if I'm calling about a cough, a fever or a bite from the camp pet pig -- I know that ...

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Recently, I had an opportunity to drop in on two of the foremost researchers in physician burnout, Sara Poplau and Mark Linzer of Hennepin County Medical Center in Minneapolis. We chatted about various aspects of the current burnout crisis and exciting new initiatives on the horizon. Then we spent some time contemplating a frustrating truth: leaders in health care often fail to acknowledge a reality that leaders in other industries ...

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After years and years of practicing emergency medicine, I’ve seen and treated thousands of children for everything from beads in the nose to leukemia, ruptured spleens to sprained ankles. A father of four myself, I take great delight in interacting with the kids that come through my workplace. I consider it a personal challenge to make them smile whenever possible and to put them at ease. I’ve learned a few things over ...

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In February 2010, I completed my final ward round and said goodbye to my patients in Haiti just six weeks after a tragic earthquake. This earthquake was a natural disaster so devastating that within a momentary blink, a minute's tremor and a rumbling collapse, an estimated one-hundred-thousand people lost their lives. Amidst the wreckage, hundreds of thousands more were left severely injured, shocked, ...

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We emergency physicians are often thrust into the frontline battles raging in society. The pain, blood, and emotions are so real, so thick and ever present, creating an undertone that is difficult to deny. We walk the corridors of our departments actively involved in life or death, where the span of mere millimeters might as well be miles as we explore wounds, clinical scenarios and presentations. How do we do ...

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It’s 1 a.m., and I’m afraid this guy is going to die. He’s gasping for air, hunched over a table as I poke his chubby back and try to find a rib. Oxygen is flowing through nasal prongs at six liters per minute, and it’s barely making a difference as his oxygen saturation hovers around eighty-five percent (it should be in the high-nineties.) He’s sick, but what’s more worrisome is ...

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