On the morning of the tragic mass shooting in Orlando, a tweet by CNN stated, “The White House waived HIPAA regulations so that hospitals could talk with family members of shooting victims, says Orlando Mayor Buddy Dyer.” Many, including me, retweeted this thinking that it was probably unprecedented. Later that day, several Twitter followers informed me that HIPAA had been waived during Hurricane Katrina. Despite rumors to the contrary about 9/11, Katrina ...

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During a busy ED shift, my computer signaled the complaint and location of my next patient: a woman in bed 10 flagged with “GI bleed.”  I almost bolted to bed 10 to ensure this patient was stable, but then noticed orders pending, so my urgency eased. “I see you already saw the patient in 10,” I began, addressing the triage physician. “Yeah, she’s all set,” he replied, without turning from his computer. ...

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(Triage note: 45-year-old male, vomiting for two days. Abdominal pain.) Dr. Stephen Cluff is like Yoda. Judging by body hair, he's more like Chewbacca. But he's short, wise, and with his white hair and arthritic limp, he may as well have green skin, poor sentence structure, and a Muppet's voice. If I'm stumped on a case, I'll ask him. If I'm pissed off about department politics, I'll call him for advice. If I want ...

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As she adjusts her sunglasses, Mary squints to protect her sensitive eyes from the sun.  Four years ago when lymphoma threatened her life, doctors gave her a 5 percent chance of survival. “I really should be dead right now,” she states casually. A bone marrow transplant gave this patient a new lease on life, allowing for the treasured opportunity to mother her 8-year-old son. The transplant has been successful, but her ...

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Ever since the U.S. government decided to link Medicare reimbursement dollars to patient satisfaction scores, hospital administrators have been obsessed with improving the quality of care for patients visiting their emergency departments. While the motivation may be partly financial, the goal of improving the patient experience during emergency department and hospital visits is an admirable one. Unfortunately, many of the tactics used by administrators have done little to achieve that goal. ...

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“Someone else will lend a helping hand,” a physician told me once, when asked to help with an emergency in public.  As a PALS instructor for more than a decade, I have always responded when possible.  In the last decade, there have been three in-flight emergencies, two elderly individuals who passed out in church, and a host of other less serious maladies.  A week ago, I discovered the best reason I ...

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A 6-year-old boy with abnormal pupils and gasping for breath. A 26-year-old pregnant woman with a gunshot wound to her abdomen. A 54-year-old male with blood pouring from a wound in his thigh. Now add 43 more patients. Imagine you are the paramedic at this scene.  Who do you take to the hospital first?  Who do you have to choose to walk past and leave at the scene while you take your patient to ...

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Mrs. Liu, who was only 58 years old, had metastatic ovarian cancer. Despite radical surgery and chemotherapy, her disease persisted. Worse yet, her PET scan from a few months ago revealed that she had carcinomatosis -- numerous deposits of cancer showered throughout her abdomen. This particular night, she starting having more nausea and couldn’t eat or drink anything without vomiting. So, she came to the ED. I was called into ...

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Those of us who work in emergency medicine have all had these patients. They present with a complaint that started two years ago and for whatever reason now deem it an issue that needs immediate attention in the ER. I had a patient like this recently who not only had the issue for two years, but also had a primary care provider. Not only did the patient have a PCP, ...

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A JAMA Viewpoint suggests that doctors should be aware that patients may be surreptitiously recording their conversations. The author, a neurosurgeon, takes a very benign view of this issue and recommends that if a doctor suspects that patient is recording a conversation, "the physician can express assent, note constructive uses of such recordings, and educate the patient about the privacy rights of other patients so as to avoid any ...

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