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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On our recent road trip I was amazed by the number of billboards (from several health care systems and hospitals) advertising texting for emergency room (ER) wait times. My first thought was, "if you can text, how emergent is it?" This was quickly followed by the concern that the option/advertising of texting about wait times might make the ER seem, well, less for acute care and more for convenient care. Should I be concerned? There ...

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How to save hundreds of dollars on your medical bills Rob got a cat bite. Then a swollen hand. He goes to the ER, gets antibiotics, then develops itching. So he calls me for advice. A few days later, I get this email: “The itching from the antibiotics went away as you said it would. But what is NOT poised to go away is the $624 bill from the ER for talking to ...

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Attempting to alter the health care marketplace so provider decisions are based on patient value has shaped my career for the last 20 years.   Often use of the health care delivery system creates a learning opportunity for me as well as the poor, unsuspecting provider of care.  A recent experience was instructive. A close encounter with a jungle rock while mountain biking sent my husband back to our cruise ship with ...

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Several years ago I took care of an elderly woman in the ER.  She came in with a chief complaint of chest pain.  She came in via ambulance and by the time she got to the trauma bay she said she was feeling a little bit better.  She didn’t know she was about to die, usually people who are about to die look much worse. She looked good, all things considered.  ...

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Ms. Smith (name changed) is 82-years-old, but currently looks about a hundred. I met her, intubated, in the ICU two weeks ago. She lived alone, hadn't told family she wasn't feeling well, but had called 911. In the emergency department, she was struggling to breath, and was intubated, having gone into respiratory failure. She was found to have a severe pneumonia affecting the majority of both her lungs. She also went ...

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There are few professional careers centered around protecting and caring for others that garner so much verbal and physical abuse than a career in emergency medicine.  Mental health workers, police, fire, and EMS personnel are the other fields that come to mind when I think of a service that "helps" people yet gets abuse dished upon them on nearly a daily basis. A 2006 survey of emergency nurses showed that 25% ...

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I came across a really good post on the Daily Beast written by a pediatrician in New England, griping (appropriately) about parents who were unwilling to trust his judgment about vaccinating their children.

Why have so many patients lost trust in their doctors?

You might challenge the assumption that patients used to trust their doctors more, and that would be a fair question.  I haven’t found any ...

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