He didn't correct me when I addressed him as “Mr.,” only grimaced in his hospital gown like any other 80-year-old with abdominal pain. I knew he was intelligent when he began giving a history of present illness so precise I could transcribe it verbatim into my note, but it wasn't until he described his pain as “epigastric” that I gleaned he had a medical background. “Are you medical?” “Yes, I'm a retired ...

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I’m in the midst of a run of shifts in the emergency department. I’m doing locums away from home. Last night, I left work at about 3:30 a.m. (My shift was 6 p.m. to 2 a.m.) It was busy — not "crazy busy," just "normal busy." I finished my last note, wrapped up the information about the one patient I was leaving behind with the valiant night doctor and headed ...

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As she lay on the gurney telling me she was tired and having vaginal bleeding yet again, I was doing my own biopsy of her medical record. It stated very clearly that palliative care and hospice had been recommended to her for her end-stage gynecologic cancer. So, why, I’m thinking, highly annoyed, is she now in the ER, late at night, creating problems for me? Why could she just not accept ...

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Recently I've seen a number of reports of women who are denied the ability to help in a plane emergency because they are not believed to be doctors. While most of the denied women are of color, since this became public a large number of women of all races have come forward because of similar racial and gender discrimination. I am an emergency physician, and I was once called to duty ...

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Four years ago, I was having a conversation with a friend of mine. We had graduated residency the same year and our careers had taken us to different parts of the country. It was ACEP 2012. We’d been mingling with old friends and current colleagues, and the conversation turned to kids. I told him my wife and I were getting ready to start having children. He said he and his wife ...

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"Good morning, Sandy. How was work?” How do I answer that in a normal way? Any given shift in any given ED is comprised of the gamut of emotions playing out behind the calm facade of physicians and nurses. Afterward, we often don't articulate or even process the roller coaster of feelings. The story of a recent Monday overnight illustrates the wild ride of emotions most people don't realize that emergency ...

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One very late spring evening during my last year of residency, I was driving home and got stopped at a police DUI checkpoint. I was exhausted from being up all night from being on call the night before and having been very busy had no time to shower, shave or change into my street clothes. I also got called in at 4 a.m. the previous day and had not showered or shaved that ...

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You have to create a disconnect from death. Not indifference, in fact, it’s your duty to combat it. But as an emergency medicine physician, you lose that battle often. I encounter death on a near daily basis as a resident in the emergency department, and despite all my years of training, there’s often nothing I or anyone can do to prevent it. Health care workers in such an environment often ...

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I am sharing this account of a serious medical emergency on a transoceanic flight because I hope it helps other health care providers assist people in the future and learn from the difficulties I encountered. About 8 1/2 hours into a 17-hour flight, a gentleman had a syncopal episode in the exit row I was sitting in. His face was bleeding, and he was having issues controlling his bowels afterwards. His ...

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Speech recognition errors occurred in 71 percent of emergency department notes, and 21.1 percent of notes with errors were judged as critical with potential implications for patient care says a recent study in the International Journal of Medical Informatics. Investigators looked at a random sample of 100 dictated notes and found 128 errors or 1.3 errors per note. More than half of the errors were ascribed to speaker mispronunciation. Although ...

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