While working at small rural hospital I was once again faced with the emergency physician’s dilemma.  Admitting  a patient and being told to write holding orders.  In the midst of a very busy department, I sat with a nurse who guided me through the ridiculously complex and counterintuitive electronic orders system.  All this so that the admitting doctor wouldn’t have to log onto the computer, from home mind you, and trouble ...

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shutterstock_149598137 By now, everyone in health care is accustomed to the idea of patient satisfaction data and the multi-million dollar industry ($61 million in annual revenue for Press Ganey alone) which exists thanks to the health care leaders and policy makers who embrace it.  Most physicians believe it is absurd to use it as a marker of quality care, but have accepted ...

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medpagetodayFrom MedPage Today:

  1. Nicotine Replacement in Pregnancy: How Risky? The absolute risk of major congenital anomalies was similar among infants born to smokers and those born to women on nicotine replacement therapy (NRT), but respiratory problems were worse in the latter group.
  2. AS Activity Tied to Future Risk for Heart Disease. Early ...

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shutterstock_83139052 Dear Bill Maher, I respect your First Amendment right to exercise free speech. In regards to your recent comments on doctors, however, your words don’t matter. Here’s why. There is a concept known as the beauty of medicine; I attempt to capture it in the following paragraphs. If you present to the emergency department with acute chest pain, we will work you up for ...

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The sad thing is, I hardly remember the patient. Everything about her is just an overhead pediatric trauma alert followed by the flurry of cutting clothes off, throwing IV lines, and calling out our primary and secondary survey -- "blown right pupil," "unequal breath sounds," "gross deformity to left ankle," and then, "no pulses" -- followed by the age-old barbaric resuscitation efforts that are now muscle memory to us, as ...

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As medical providers, we recognize the value and importance of emergency medical identification (EMI), especially for our patients who live with chronic medical conditions, such as diabetes, epilepsy, and severe allergies. Of particular concern are those who may require emergency care during a time when they are unable to communicate, but how often do we address this topic with our patients, and do they really listen? Health care professionals have long recommended that such patients obtain emergency medical identification, such as MedicAlert jewelry (bracelet, ...

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Physicians need to complete about 50 hours of some kind of continuing medical education (CME) every year. The ideal kind of class is one that we actually attend in person, with teachers who are expert in the field being taught and are somewhere near the cutting edge. CME classes are especially nice when they include something hands-on rather than just a lecture format because much of medicine is hands on ...

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It is amazing to me how far emergency medicine has come as a specialty. Until the 1970s, emergency rooms were staffed by low-level resident interns who moonlighted for extra money or physicians who couldn’t find work elsewhere. After finally getting recognized as a specialty, the specialty still spent a few decades finding its way: developing training programs, improving quality, and generally trying to raise the bar on emergency care in ...

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shutterstock_117726904 I suppose it is obvious that I am a fan of stories. I like to hear them, read them, watch them, collect them and tell them. I believe I am participating in stories every day of my life. The story of my family is a beautiful epic. The stories I hear at work can break my heart. One of my favorite ...

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Although I pride myself on catching the obscure snapshots of typical life moments that occur daily while dealing with patients and their families in the emergency department, occasionally there are times when I am so focused on the task at hand that I completely fail to see a glaring moment of obvious humor, sadness, or tenderness. At times like this, then, I am glad to have our hard-working nurses and ...

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