I  have lately been discussing the state of health care with a lot of doctors. I’m a doctor, and I’m also a consumer of health care services. Imagine my surprise when I visited a local ER on a three day weekend, hoping to get some advice from someone who might be able to use the panoply of diagnostic tools available in the ED to help me mitigate the pain of a ...

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What do I need to know as I age?  While scientists ponder the questions of water existing on Mars and if it can essentially sustain life, my duty it to assess if there is life left in Oliver -- a nursing home patient transferred to the ER. Oliver was not oxygenating well but appeared to be resting comfortably. Reportedly, Oliver had fallen that day and EMS discovered a sizeable bruise ...

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The cost of medical service provision in the United States is one of the most palpable strains on the health care system, but we must not forget that cost is the sibling of quality and access -- without considering the three as such, we will undoubtedly fail to navigate our country’s health care quandary. Low-quality care inevitably results in the need for more care in the form of readmissions, while ...

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An excerpt from Trauma Room Two. Sometimes when I am bored, when it is all sore throats and dental pains, when I feel more like I am a social worker and a hand-holder than an emergency medicine physician, I play a game. I do not look at the chart before ...

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A new television series called Code Black debuted on CBS. The show’s name supposedly means the emergency department has too many patients and not enough staff. In my over 40 years in medicine, I’ve seen many busy, understaffed EDs but never heard anyone call it a Code Black. There is the usual array of standard medical characters -- the inexperienced new residents on their first day at work, the savvy nurses, ...

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I was working at a small hospital when I heard the nurses talking about a new rule. The rule was that the only people who could wear lab coats would be physicians and administrators. It made me laugh a little. I’ve hated lab coats since medical school. I currently sport what a family medicine resident told me was the ER mullet: khakis and polo shirt. (Who knew?) I find it much ...

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It all started out seeming like a pretty routine visit. My patient was in her early 30s and had come into the emergency department for weakness and was in no distress. As I was talking with her about her symptoms she would flash the occasional smile. It was then I noticed that she had fangs. Not the kind that some people naturally have from misaligned teeth, but she had really long, ...

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Recently, Pope Francis visited Philadelphia to finish out his five-day visit to the United States. Prior to his visit, many hospitals in the city were preparing for possible emergencies involving visitors from many countries around the globe, particularly elderly visitors. On-call teams were present in these hospitals, and contingency plans were in place in case people needed to be transported emergently to different hospitals despite the high level of security ...

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It’s amazing when events that seem to be “miracles” happen, and even more magical to be a part of them, however peripherally. My husband, David Merzel, MD, a physician anesthesiologist and pediatric intensive care specialist, and his patient, 17-year-old Chiann Wheeler, share the remarkable story of Chiann’s brush with death from sepsis, and how David’s quick diagnosis saved her life. The story began one morning when then 15-year-old Chiann felt so sick ...

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A colleague recently told me of a patient encounter he had in an emergency room. When he picked up the chart, it described the patient as a 62-year-old woman complaining of epistaxis, or a nosebleed. He walked into the room and saw a perfectly well appearing 62-year-old woman. There was no blood on her clothes and none on her face. Her nose was not bleeding. When he asked her what could he do for her, she said ...

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