"Remember that patient you saw?" What a horrible question that always was. You came to work, and a friend would come up to you quietly and take you aside. "Remember that guy yesterday with the chest pain?" "Mr. Hayes?" "Yeah him." "What happened?" "He came back with a heart attack." "Oh wow, I feel terrible." It wasn’t always bad news. Occasionally it went like this: "That child with leukemia you diagnosed last month? His mother stopped by to ...

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I was working a few days ago and pulled a tooth.  Mind you, it’s not something I do with any regularity.  However, it was a very sweet little lady who was too weak and ill to get to the dentist and had other issues.  That lower incisor was loose, and constantly in the way. Furthermore, it was painful. I had seen her for something else in the emergency department.  I took ...

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I write for several publications, and I’m always pitching to new venues.  Recently I pitched an idea to an editor.  I wanted to write about gun research from the perspective of a rural physician. In particular, I wanted to ask what might physicians say if researchers found answers that were uncomfortable.  What if they found that intact families, strong fathers, religious engagement or familiarity with guns were factors that reduce ...

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My friends and family used to say that I was born 30 years old.  I get it.  From the time I was young, I was controlled, risk-averse, studious, and polite.  In addition to the fact that I was naturally reserved, I learned over time to do my best not to make anyone uncomfortable.  I frequently refused to stand up for what I wanted, always deferring to the wishes of others. ...

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I use social media.  Specifically, I use Facebook, Twitter, and LinkedIn.  In the beginning, I did so for utilitarian purposes.  As a columnist and aspiring writer of books, these were (and indeed are) useful marketing tools. I have, in the past, carried around a note-pad to jot down ideas.  I was never without my note-pad.  I always wanted a small legal-pad with a blue or black gel-ink pen.  It was my ...

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Does anyone in medicine, particularly emergency medicine, understand why we lose money? Why we have to push those metrics so hard to capture every dime? I mean, we’re constantly reminded that satisfaction scores, and time-stamps and time to door, time to needle, time to discharge, reduced "left without being seen" scores are connected to the money we make. Medicine now is far less about the wonder of the body, the ravages of ...

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Dear Lord Jesus, I just finished my shift in the ER. Of course, you knew that.  But I was thinking about how often I’m ungrateful and irritable.  I know that I complain about rules and regulations, about time-stamps and metrics and satisfaction scores and all the rest.  I know I’m that guy.  I get annoyed by people who are annoying.  (I’m glad you don’t.)  I get annoyed when I’m tired, and ...

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We all know that there’s a remarkable shortage of physicians in America and that it’s growing worse.  This is especially true in primary care but it’s present across all specialties.  This shortage alone is a significant stress on practicing physicians.  But when it is coupled with corporatization, the increasing complexity of medical care, unrelenting electronic charting requirements and the explosion of administrative tasks, physicians barely keep up each day. This is one of the ...

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School is back in full swing.  The kids are packed up, scheduled and loaded with notebooks, pens, pencils, computers, and calculators.  Long lines form outside school drop-off areas.  Tired, pajama-clad parents drop off bleary-eyed children, accustomed to sleeping and playing all day, now headed off to fill their little brains with knowledge. Of course, it isn’t just the little ones.  All of our children were home over the Summer.  Now our daughter is a high school ...

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There’s an ugly undercurrent that sometimes shows up in the emergency department: indeed all over the world of medicine. I’ve seen it in doctors and nurses alike. It’s a meanness, a smallness, a kind of moral judgment that can lead us to make poor medical decisions. Or it can simply make us poorer in spirit. I remember the day I had a young man who was in custody. He was 18, ...

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