I hate confrontation.  It’s just the way I was raised.  I’m not saying it’s right, or healthy, it just happened.  My parents and I almost never confronted one another; even when it would have been healthier.  That, of course, is water under the bridge and not in any way a condemnation of my folks who were kind and loving and indulgent parents. But this tendency caused me to suppress emotions.  Whether ...

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It seems that all day, every day, I care for patients who simply won’t take care of themselves.  And I sometimes think that we in emergency medicine have caused more harm than we expected. Now let me first say, I also take care of those who can’t care for themselves.  There are those who, through age, infirmity, or poverty, simply have no means.  The patient with a chronic condition who can’t ...

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Job shadowing is a long-standing tradition.  High schools often have dedicated shadowing days, during which students can come and spend time with people working in careers that the students find interesting.  While a few hours isn’t really enough to know if you like, love or hate a job, it’s a start. In health care, it can be especially important to spend time shadowing.  In fact, PA schools want applicants to have ...

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Many years ago, it was called the emergency room. Now we call it the emergency department. However, unlike so many departments in the world, the emergency department has almost too many purposes, duties, and mandates to number. However, in the process of being the under-funded safety net for American health care, it has also become a place of remarkable danger where medical and nursing staff, support personnel and even patients face ...

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Dear emergency department clinicians: We at the top of the administrative and regulatory chain understand that you deal with enormously complicated mental health and substance abuse patients all the time. Your resources are limited, and the demands placed upon you are growing. As such, we (the anointed and well-meaning) wish to offer you some guidelines based on our committee’s extensive lunch-time meetings and brainstorming sessions. All of which, you will certainly understand, ...

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I hear it all the time.  Young resident physicians are taught it.  It infects our failed attempts to staff rural hospitals.  (Among other things.) It’s this.  ‘If you’re well trained in a teaching center, and you go to a small rural hospital, you’ll lose your skills.  Better to stay in the big center.  Let less qualified people work in ‘the hinterlands.’  It won’t matter that much out there.  They’ll be fine. ...

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Here is a standard emergency department situation, played out all across America today. Patient X has schizophrenia.  He takes medication, but only until he feels better.  He is calm when he takes it, but sometimes aggressive and assaultive when out of treatment and off medications. Patient X decides to leave town and drive somewhere else because he is angry at 1) family 2) significant other 3) health care system 4) situation. He is ...

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When the paramedic calls in and says "transporting non-emergent …" I think of this wonderful story. I was once "deposed" by the state medical board to speak on behalf of a friend who had been charged with "unprofessional behavior," because he missed an abnormal lab that resulted in a patient having unforeseen (but non-lethal) complications. It was really a systems issue, but somebody thought my friend needed to be made an ...

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"Mens sana, in corpore sano," goes the old Latin saying. "A healthy mind in a healthy body."  It’s vital that way pay proper attention not only to our physical existence but to our minds and souls; to the intangible but essential part of who we are. While I write a lot about things we need to do to keep our bodies healthy, it’s important to remember that our eyes and minds ...

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If you ask people if there is evil in the world, a lot of them will smile politely at such an obviously Medieval (or Neanderthal) view of the world.  Which, of course, is a bit of an insult to both groups who were from all evidence quite intelligent folks. Some might rattle off some examples of evil.  Things like intolerance, racism, sexism, homophobia, transphobia, Islamophobia, and assorted others.  Disregard for the imminent ...

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