I have been writing columns for physicians for twenty years.  And year after year, I have had physicians say this: "I'm glad you said what you did. If I said it, I'd be fired." There are variations on the theme, but they're much the same.  Twenty years, and far more than 20 years, during which the alleged health care leaders in America have been routinely muzzled because they aren't supposed ...

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This is a frightening time. The coronavirus is called “novel” because it is new, and what is new is often terrifying. We don’t know enough about our new microscopic enemy. Scientists, clinicians, and policymakers are all working tirelessly with limited data and learning along the way. Consider that many diseases that we regularly face have been observed, reported, studied, and treated for decades; some for centuries (although with less success than now). Novel coronavirus ...

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Coronavirus, a.k.a. COVID-19, is lurking on the edges of the United States.  What it will do here has yet to be seen.  I was initially very concerned since I work on the front lines in community emergency medicine.  For the last week or so, I have felt a little better after reading several articles. I suspect it will not have a high lethality among otherwise healthy individuals.  But I'm no ...

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I once saw an older gentleman who was mentally impaired from birth. A hard enough blow, he had slowly, inexorably drifted into dementia.  He cut his head in a fall, suffering the ravages of gravity as so many do every day, every night. He was Caucasian.  His full-time care-giver was African-American.  That young man was the only person who could calm the angry, profane mood swings of his increasingly difficult, neurologically ...

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I sometimes work as a church security volunteer.  And when I do it, I get to simply stand and watch.  Watch for someone sick or injured (we have defibrillators and wound care equipment).  Watch for someone coming to cause harm.  Watch in order to call the police.  Watch to keep the children safe. And it occurs to me, when I do it, that watching is incredibly important.  I know this as ...

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It’s hard to explain what we do. And so maybe, it’s hard for others to sympathize with our situations. I mean, physicians, mid-levels, and nurses in emergency departments are tied to computers in often cramped work-spaces, even as they are required to be at the bedside almost constantly for the latest emergency or (in other cases) the latest bit of pseudo-emergency drama. If you haven’t worked there, or haven’t for a ...

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In the emergency department, we see them all the time.  The person with a medical problem too serious to ignore, but not quite bad enough to require admission.  The patient referred to the specialist who comes back to the ER. "I couldn’t afford the cash upfront."  The new cancer in the uninsured.  The pneumonia without a doctor.  The homeless not eligible for Medicaid. The senior barely able to stand, but whose ...

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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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There are a lot of unhappy physicians in a lot of bad situations. I know because I write for them, and they write to me. The thing is, we deal with patient satisfaction all day long. Why not work harder on physician satisfaction? I want my colleagues to have a higher "physician satisfaction score." So first off, what makes us dissatisfied? What lowers that score for the hard-working physicians of America, ...

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"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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