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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