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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So let’s get down to it.  Everyone is tired of shooting sprees.  If you’re a gun owner, you’re tired of seeing weapons abused and misused to harm the innocent.  If you’re a gun opponent, you feel the same way but can’t imagine why anyone has these weapons in the first place.  I get it.  I hope both sides get it. I’ve thought about this a lot.  I’m a gun owner.  I ...

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This summer, new resident physicians begin their training all across the United States. Today, our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (OK, not really a specialty, just a sideline) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school. Anxiety-filled and debt-ridden, they will embark on four ...

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It’s peculiar, I think, that we live in a time of physician shortage and yet some things remain abundantly clear: 1. Physicians can’t work together to fight, either for their own good or the good of their patients. 2. Like hostages, or abused spouses, they just keep going back for more of whatever bad policies they endure. 3. They are devalued. Now, this isn’t about money. I’m not enough of a medical economics expert ...

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I have met, in the emergency department, some fierce individuals. Sometimes they can be terrifying.  Their clothes, their manner, their demeanor, the way they pace, all suggest potential danger.  They seem clearly capable of violence.  They look at me with distrust, expecting to be disrespected, dismissed, treated harshly. Sometimes, they are covered in piercings; a thing alien to me.  Other times, the symbology on their clothes speaks volumes.  My colleagues in ...

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It’s easy to be excited about facts when they support our own opinions. It’s nice to believe that uncomfortable facts are fake. Likewise, it’s comforting to believe that everyone who disagrees with us is ignorant. When the truth is so obvious, we say, "How could anyone but an uneducated bumpkin deny it?" And yet, it seems that much of our knowledge is incomplete and that our deeply held beliefs may be ...

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I know a bit about the opioid epidemic ravaging America. My wife and I grew up in West Virginia and follow the news from home. I practice emergency medicine in rural South Carolina, and have worked in Georgia, North Carolina, Kentucky, and Indiana. I have seen the enemy, and it is terrible to behold. The genesis of the epidemic has been covered over and over. It is a complex problem with ...

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I am convinced that I have one of the best jobs a writer can possibly have. I practice medicine, in an emergency department. My life, every day, is filled with conversation with humans. I see their faces and touch their hands. They bring me their children, their very children (!) and trust this stranger to make their precious ones well. I hear their stories! Such stories. Of sorrow and sadness. Loss ...

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Without doubt, the future of medicine will include mandatory education for physicians on their conscious and unconscious biases. The politically and culturally progressive nature of medical education and graduate medical education almost ensure that this will eventually be a deeply-ingrained part of our training and our continuing certification. I’m sure that as our culture purports to discover ever new and egregious forms of bias, we will be endlessly reminded, in ...

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We had a pretty busy shop when I was in residency. So busy, in fact, that we had three secretaries working simultaneously -- one for paging, one for order entry, and one for admissions. I haven't been back there in a long time, but I hope the secretarial staff has grown commensurately with the volume and acuity of the ED. But from what I've seen around the country in my ...

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I’m an emergency physician. In common parlance, an ER doc. Which means, like a little kid who will eat dirt on a dare, there’s not much I won’t try in the practice of my profession. Many of my colleagues have had far more challenging careers than me, I assure you. But I have some stories to tell. Cyanide overdose while moonlighting as a resident. Patient nearly dying from bite by ...

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What are the most important things we can teach our kids? These days there are a lot of possible answers. Obviously, STEM skills (science, technology, engineering, mathematics) often lead to lucrative, stable careers; they seem to be tickets to "the good life," or so we’re taught. Languages are helpful. You can’t go wrong with basic computer programming skills. But in a world where people seem increasingly unkind, dishonest, greedy, violent and ...

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So you made a mistake. I know you’re busy beating yourself up about it. I know that after years and years of training in life-saving medicine you’ve also trained yourself to accept the blame for all sorts of things beyond your control. You’re asking, "How could I have missed that," or "Why didn’t I think about that?" You’re wondering why you didn’t give a different drug, order another test or do ...

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It’s hard to put into words the horror we all feel about the events in Las Vegas. So I won’t try. But what I will try to do is point out an often unspoken reality. Which is that those who work in emergency care constantly face terrible things with courage and skill and keep coming back for more. And everyone needs to remember that all those folks society counts on ...

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So I’ve finished up at one job and moved on to another. I was a director for a year, and it was a learning experience. Right now I’m nearing the final approach after working a long run. Last week I had five nights, 12 hours duration each. I stayed in a hotel near the hospital. Then, after two days off at home, I started a run of five days, of ...

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Unless you’ve been living under a rock, you’re well aware that the United States is in the grip of a really big epidemic of opioid abuse.  The epicenter of much of this has been my beloved Appalachia.  My home-town, Huntington, WV, might as well be re-named "Oxycontin," or maybe "Heroinville."  It’s ugly. Enormous amounts of ink have been spilled on this topic, and ...

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