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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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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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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