In 1994 I was thrilled to become certified by the American Board of Emergency Medicine. I had worked very hard. I studied and read, I practiced oral board scenarios and even took an oral board preparatory course. It was, I believed, the pinnacle of my medical education. Indeed, if you counted the ACT, the MCAT, the three part board exams along the way and the in-service exams, it was my ...

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I recently sat by a man whose young wife was dying. Her cancer was taking her away from her husband and toddler. She was sleeping intermittently as the pain medication we administered did its work. Her husband’s eyes were red from crying and he could barely suppress a sob. He touched her and looked at me. I barely kept my own composure. I wanted to avoid that room and that patient. ...

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I once asked a man in his 30’s why he was on disability. He had fallen attempting to ford a swift stream while fishing. He replied: "Well, the judge said I have a bad attitude, I don’t like people and I can’t hold a job." Shocking as it sounds, it wasn’t very different from other reasons I’ve heard. "I don’t remember, my Dad put me on it." "I have anxiety." ...

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So I have a Droid.  I purchased it in July, not long after taking my old flip-phone for an oceanic bath at Hilton Head, SC.  I waffled for a long time.  In fact, I almost purchased a Casio phone that was marketed as water and impact resistant.  "Mil-spec," was the phrase used ... a phrase which appeals to me as a one-time Air-Guard flight surgeon.  What it meant to me ...

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July is the month that new resident physicians begin their training all across the United States. Our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (ok, not really a specialty, just a side-line) 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 ...

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Lying on the backboard, a frail little old lady moaned with discomfort. She had fallen beside her bed in the nursing home and was then tightly bound by straps onto the backboard, a cervical collar pushing her chin up and holding her immobile. A person not familiar with modern medicine might think the ensemble looked like a torture device. Indeed, it can ...

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Every day, mental health clinics, emergency departments, psychiatric hospitals, physicians’ offices, counselors’ offices, school counselors and police officers are faced with an almost impossible responsibility. It is a responsibility, a burden, often highlighted retrospectively, after a tragedy. Their job is this: identify every dangerous person, treat them properly and avoid horrific events like the recent murders in Tuscon. I sympathize greatly, since I work in the emergency department of a hospital ...

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So now, in addition to the many other bits of medical meddling we have from CMS (Centers for Medicare and Medicaid Services), there’s this. Reimbursements to hospitals, from Medicare, will be partly tied to patient satisfaction scores. We’ve seen payments already being tied to ‘quality indicators,’ as dictated by the federal government; rewards for doing a better job on care for heart attacks, pneumonia, etc.. At least that’s quantifiable, whether scientifically ...

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I have a suggestion for all of those federal workers who were concerned about a government shutdown.

To all those who already have better insurance and better benefits than most in the private sector; for all those whose jobs pay more than equivalent private sector jobs for the same activities. Do what hospitals do. ‘Go to your jobs, and do the necessary work anyway.’ It is ironic, but hardly surprising, that the ...

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I was talking to a young man who is starting medical school this fall. His tuition at one of South Carolina’s newer schools will be $40,000 per year. That’s admittedly on the high end. On the low end, it runs a paltry $33,000 per year. And this is all after college, of course. He and others like him are taking out loans to the tune of $240,000 to pay for their ...

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My partners and I have long struggled with the lack of specialty back-up at our hospital. Semi-rural hospitals, out of the way facilities, just can’t always attract specialists. So, we’re happy to have cardiologists every night, but understand that we only have an ENT every third night. We’re thankful to have neurologists, even if they don’t admit anyone. We’re glad to have radiologists, even if they don’t read plain films ...

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I was talking with a pre-med student recently.  He had completed his very first medical school interview and was, understandably, excited.  But he told me the interviewer had asked him what he thought would be the outcome of the current health-care reform measures. I laughed to myself.  After 17 years in practice, even I don't know the outcome, though I have my suspicions.  It seemed a loaded, almost unfair question.  After ...

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Why do we physicians chart the way we do? Hopefully, you do it perfectly well and have no concerns at all. But where I practice emergency medicine, we are approaching maximum inefficiency in charting. It all became much clearer when we started using our new EMR system. Let me make it clear, I'm not against EMR. In fact, typing and templates work better for me than dictating. My dictations were usually ...

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Our state of South Carolina is a delight. From wonderful people to beautiful landscapes, from a vibrant Southern culture to excellent food like shrimp and grits, it’s a place I’m thrilled to live. But we do lack a few things. And one of the most striking is adequate mental health care. The state budget, like so many state budgets, has been trimming anything and everything. And of course, mental health coverage ...

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A sweet little lady came to the emergency department recently. She said she felt short of breath and sweaty at home. In the department, she looked like a rose! Normal oxygen levels, normal labs. Her chest x-ray had a faint area that ‘one might possibly imagine could perhaps be’ a pneumonia. It looked remarkably like her previous film. But her history was concerning to me, and it was concerning to ...

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I’m becoming an amateur archeologist. The hilltop where we live is strewn with arrowheads and bits of Native American pottery shards. I have slowly, surely, trained my eye to find them. There is little flint here; so most of the pieces I find were made of quartz. (Hard to work with, but remarkably beautiful and almost always a brilliant white.) My kids and I walk the red-clay paths and look down ...

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I am very blessed. The hospital where I practice, while concerned with patient satisfaction, does not worship at its altar. That is, so far our administrators seem to understand that people will occasionally be angry or unsatisfied, and that such dissatisfaction is within the realm of real life. We still have people storm out of the emergency department, prattling on about lawyers and lawsuits, promising to go to another hospital in ...

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The cell-phone is a wonderful device. Even I, somewhat Luddite about certain technologies, find it delightfully useful for things like calling my wife when I lose the grocery list, calling my wife for directions and calling my wife to remind me of what I was supposed to be doing. I’m not really a fan of texting, though my wife and oldest son seem to communicate that way quite effectively. It’s ...

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We have a new EMR system. I like it because I type well. I’m facile at using a keyboard and touch-screen. Not everyone in my group is so blessed, and we’ve had some difficulties using the voice-transcription software. Nevertheless, my gut tells me that in a month or two more, we’ll be getting along with our new system swimmingly. It’s the sort of thing I have wanted for a while, ...

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I must admit I’m a little weary of the entire debate on health-care reform. But something still haunts me. And that something is accountability. Of course, over the almost twenty years that I have borne the title ‘MD,’ I’ve learned a few things about accountability. I understand that, almost without fail, the buck stops with me. The nursing home director knows the elderly lady wasn’t seriously hurt in that fall, but ...

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