The boom in telemedicine is here, and understandably so.  The “consumer” is in control now, and they sure don’t want to be “patient” anymore.  When Americans want care, they want it cheap, and they want it now.   Telemedicine has grown to accommodate 7 million annual patient encounters, up from 350,000 five years ago.  What savvy health care administrator doesn’t see numbers like that and get dollar signs in ...

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I took a fantastic emergency medicine (EM) job when I finished residency.  There was no question in my mind that it was the best job within a hundred mile radius, maybe more.  When I first started, my expectations were met.  My group held a contract to staff a busy but well-staffed suburban emergency department, and had held that contract for almost 20 years when I signed.  The hospital was independent, ...

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Although I didn’t think much of the statement when I first heard it from my residency director, now, nearly twelve years later, I realize its value.  I learned so much during those three years.  I learned to prepare for success prior to every procedure I started to avoid clumsily searching for needed equipment mid-procedure.  I learned what an eternity of time I gained during an intubation if I could be ...

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shutterstock_208716340 I have been an emergency physician for 12 years.  I have had the opportunity to learn from and try to emulate an impressive number of amazing clinical physicians.  These doctors seemed god-like at first, but as my training and career progressed, I realized that they were mostly teaching me through their own experiences. One of my favorite teachers had a humbling saying:  “Good ...

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caitlyn_jenner_e This piece will likely draw ire from many, but I do not intend it to be inflammatory.  I write it to explain why Bruce Jenner’s recent, and very public, transformation into Caitlyn shouldn’t necessarily make us feel all warm, fuzzy, and optimistic.  This is not meant to insult or degrade any individuals who are transgender or merely confused about their own ...

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She was lying there stretched out, her mouth open, her eyelids sealed, her fingers straight, immobile, and paler than an image made of wax.  From out of her eyes came two streams of tears flowing slowly down onto the pillow … For forty-three days, Charles did not leave her.  He neglected his patients; he sat up every night, he was constantly taking her pulse, applying sinapisms, cold-water compresses.  He sent Justin to ...

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shutterstock_149598137 By now, everyone in health care is accustomed to the idea of patient satisfaction data and the multi-million dollar industry ($61 million in annual revenue for Press Ganey alone) which exists thanks to the health care leaders and policy makers who embrace it.  Most physicians believe it is absurd to use it as a marker of quality care, but have accepted ...

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shutterstock_141195013 American physicians have had it.  We are retiring early, cutting back, changing careers, and moping in to work in astounding numbers.  The typical pep talks, whether given aloud by medical directors and administrators or consisting of internal dialog occurring in the physician’s mind, are not working anymore.  “You have it better than most people.”  “You are still making good money.”  “Your ...

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shutterstock_139099052 I have been doing emergency medicine for almost ten years -- thirteen if residency counts, and I sure think it does.  I face the same issues that cause my work colleagues, physicians and nurses alike, to burnout. I struggle with burnout myself, but I keep coming back.  Many days (and nights), I ask myself why I continue to do what I ...

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