I was struck by a post by Dr. Saurabh Jha about his views of the jury system — as some of his comments mirrored things I’ve said to juries in the past. Some things he got right, which go to the core our civil justice system. Some things, however, not so much. His perspective comes from growing up in India, which doesn’t exactly have the most efficient of justice systems. And ...

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The emergency room is an interesting place to work. It’s controlled chaos. Walk through the hallways, and you’ll hear people screaming, see others crying, and others wincing in pain. Over time, you get a unique perspective on the human condition. In my years of training and practice, I’ve seen so much. People experiencing their worst days. Others receiving news that will change everything. Some lives ending. Others returning from the brink. Certainly, ...

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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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One of my most vivid early memories is from when I broke my collarbone.  In a first-grade relay race, kids were running at top speeds in opposite directions, so it was no surprise that I collided into a classmate.  I was knocked to the ground and cried in pain.  The school nurse called my mother, who came and took me home, carrying me all the way. Now that I have a ...

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A massive smile creased my lips upward as the rumble of the moving truck pushed the miles farther behind. My dream job and life on a quiet lake lay in wait at the end of this day's journey. Trading in urban life and working two to three weekends every month required little neuronal firing. The first few years went as slated. Decent hours, great pay, no call, and a package of benefits ...

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I’m in the back of an ambulance rig driving 110 miles an hour down the highway with the lights and sirens blaring.   The knuckles of my right hand are crushed every four minutes as my patient has contractions.  She cries only a bit.  She’s sixteen and her last period was nine months ago, but she hasn’t seen any other physician before me. This last contraction was an intense one -- my ...

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Another emergency physician asked me what I think will happen if the “surprise bill reform” with a benchmark fix happens.  I told her privately, but I am sharing, so everyone can understand why I am working so furiously on a seemingly boring and crass issue of reimbursement.  I do believe that patients should be taken out of the middle and shouldn’t ...

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When I was an intern, one of my attendings told me that I was “too nice.” He said it to mean that I needed to toughen up to “make it” as an emergency medicine (EM) physician, and that the alternative might be fatal. To give some context, this attending was of the direct, overly sarcastic, wry sense of humor variety. In the end, I left that shift alarmed, with a ...

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