Taking exception

A commenter responds to what I wrote about the Boston Herald story on ER care yesterday:

Not surprising is that most healthcare workers always side with the hospital. Why is that? What if that had been your family member that had been refused treatment and ended on a vent at a different hospital? Would your loyalties still be with the hospital? Blaming the victims is not the way to ...

Read more...

Black and white

Tort reform = lower malpractice rates:

Texas' largest medical liability insurance provider said Monday it will cut its rates by 5 percent starting in January.
No tort reform = soaring malpractice rates:
Physicians in a northwest Maryland county plan to halt non-emergency surgeries for at least two weeks to protest a 33 percent increase in malpractice insurance premiums.

Overuse of OTC pain medication

I had a small amount of input in an article on the effects of over-the-counter (OTC) painkiller overuse in today's Nashua Telegraph:

Over-the-counter pain killers are killing more than pain: they have been linked with more than 16,000 deaths and 103,000 hospitalizations a year in this country . . .

"They're not benign, especially now that what was prescription medicine is now over the counter," said internal medicine physician ...

Read more...

B-natriuretic peptide

One of the more helpful tests that I've used recently in the past few years or so is the B-natriuretic peptide (BNP). It recently came up in a story I was reading.

I was reminded of how useful the test was during a recent emergency room shift. In those presenting with shortness of breath, one has to decide whether the cause is the lungs (pneumonia, COPD, ...

Read more...

The hidden cost of medications

From the Archives of Internal Medicine, comes this story:

About one-third of chronically ill adults who underuse medications because of the costs associated with buying the drugs, never tell their health care practitioners . . .

The underuse of essential medications, including cholesterol-lowering medications, heart medications, asthma medications and antipsychotics, has been associated with increased emergency department visits, nursing home admissions, acute psychiatric hospitalizations, and a decrease in self-reported ...

Read more...

Active euthanasia

What an incredible story today from Medpundit:

An elderly, "comfort care only" patient was transferred from her nursing home to the ER in the middle of the night because the nursing home didn't know what to do when she developed abdominal pain. She was much too frail to withstand surgery, and since she was "comfort care only," that wasn't an option anyways. The emergency room doctor who drew her ...

Read more...

I just completed another shift in the emergency room (which I do about once per month), and it continually amazes me the amount of non-emergent cases that comes through - but that's for another rant.

So I'm reading that the family of John Ritter is suing the hospital for misdiagnosing his ascending aortic aneurysm. Galen certainly has some tough words for this. I'll reserve opinion since I'm ...

Read more...

Hostages in the ER

In a reminder that an emergency room can be dangerous place, this story reveals how desperate some patients are to continue their prescription drug abuse:

A man apparently distraught at not being able to see a doctor immediately held two hostages for 20 minutes at Frisbie Memorial Hospital Wednesday. . .

"They were able to get a doctor to respond to the emergency room," Officer Mike Allen said. ...

Read more...

In our instant gratification culture, this is an inevitable trend. Fast-food style medicine. These so-called "Minute-clinics" are being placed in department stores for walk-in urgent-care visits, which also serves to drive traffic into these stores. I think the underlying problem of poor primary-care access is certainly contributing to the demand. People are growing tired of waiting several weeks for appointments, and endless hours in ...

Read more...

The final word on South Shore ER

Today the Massachusetts Department of Public Health came down with its decision on South Shore hospital, just south of Boston. I have written about the situation previously and followed up here.

The Department of Public Health report, released yesterday, ends review of a dozen complaints about the pace of care in South Shore's emergency room since last year. It found that emergency room staff at the ...

Read more...

A recent study suggests that a single IM dose of steroid is equivalent as an 8-day tapering course of oral steroid in the setting of relapse rates from acute asthma attacks:

Objective: To compare the efficacy of long-acting IM methylprednisolone to tapering oral methylprednisolone in adult asthmatic patients discharged from the emergency department (ED).

Methods: Randomized, double-blind, placebo-controlled trial of a single IM dose of 160 mg depot ...

Read more...

A new study was released saying that tests are delayed on the weekends versus the weekdays.

In the study, published in the August edition of the American Journal of Medicine, researchers analyzed six procedures commonly used in emergency situations:

Purpose
Many hospital departments tend to have lower staffing levels on weekends. We evaluated the use of selected urgent procedures for emergently hospitalized patients and measured the time ...

Read more...

Nothing like reading an article about my old training ground, Boston Medical Center. Having the state's busiest emergency room gave them incentive to decrease waiting times, especially in light of the recent stories about other ER's in the state. They brought in a management consultant, and instituted some radical ideas. So far, seems pretty successful.

A sign of things to come?

We have concierge practices, now people can pay extra for "priority access" at emergency rooms:

The 95-year-old financially ailing Southampton Hospital - the only serious medical emergency center on the South Fork - is offering a plan aimed at wealthy summer visitors whose primary doctors are back in Manhattan and out of reach, presumably along with the hospital's sense of propriety. For $6,000 per family, or $3,800 for individuals, ...

Read more...

Medpundit has commented on the ER (mis)use piece written earlier this week, emphasizing the convenience ("In fact, you don't even have to walk to your tests. You get rolled to them in a wheelchair or gurney." - how true). Perhaps people are willing to wait the 5-6 hours in exchange for a second opinion, or in some cases a specialist evaluation. Beats waiting months. ...

Read more...

As a follow-up to what I wrote last week on the ER stories near Boston comes this report. Most of it we know already, but it's nice to see some concrete data:

One-fifth of patients coming to the ED did not have conditions requiring emergency care, and another one-fifth had urgent conditions that could have been treated in a primary care setting, the report shows.

Uninsured ...

Read more...

As a follow-up to what was written here last month, the AMA chimes in with their opinion.

An Alaska surgeon was sued because a patient ignored his advice to go to the emergency room. Again - a failure of personal responsibility has resulted in yet another malpractice suit. Fortunately, the jury was sensible and ruled in favor of the physician. I still have hope yet.

The VA hospital has always been special to me. My very first clinical rotation as a medical student was inpatient wards at the Jamaica Plain VA Hospital in Boston. Today, I still do occasional shifts in the VA emergency room, and see first hand the work and effort that is put in every day caring for our veterans, despite serious shortages in money and personnel. Today's Boston ...

Read more...

From EMedConcepts, a physician took this picture of a "mobile lawyer van" parked outside the emergency room. When security chased the van away, it moved across the street where it stayed for the rest of the day. Unbelievable.

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories