Emergency Medicine

Improving access to care in rural America: Keeping rural hospitals in the game

Policy
September 11, 2022

Almost 20 percent of America’s population lives in rural areas of the country, where accessing health care facilities and services can be challenging. The patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 residents, compared to 53.3 physicians in urban areas.

Rural hospitals work diligently to meet the health needs of the populations they serve, but they have long struggled with staffing shortages, inconsistent patient volumes, …

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10 tips for smoothing the transition from resident to academic emergency medicine attending

Physician
September 11, 2022

Congratulations! You made it through residency. On to the next stage of your emergency medicine career – attending-hood (and for some fellowship)!

Here are ten tips we learned during our first year as attendings at an academic emergency medicine department.

1. Efficiency comes with time. Start off making sure you are methodical. Unlike residency, you will no longer have an attending re-ordering hemolyzed labs or ensuring a negative HCG prior to obtaining …

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Residency almost killed me — literally

Physician
September 5, 2022

One morning, I was sitting in resident lecture. This time was supposedly protected, but we realized fairly quickly that the work still had to be done, and “I had lecture” never really worked out well as an explanation.

By this time in the week, I had already worked 80 hours, and the luxury of sitting down for an hour in a row was the main upside to the lecture. I kept …

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Grief on the front line

Physician
September 4, 2022

Several years ago, I wrote a piece about my experience of personal grief while working as an emergency physician in Australia. The grief I experienced was due to the untimely death of my older brother Martin — a high-achieving lawyer and sportsman — who slowly withered away as he lost his battle with a rare and aggressive lymphoma. It is fair to say that his death broke me, but …

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Why I’m leaving emergency medicine

Physician
August 31, 2022

I am hanging up my stethoscope and exiting the ambulance bay doors for the last time. I chose emergency medicine to care for critically ill and injured patients, and I’m leaving because this has become near impossible.

I believe it imperative to share some of the reasons that I, and many like me, are leaving a field we once loved, as their ramifications will sooner or later impact you and those …

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Teen dies when blood culture protocol botched: What can we learn from this tragedy?

Conditions
July 25, 2022

It’s 4 a.m. when a 17-year-old awakens at home with severe left shoulder pain that his worried parents call 911. By the time he reaches the emergency room (ER), he has pain all the way to his wrist.

“Any recent injuries?” asks the doctor.

“Yeah, about three days ago, I was lifting about 200 pounds at the gym and noticed that my shoulder was really sore.”

When questioned further, he admits that he’d …

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It’s time to prevent the exploitation of sick people for profit

Physician
July 9, 2022

As a former emergency medicine doctor with ABEM certification, I anticipate questions about why I sought medical care. At this point, my problems are complex, and I need someone with a clear head to weigh in. At every encounter (and there have been nine or ten in three weeks), I have been both shocked and disappointed, as it seems patient well-being is barely a consideration in health care settings in …

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Don’t let medicine crush you

Physician
July 4, 2022

The house is asleep, and I can’t turn off my brain. I just cried my way through an episode of SEAL Team, especially the part where two SEALs are opening up to a psychologist about feeling broken. One says he’s tired of pretending he’s OK that he has PTSD and needs help. Later, he breaks down, and his wife folds him in her arms and tells him she’s there to …

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The gravity of difficult questions

Conditions
June 15, 2022

“I don’t want to be alive anymore.”

My friend Margot was despondent. Her lips quivered. Her eyes, normally the shape of almonds, folded themselves into little triangles when she cried. This kind and gentle woman of 62 years – my neighbor –  was undeniably at her lowest point. I was sharing a couch with her during my junior year of college as her composure crumpled before me.

I first met Margot when …

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Cardiac callus

Physician
June 6, 2022

I had wanted to take a long motorcycle trip for years, and I finally carved out two weeks to do so.  My pal Doug and I packed our gear onto our Harleys and headed out without an itinerary.  We would select the day’s route each morning.  Initially, we enjoyed spectacular scenery and good times.

After a few days, however, we encountered pouring rain while winding through remote mountains.  There was no …

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Death and Dvořák

Education
May 30, 2022

Dvořák Symphony No. 9 in E minor (“From the New World”) – Movement II ‘Largo’: a soundscape like floating beside the clouds in a perfect blue sky. The brass chords flood your ears. The underlying orchestra adds harmonic depth and richness. The English horn solo tugs at heartstrings, sighing at the end of each phrase.

After years spent in numerous youth symphonic orchestras, this performance stands out to me among an …

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Finding meaning with medical missions [PODCAST]

Podcast
May 6, 2022
YouTube video

“One initiative that more administrators should support is global medical outreach. The ability to practice pure medicine, like the neighborhood doctor from long ago, renews a love for the vocation that physicians sought when they first entered medical school. Humanitarian outreach will help reinvigorate physician workforces immediately, allowing physicians to have …

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A mother’s advice to her physician son

Education
May 1, 2022

I hope this finds you well. Today, I took some time shopping for a new outfit to wear to the upcoming festivities marking the end of your emergency medicine residency. We have celebrated many educational milestones over the years, haven’t we?

It seems like only yesterday that you started the third year of medical school. I remember the anticipation and pressure associated with moving out of the sim[ulation] lab and beginning …

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A voice from the lower decks of health care

Policy
May 1, 2022

“It feels different down here,” she said. I had just approached a young woman in our ED waiting room to apologize for the seven-hour wait to be seen. She looked at me with bloodshot, dark brown eyes and continued, “It feels like … the lower decks … Do you know what I mean?” I placed my hand on her shoulder, acknowledging her analogy with a shudder of complete understanding.

She was …

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Seen but not heard: How does the medical system value its scribes?

Physician
April 12, 2022

As an off-cycle medical student with an extended break between the completion of my M4 rotations and the conferment of my MD, I took a job as a medical scribe to keep myself active in the clinical setting (and, it must be said, provide myself with much-needed income).

I was atypical among most medical scribes, who are generally college students/graduates looking to obtain experience before applying to postgraduate medical programs, so …

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Are my coping skills a result of my emergency medicine training?

Physician
April 10, 2022

In the wake of a harrowing year, I’m left wondering, is a career in emergency medicine worth it? Like so many of my colleagues, I suffered personal tragedies during the pandemic that exacerbated the incredible stress at work.

My brother died in March of 2021, three weeks after receiving a diagnosis of metastatic colon cancer, and tragically, just six months later, my mother also died unexpectedly.

I have no doubt that emergency …

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True happiness and fulfillment come in servitude of others

Physician
March 21, 2022

Have you ever really appreciated the silence? The true silence that transports you to the root of it all. Our lives are a perpetual hamster wheel, chasing aspirations with underlying motivations that I often don’t completely understand. Good intentions and acts of kindness, seemingly altruistic, have hidden motivations of affirmation or appreciation. Why do you do what you do? It seems so obvious on the surface, but like an onion …

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Combat name-based microaggressions with these commitments today

Physician
March 13, 2022

A recent conversation with a colleague took an unfortunate turn when he asked me to teach him how to say my name. I happily obliged. “It’s O-HA-BUN-WA” I said phonetically with a smile on my face. Like many with ethnically distinct names, I get so happy when people attempt to say my name correctly. His response, however, was quite shocking.

“I will never be able to pronounce that,” he said emphatically. …

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Only patients can save U.S. health care

Physician
March 11, 2022

U.S. health care is going to hell in a handbasket, but only as patients can we alter this. Centers for Medicare & Medicaid Services (CMS), hospital administrators and we patients are all guilty of worshiping at the altar of “patient satisfaction.”

It’s not that patient satisfaction is necessarily a bad thing. As a patient myself, I certainly seek out convenience and satisfaction. A UC Davis study in 2012, …

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