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Latest Posts

Little Evidence For ER Wait Time Marketing Claims And Other Health News

ER Waits: Hospitals’ marketing claims of short waits for emergency room care aren’t backed up by any evidence, John Dorschner reports for the Miami Herald.

Chronic Fatigue: The editors of prestigious journal Science have retracted a controversial paper linking chronic fatigue syndrome to the XMRV virus; critics of the study believe contamination of samples was to blame for the results, which have not been replicated by other scientists, Ivan Oransky reports for Reuters.

Environmental Health: Tough new EPA rules on mercury emissions from oil- and coal-burning power plants are being Read more »

*This blog post was originally published at Reporting on Health - The Reporting on Health Daily Briefing*

Paying Diabetes The Attention It Deserves

Diabetes?  Isn't any of this unicorn bullshit.Two weeks ago, I was in the emergency room for some severe stomach pain, down on the lower right hand side of my abdomen.  After consulting with Dr. Google, I realized that it could be appendicitis.  Knowing I was heading to Toronto the next afternoon, I didn’t want to take any chances with this pain.  So I headed off to the ER (conveniently, the one my best friend works at) to check things out.

Looooong story made Twitter-esque short, I didn’t have appendicitis.  I just had some rogue stomach pain.  However, while I was at the hospital, I asked to have my A1C run.  I figured I was there, they were already drawing blood, so what’s one more vial?

“Can you guys grab an A1C while you’re at it?” I asked.

“Is your diabetes under control?”  asked the doctor.

“Um … define control?  I wear a pump, I wear a CGM, and I’m very aware of my disease.  But I’ve been having a hard time juggling things lately, on just about every level, so I’m pretty sure my A1C is crap.”

The doctor shot me a very rude, very judgmental look.  I shot one back at him.

“I’m asking you to run an A1C because Read more »

*This blog post was originally published at Six Until Me.*

Dealing With Cyclic Vomiting Syndrome Given How Little Is Known About The Condition

I have been working as an ER doctor for over a decade, and in that time I have come to recognize that there are certain complaints, and certain patients who bear these complaints, that are very challenging to take care of. I’m trying to be diplomatic here. What I really mean is that there are certain presentations that just make you cringe, drain the life force out of you, and make you wish you’d listened to mother and gone into investment banking instead. Among these, perhaps most prominently, is that of the patient with cyclic vomiting syndrome.

The diagnosis of cyclic vomiting syndrome, or CVS, is something which is only in recent years applied to adult patients.  Previously, it was only described in the pediatric population. It has generally been defined as a disease in which patients will have intermittent severe and prolonged episodes of intractable vomiting separated by asymptomatic intervals, over a period of years, for which no other adequate medical explanation can be found, and for which other causes have been ruled out.

That is not much in the way of good literature about this disease entity, which is surprising, because it is something that I see in the emergency department fairly regularly, and something with which nearly all emergency providers are quite familiar. These patients are familiar to us in part because we see them again and again, in part because they are memorable because they are so challenging to take care of.

Some things about the cyclic vomiting patient that pose particular challenges: Read more »

*This blog post was originally published at Movin' Meat*

ER Physician Amazed By The Technological Advancements In Medicine

My father in law, now deceased, was a nephrologist. I met him while I was in medical school. He was a reserved guy, not prone to butt into what he saw as others’ business. So I still remember that while I was considering what sort of residency to pursue, he took a surprisingly strong stance that I should go into interventional radiology. His reasoning was simple: they have a great lifestyle, they make bags and bags and bags of money, and they get to play with all the coolest gadgets.

It was tempting, I admit. As anyone who knows me can attest, I am ALL about the gadgets. I’m not averse to bags of money either. But I never gave it much consideration, mostly because I am just not real good at radiology, though for an ER doc I do OK. (A low bar, it is true.)

I sometimes regret that decision. For example, I wrote the other day about a gentleman who presented with a ruptured abdominal aortic aneurysm. We had some heroic fun in the ER resuscitating him and getting him to the OR. After the fact, I had to wonder whether it was all in vain — Read more »

*This blog post was originally published at Movin' Meat*

BBC America Introduces New TV Show About Real Life In The ER

You know me.

I’m all over anything that is from the BBC.

But this is different.

There is no TARDIS. And there are nurses along with the doctor. Lots of nurses.

And the only people flying through time and space are the trauma patients before they hit the bus or the ground.

24 Hours in the ER premiered last night on BBC America. I received a copy of the first two episodes from BBC America unedited for American television. Of course in Great Britian, this was called “24 Hours in A&E”.

On a personal level, I like it. It reminds me of the old “Trauma in the ER”.

On a professional level, Read more »

*This blog post was originally published at Emergiblog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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