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The Reality Of Being A Doctor

Lest the students out there get disillusioned, it is probably a good idea to be upfront about the reality of being a doctor:


Maybe it’s not always this bad, but in the ER there is a real ring of truth to this.

From the marvelous Saturday Morning Breakfast Cereal

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

Dealing With Acute Pain: What Are The Treatment Options?

Whether caused by injury, surgery or a toothache so bad it slams you awake in the middle of the night, acute pain is difficult.  Receiving prompt and helpful treatment can make all the difference in the world.  But lack of care or inadequate care means that the acute pain may develop into chronic agony.

Fortunately, acute pain is not always long lasting or overwhelming, such as when you have a short severe cramp or multiple bee stings that can be handled with time, over-the-counter medication and other home remedies [See: Pain Treatment Options].

Since individuals’ tolerance for pain varies widely, the question of when pain itself requires urgent medical attention is difficult to answer.  Chest pain should prompt a visit to the emergency room, of course—but other types of pain are trickier to call. Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

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*

When Instinct Trumps Expertise

A hard thing about being an ER doctor is that I know a little, sometimes very little, about a lot of things. When I am faced with a particular condition, I often need to call the specialist for that organ, who knows way way more about it than I ever will, and they all think I’m an idiot because I don’t know as much about their organ as they do. There’s a huge asymmetry of knowledge, and it can create some tension and conflict.

I’m OK with it, because I can ignore their condescension and I am secure with what I do know, and its limits. But sometimes I get perplexing instructions from the specialists. The emergency medicine dogma can be overbroad and a little hidebound and what the specialists will do in the real world often radically diverges from what the Emergency Medicine textbooks say to do. It’s often an interesting learning opportunity for me, especially when it’s a condition I don’t encounter that much.  But I also have to work to maintain a flexible and open-minded attitude when I call a consultant and my side of the conversation consists of “Really? I didn’t know you did that for this…” You need to know and trust your colleagues in other specialties, and know when to call BS on them and push to do something else, which is really hard to do when you are talking to someone who is so much more of an expert than you are.

So I saw this guy recently, an urban hipster who was perhaps a bit too old to be riding his longboard on the hilly streets of our fair town. He didn’t seem to be too good at it, judging by the collection of crusted abrasions and aging ecchymoses he was sporting. He had been falling a lot recently — we only get about a month of sun here, so I guess he was making the most of the summer weather practicing his new hobby.  He had a variety of complaints from Read more »

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

When HIPAA Doesn’t Apply

Got a call from a long-time patient over the weekend. Hearing a not overly alarming story but one that was not terribly reassuring either, I suggested she go to the Emergency Department.

Later that morning, sitting at an internet cafe with DSS eating breakfast, each of us surfing on our respective laptops, he says conversationally, “So I see Miss LTP is in the ER.”

My heart stopped and my stomach dropped. Had he managed to access the voicemail program I use for after hours calls? My EMR? Had I left shortcuts up to any patient-related materials on that machine? When had I last used it anyway? My mind was racing. I wasn’t all that concerned specifically about him knowing that a particular person was in the ER, since he understands confidentiality. But if he was able to access confidential patient information, did that mean I had a security breach?

“How do you know that?” I asked him carefully, after a very long pause, during which all of the above ran through my head. Read more »

*This blog post was originally published at Musings of a Dinosaur*

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

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Latest Book Reviews

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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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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