December 5th, 2011 by Edwin Leap, M.D. in Health Policy, Opinion
No Comments »
Here’s my column in this month’s Emergency Medicine News.
In 1994 I was thrilled to become certified by the American Board of Emergency Medicine. I had worked very hard. I studied and read, I practiced oral board scenarios and even took an oral board preparatory course. It was, I believed, the pinnacle of my medical education. Indeed, if you counted the ACT, the MCAT, the three part board exams along the way and the in-service exams, it was my ultimate test. The one that I had been striving for throughout my higher education experience.
I am now disappointed to find that my certification was inadequate. In fact, all of us who worked so hard for our ABEM certification find ourselves facing ever more stringent rules to maintain that status. And it isn’t only emergency medicine. All medical specialties are facing the same crunch. Our certifying bodies expect more…and more…and more.
And the attitude is all predicated on the subtle but obvious assumption that those of us in practice are not competent to maintain our own knowledge base. Despite spending decades in education that we are not to be trusted. That we are not interested in learning. That we do not attempt to learn and that our practices are not, in fact, the endless learning experiences they actually are. They assume we need more supervision, despite demonstrating (by our continued practice) that we are willing to do hard work, in hard settings, and do the right thing.
Unfortunately, the rank and file Read more »
*This blog post was originally published at edwinleap.com*
September 27th, 2011 by Edwin Leap, M.D. in Health Policy, Opinion
No Comments »
I recently saw a teenage boy with headaches. His father, wringing his hands, said that the headaches had been present for two years; but that the child had never been evaluated for them. No imaging, no neurologist. No insurance, of course.
A family friend, another child, had been diagnosed with a brain tumor. The family of my patient was terrified. Where to turn? They were, reasonably, concerned about cost.
Contrast that with the woman I saw on state assistance. Read more »
*This blog post was originally published at edwinleap.com*
September 12th, 2011 by Edwin Leap, M.D. in Health Policy, Opinion
No Comments »
Nostalgia for the house-call
Not too long ago, I made a house call. As a physician accustomed to working in the emergency department of a hospital, this was quite a change of pace. But it involved dear friends and their sick child, and it was a joy. We had spoken on the phone and I had some concerns about their infant, who was stricken with a high fever. When I went to their home I took only my stethoscope. That and my experience as a physician and parent of four.
When I walked through the door on Friday evening there were candles burning as dinner was prepared. There were no florescent lights. There was none of the chaos of a waiting room. No ambulances idled outside. No bloody, angry drunk screamed profanities. No one was stood by their exam room door, arms crossed in annoyance with waiting. It was a quiet place to be; and the child, on his worried mother’s hip, was quiet as well. He was in a place where he felt safe and was thus able to tolerate my poking and prodding.
I examined him and decided that he was not seriously ill. Because his mother had described him as lethargic when we spoke, I had been concerned that he might have meningitis. This was not actually the case. His parents and I were obviously relieved.
After he was dosed with ibuprofen and put to bed, I chatted a while with his mom and dad, then left for home. As I drove home I realized that Read more »
*This blog post was originally published at edwinleap.com*
September 8th, 2011 by Edwin Leap, M.D. in Opinion
No Comments »
I think a lot about the slow, certain dissolution of medicine as we know it. Mental health issues crowd emergency departments, as few mental health clinics are available. Psychiatrists are in short supply. Drug abuse overwhelms the medical system, with either patients seeking pills or patients families hoping to get them off of pills.
Persons with little interest in their own health continue to smoke and drink, use Meth and eat poorly. Disability claims are skyrocketing as younger and younger individuals confabulate their misery in hopes of attaining a check, paid for by someone else.
The poor, with genuine medical problems, have increasing difficulty finding care as jobs, and insurance, fade away. Politicians, eager to be re-elected, eager to be loved, promise Read more »
*This blog post was originally published at edwinleap.com*
August 26th, 2011 by Edwin Leap, M.D. in Opinion
No Comments »
This might sting a little…
When I was a child, I was often painted orange with Merthiolate. My grandmother, like every good grandmother, kept a bottle handy at all times. Merthiolate was an antiseptic, containing Mercury, that was marketed for cuts and scrapes.
A fall on the gravel, a slide on the pavement, a run through the briar patch and you’d be sitting on the kitchen table while grandma colored you orange with the magical elixir, which incidentally burned like fire!
On a recent emergency department shift, we were colluding about the general state of drug-seeking in America, which has been enabled by our ‘nothing should hurt’ ideology. One of my dear friends, Nurse Nancy, had a realization; an epiphany, really. Read more »
*This blog post was originally published at edwinleap.com*
