August 11th, 2011 by Edwin Leap, M.D. in Health Policy, Opinion
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The American College of Graduate Medical Education has enacted further restrictions on resident work hours. No more than 80 hours per week of work for resident physicians, averaged over one month. And no more than 16 hours of continuous work for first year residents (24 after that), which includes patient care, academic lectures, etc.
Whenever they do this sort of thing, everyone seems excited that it will make everyone safer. After all, residents won’t be working as much, so they’ll be more rested and make much better decisions. It’s all ‘win-win,’ as physicians in training and patients alike are safer.
I guess. The problem of course is that after training, work hours aren’t restricted. There is no set limit on the amount of work a physician can be expected to do, especially in small solo practices, or practices in busy community hospitals.
I understand the imperative to let them rest. I understand that fatigue leads to mistakes. I get it! But does the ACGME get it? Read more »
*This blog post was originally published at edwinleap.com*
July 31st, 2011 by Edwin Leap, M.D. in Health Policy, Opinion
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Last night I was contacted by a physician in the local urgent-care. I like him, and we made polite, but brief, conversation. ‘So, are you guys busy?’
I gave him the status report. ‘Well, yeah. We have about 25 people waiting to be seen the waiting room is full and every patient room is full. Also, we just received a gun-shot wound to the head by EMS.’
‘Wow, sounds terrible! So, here’s what I need to send you…’
What he sent was, in fact, reasonable. A young woman with signs and symptoms of meningitis (who was treated earlier in the day for and upper respiratory virus…with Amoxicillin, of course.)
She needed a lumbar puncture, which I performed and which was negative.
But I had this thought. I could probably have said, Read more »
*This blog post was originally published at edwinleap.com*
July 25th, 2011 by Edwin Leap, M.D. in Opinion
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For years now, we’ve all heard the drum-beat. Bill-boards in cities have proclaimed it. Various medical associations have touted it’s importance. Stroke symptoms have to be treated immediately! Give clot-busting drugs, also known as ‘thrombolytics!’
Until, of course, those in favor of giving the drugs (namely neurologists) realized that a) Not everyone with a stroke, aka ‘brain attack’ has insurance and b) people have a very inconsiderate habit of having said strokes at the most inconvenient of hours. For instance, after 5PM, on the weekend, on holidays. The nerve!
So across the country, physicians in emergency departments like mine are finding themselves expected by the court of public opinion to give a potentially dangerous drug (albeit a sometimes useful drug) without any neurologist being available to evaluate the patient. Our emergency department thought we had a tele-medicine link; even that has failed, as nearby physicians in our regional referral center don’t feel keen to take responsibility for our patients. Our own neurologists, of course, have Read more »
*This blog post was originally published at edwinleap.com*
July 17th, 2011 by Edwin Leap, M.D. in Health Policy, Opinion
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The old joke in medicine goes, ‘don’t get sick on July 1st.’ That’s because it’s the day when new resident physicians, freshly graduated from medical schools across the land, begin their training programs. Although they have spent four years in undergraduate school and four years in medical school, it’s residency where physicians are made from the raw material of knowledge-rich, experience poor high achievers.
However, even in residency physicians are seldom told the entire story of how the practice of medicine, and their lives, will look and feel as their careers evolve and they enter the medical work-force.
Since our profession changes from year to year and administration to administration, it seems a good time to mention some of the things upcoming young physicians will face. Sadly, these are things seldom mentioned by pre-med advisors or academic medical educators.
You see, physicians are struggling. Due to falling reimbursements and the ongoing federal mandate to see non-paying patients on call, it is increasingly difficult for physicians to cover costs like malpractice insurance, licensure, professional memberships and office overhead. (Well, if they want to have a house, family and food, that is.)
Many physicians are Read more »
*This blog post was originally published at edwinleap.com*
July 9th, 2011 by Edwin Leap, M.D. in Opinion, True Stories
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This is my column in July’s EM News. Have a restful day!
We travel to Hilton Head, SC, every spring for an ‘end of school-year’ vacation. It is a tradition that started several years ago; one which our family treasures. We plan months ahead, when we arrange lodging. Then, as the date draws closer we have to restrain ourselves from jumping up and down at odd, inappropriate times. The beach calls to us in an inexplicable way.
We live in a beautiful county, surrounded by mountains and lakes. It is, in itself, a worthy destination, perfect for biking, hiking, fishing and/or kayaking. But when May rolls around, our eyes turn to the east, and we long for the sand and sea. It is one of the special gifts of South Carolina, that highland forests and crashing surf are half a day’s car ride apart.
The morning we leave, the car is packed, the snacks tucked away, and we drive through the local Chick-fil-A for drinks. Then my dear wife immerses herself in a novel, her i-Pod turned to her music collection (eclectic as when we first met, running the gamut from Prince to Loreena McKinnet, from Aaron Copeland to Veggie-Tales). The children slip off their shoes and drift into games, or their own books and music before boredom takes them to sleep.
I am left enjoying the singular pleasure of driving across the state of South Carolina, Read more »
*This blog post was originally published at edwinleap.com*
