June 24th, 2010 by Edwin Leap, M.D. in Better Health Network, Health Policy, Opinion, Research, True Stories
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Every day in the emergency department I am confronted by pain. In fact, the treatment of pain is one of the most important skills emergency physicians, indeed all physicians, possess.
For instance, I recently cared for a child with sickle cell disease who was having a pain crisis which involved severe leg pain. His life is one of frequent, intense pain. I gently, and repeatedly, treated his pain with morphine until he had relief. I see hip fractures; all broken bones hurt. I am thrilled to alleviate that discomfort. Pain is one of the things I can fix, if only temporarily. It makes me happy to see the relaxed face of a man or woman with a kidney stone or migraine, who suddenly smiles and says “thanks!”
But pain is also the source of so much subterfuge. Emergency department are full of individuals who use controlled substances for recreation. I know because they have pain that is entirely unverifiable. They have terrible right flank pain with no gall-bladder, no pancreatitis, no kidney stone (documented by CT), no pneumonia or rash. They have nothing to cause the pain. And yet, dose after dose of narcotic later, snoring in their ER stretcher, they look up at me with hazy eyes and say, thickly, “Cann I gettt somethinn elsss for paaiin…it hurtssss so…bad. zzzz. Itzzz a tennn.”
So I began to wonder about science and the pain scale. Read more »
*This blog post was originally published at edwinleap.com*
June 16th, 2010 by Edwin Leap, M.D. in Better Health Network, Health Policy, Opinion, True Stories
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Why do we physicians chart the way we do? Hopefully, we do it perfectly well and have no concerns at all. But where I practice emergency medicine, we are approaching maximum inefficiency in charting.
It all became much clearer when we started using our new EMR system. Let me make it clear, I’m not against EMR. In fact, typing and templates work better for me than dictating. My dictations were usually a mine field of blanks and misunderstood words.
Furthermore, if I wanted to use it, we have a new voice recognition dictation system in addition to our templated chart. Though admittedly, the voice recognition program clearly hates some of my partners, as evidenced by the way they grasp the screen and yell at it (‘Chest Pain, not west rain!’) and by its inexplicable use of profanity in the occasional chart.
But I digress. The problem as I see it is the evolution of the medical record. Why does the medical record exist? Read more »
*This blog post was originally published at edwinleap.com*
June 13th, 2010 by Edwin Leap, M.D. in Better Health Network, Opinion, True Stories
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I was about to leave work a few nights ago when EMS was dispatched to a 10-50, which is a motor vehicle accident.
Enough years in emergency care and that tone makes your radar, but doesn’t create much of a blip. Many of those crashes have EMS arrive, only to discover no injuries. Some have patients transported, with minor problems that lead to their speedy evaluation and discharge from our ER. A few have serious, life-threatening injuries. They take all our speed, skill and attention to save life and limb. And often, require transfer to other facilities.
But this last call was none of those. Around 1AM the radio traffic crackled back to dispatch (which we could hear in the emergency department): “Probable Signal Nine.” Signal Nine means the victim is dead at the scene. Not “Dead On Arrival” (DOA) at the hospital, but no hospital necessary.
I knew the paramedics were finished when they asked dispatch to call for the coroner. And my heart sank a little. For all that a multi-trauma is work, I’d rather do it anytime than have someone die, and someone learn of the death. Read more »
*This blog post was originally published at edwinleap.com*
June 5th, 2010 by Edwin Leap, M.D. in Better Health Network, Health Tips, Opinion, True Stories
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Here on this balcony, in Hilton Head, South Carolina, the wind is cool, the air typically thick with humidity, my wife reading a novel by my side. Inside the rental, our children are winding down after days of sun, sand and sea. Their bodies scrubbed pink by salt water and ocean breezes, their faces glowing with sun. My daughter’s lovely blonde hair is more blonde than usual.
I am on leave, in a sense. I am not, however, in the armed forces. Furthermore, I am not at a conference or working at all (except for a little writing, which is as much breath as work.) I am, in fact, celebrating my 20th wedding anniversary on a trip suggested and planned by my love.
I have accomplished little that the world would view as substantial this week. I have viewed it as a kind of sabbath. I have enjoyed my family, played on the beach, eaten far too much and delighted in every single, solitary minute…and Oreos.
“Sabbath,” “on leave,” “R&R” — however one describes it, we must remember to do it — we need it — because life is a kind of battle. Many well-educated, peaceful post-moderns think that’s far to bellicose a description, but the truth remains: Life is a struggle that rises to the description of battle with stark regularity. Read more »
*This blog post was originally published at edwinleap.com*
May 29th, 2010 by Edwin Leap, M.D. in Announcements, Better Health Network, True Stories
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To those who haven’t heard, an icon of emergency medicine has passed away.
Carol Rivers, M.D. died last week following a cardiac procedure. Carol was an outstanding clinician and educator, and one of the founders of modern emergency medicine as we’re fortunate to know it today.
Carol was perhaps best known for her board preparation guides, which helped many a terrified physician to navigate his or her emergency medicine board exams. I know her expertise helped me when I took my first American Board of Emergency Medicine (ABEM) exam. Read more »
*This blog post was originally published at edwinleap.com*
