I wish I could say that every patient encounter worked out well, that all my patients went home happy and satisfied. It would be nice, but unfortunately that is not true at all.
There are many patients who present with unrealistic expectations or an agenda which is non-therapeutic, and I am relatively straightforward and unapologetic about correcting patient’s misconceptions about the care that is or is not appropriate in the ED. Unsurprisingly, this often though not always involves narcotic medications.
Which is not to say that I am a jerk. I try to be compassionate, and I try to find alternative solutions, and I have been told that I can turn away a drug seeker more nicely than any other doctor in the department. But when it is time to say “no,” I say “no” firmly and without evasions or excuses. People don’t like to hear that, and all the more so in this “the consumer is king” environment of customer-service culture we foster in the medical industry these days.
So when I do say “no,” as nice as I try to be, some people get upset. Sometimes they escalate. They hurl insults, spit, throw themselves on the floor and throw a fit or feign unconsciousness. Read more »
*This blog post was originally published at Movin' Meat*
We can stop baseless malpractice suits before they get started. How? By having a majority of practicing emergency physicians go on record as to the baseline “standard of care,” beneath which is negligence.
This has been rolling for a while, and I’ve been late to blog it. That does not in any way mean I’m not 100 percent FOR it.
The idea is beautifully simple: The standard of care in emergency medicine (EM) should be set by practicing EM physicians, not case-by case in courts before lay juries with battling experts. (AAEM had the “remarkable testimony” series as a retrospective attempt to shame “experts” who gave, well, remarkable statements under oath, which to date has two cases in it.)
This has the very real advantage of being a clear, concise peer statement that this is/is not the standard of care.
I voted (while at ACEP). If you’re an emergency physician (and you have to cough up some information to determine your bona-fides before you can vote), go to the Standard of Care Project and cast your vote. They’ve set the bar at 30,000 votes, which is ambitious. It’s also worth it.
*This blog post was originally published at GruntDoc*
In a better setting than the animation of the ER patient faking a seizure (which was inexplicably set in what appeared to be a convenience store), this one at least looks medical. But I’m a little concerned about the red blood infusion just hanging in the background, not connected to anything. I’m pretty sure the Joint Commission wouldn’t approve of that.
*This blog post was originally published at Movin' Meat*
Texas is at the center of a heated national battle over the training emergency physicians need in order to advertise themselves as “board certified.” Via the Houston Chronicle:
At stake is the welfare of patients requiring immediate medical attention. Leaders of the traditional board say allowing physicians without proper training to advertise themselves as board-certified would mislead the public. Leaders of the alternative board say the proposed rule change will undermine the ability of Texas’ rural hospitals to staff their emergency departments with board-certified ER physicians.
A final verdict may only come, given one board’s already delivered threat, in a court of law.
At stake also are the careers of a lot of practicing Emergency Physicians, many of whom I’m proud to call friends and colleagues. (And it’s not just docs at rural hospitals, they’re in nearly every ED in Texas, and your lesser state). They practice high quality Emergency Medicine, and I have no qualms about the practice of those who are alternately boarded. Read more »
*This blog post was originally published at GruntDoc*
The Patient Protection and Affordable Care Act (our government’s name for healthcare reform) may make our already crowded emergency rooms swarm with more patients.
A new study from Health Affairs shows that more than a quarter of patients who currently visit emergency departmentsin the U.S. are there for routine care and not an emergency. New complaints like stomach pain, skin rashes, fever, chest pain, cough or for a flare up of a chronic condition should not be treated in emergency rooms. They are best worked up and treated by an internist or family physician, preferably one who knows the patient. So why are these patients waiting for hours and spending up to 10 times as much money for emergency department care? Read more »
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I wish I could say that every patient encounter worked out well, that all my patients went home happy and satisfied. It would be nice, but unfortunately that is not true at all.
