July 5th, 2010 by Shadowfax in Better Health Network, Health Policy, Opinion, True Stories
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I don’t know what’s going on with American College of Emergency Physicians (ACEP) lately, but it’s disheartening. Their abdication of responsibility and engagement during the healthcare reform debate was depressing. Then there was a rigged poll designed to elicit a predetermined result. Now I see a bizarre op-ed piece in USA Today entitled “Opposing view on drug addiction: Don’t make us ‘pain police'” and authored by ACEP President Angela Gardener. An excerpt:
The patient-physician relationship is sacrosanct, demanding candor and trust. In the emergency department, trust is built in nanoseconds because patients and doctors do not have prior relationships. Knowing that any pain prescription will be entered into a large, public database might prevent patients from being truthful, or in the worst case, from seeking needed care. … As an emergency physician, I can assure you that the drug abusers who use the emergency room simply to get a prescription drug fix represent a micropopulation of the 120 million patients who seek emergency care every year in the USA. … Put bluntly, if legislators have money to spend, they should spend it where it will do the most good for our patients, and that is not on drug databases.
I really don’t know what to say, other than to wonder whether Dr. Gardner and I practice in the same United States in which abuse of prescription drugs is growing exponentially and in which “drug-seeking” patients are a part of each and every shift worked in the ER, where deaths due to overdoses of prescription medications are on the rise, and where diversion of narcotics is a serious and growing problem. Read more »
*This blog post was originally published at Movin' Meat*
July 5th, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion, Research
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Emergency physicians are in a dilemma. Risk missing a diagnosis and be sued, or be criticized for overtesting.
Regular readers of this blog, along with many other physicians’ blogs, are familiar with the difficult choices facing doctors in the emergency department.
The Associated Press, continuing its excellent series on overtesting, discusses how lawsuit fears is a leading driver of unnecessary tests. Consider chest pain, one of the most common presenting symptoms in the ER:
Patients with suspected heart attacks often get the range of what the ER offers, from multiple blood tests that can quickly add up in cost, to X-rays and EKGs, to costly CT scans, which are becoming routine in some hospital ERs for diagnosing heart attacks …
… and the battery of testing may be paying off: A few decades ago insurance statistics showed that about 5 percent of heart attacks were missed in the emergency room. Now it’s well under 1 percent, said Dr. Robert Bitterman, head of the American College of Emergency Physicians’ medical-legal committee.
“But you still get sued if you miss them,” Bitterman added.
The American Medical Association’s idea of providing malpractice protection if doctors follow standardized, evidence-based guidelines makes sense in these cases. Furthermore, it can also help reduce the significant practice variation that health reformers continually focus on. Read more »
*This blog post was originally published at KevinMD.com*
July 4th, 2010 by RamonaBatesMD in Better Health Network, Health Tips, News, True Stories
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Time for a reminder about safe fireworks use. This Daily News article by Lauren Johnston — Doctors replace woman’s missing thumb with big toe transplant –- shows and tells you why. An excerpt:
A Long Island woman’s big toe will adapt to function as a thumb after doctors performed a rare transplant operation to replace the vital missing digit.
Shannon Elliott, 25, lost the thumb and two fingers from her left hand in November when a firework exploded in her palm…
Have a safe and happy July 4th — and stay out of the ER. Please follow these fireworks safety tips:
- Never allow children to play with or ignite fireworks.
- Read and follow all warnings and instructions.
- Fireworks should be unpacked from any paper packing out-of-doors and away from any open flames.
- Be sure other people are out-of-range before lighting fireworks. Small children should be kept a safe distance from the fireworks; older children that use fireworks need to be carefully supervised.
- Do not smoke when handling any type of “live” firecracker, rocket, or aerial display.
- Keep all fireworks away from any flammable liquids, dry grassy areas, or open bonfires.
- Keep a bucket of water or working garden hose nearby in case of a malfunction or fire.
- Take note of any sudden wind change that could cause sparks or debris to fall on a car, house, or person.
- Never attempt to pick up and relight a “fizzled” firework device that has failed to light or “go off”
- Do not use any aluminum or metal soda/beer can or glass bottle to stage or hold fireworks before lighting.
- Do not use any tightly closed container for these lighted devices to add to the exploding effect or to increase noise.
- Never attempt to make your own exploding device from raw gunpowder or similar flammable substance. The results are too unpredictable.
- Never use mail-order fireworks kits. These do-it-yourself kits are simply unsafe.
For more information on injuries that can occur from unsafe use of fireworks, see:
Fireworks-Related Injuries (CDC)
Facts About Fireworks Injuries (Prevent Blindness America)
*This blog post was originally published at Suture for a Living*
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*
