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 21st, 2011 by iMedicalApps in News
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The recognition and management of cardiac arrhythmias is a must-have clinical skill for residents and physicians, and one that is often not well-taught at some institutions.
For example, deciding whether a patient is in a shockable rhythm, realizing what medications should or should not be given in a particular situation, or assessing the degree of atrioventricular block, can all be important considerations in patient care.
The Arrhythmias app, designed by Abe Balsamo, recently cracked the Top 10 list of most-downloaded medical apps in the app store. This app represents Mr. Balsamo’s first foray into the app world, though he has several other apps in development, according to his website AppsByAbe.com. The app’s growing popularity has been driven by its point-of-care abilities that appeal to healthcare professionals, especially emergency medical personnel.
Read below the jump to see how the Arrhythmias app can assist healthcare professionals with the recognition of different arrhythmias. Read more »
*This blog post was originally published at iMedicalApps*
July 12th, 2011 by Emergiblog in Opinion, True Stories
1 Comment »
Ah, the benefits of sand therapy!
Time for little Bettina’s daily afternoon face plant!
Not only does it appear my colleague is about to lose her grip on her patient, I’m concerned about her choice of body mechanics.
I predict a lumbar strain in 3…2…1……
(This photo is from the Library of Congress collection.)
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I love my pediatric patients. While it is hard to see children feeling sick, they can be bright spots in occasionally hellacious shifts.
I’ve blogged before on my observation that the kids seem to be the adults in the some families.
- They don’t want to undress for an exam, so they fight the parents who are helpless in the face of taking a shirt off a three-year-old.
- They have to be restrained so they don’t run rampant in the ER, and they slap their parent across the face. The parent doesn’t respond.
- They are told they need to cooperate with a procedure and they answer their parent with a loud, clear, “F*** YOU!” At the age of five. The parent retreats. Read more »
*This blog post was originally published at Emergiblog*
