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Latest Posts

Being A Doctor Is A Lot Like Being A Parent: You Can’t Tap Out

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*

Overwhelmed ERs Continue To Rise To The Challenge

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*

Thrombolytics: To Give Or Not To Give

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*

Recognizing Different Arrhythmias: There’s An App For That

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*

Kids Gone Wild: Intimidation Of Parents In The ER

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.)

**********

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*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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