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Hot Topic: Certification Of ER Doctors

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*

Emergency Rooms Overused For Routine Care

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 departments in 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 »

*This blog post was originally published at EverythingHealth*

Electronic Medical Records, ER Wait Times, And The Medical Blogosphere

Here’s a confession: Despite my steadfast advocacy of medical blogging as a means to promote understanding and education, I continue worry a lot about professional liability. Not just whether the things I write could hurt my career, but, in terms of academic output, is blogging a waste of time? What view does my department’s leadership take on blogging?

Still, I’ve continued to support medical blogging as a useful academic endeavor, hoping that someday this support would be borne out. When sites like Sermo and Facebook came along, I despaired that more physician opinions were going to be hidden behind walled gardens, available only to select colleagues or friends.

Then, last week, some revelations — I discovered a member of my department’s leadership was blogging, or at least, had commented on a  blog. How about that! The other revelation? Facebook may be the last great hope for academic discussions to flourish on blogs.

This all arose from a pretty academic question about emergency department implementation of electronic medical records. Does the degree of implementation (full, partial, or none) impact patient wait times in the emergency department? Read more »

*This blog post was originally published at Blogborygmi*

A Meth Lab, The ER, Judgment And Grace

Last week a trailer less than a mile from our house experienced a small explosion. Trailers, which seldom explode on their own (without undiscovered volcanoes or CIA drones with missiles) was concealing a meth lab.

What can you say? If I weren’t an emergency physician I’d say, “Shocking! Ghastly! Unbelievable!” But I do what I do so I say, “Huh, how about that.”

I’ve lost much of my capacity to be shocked. I have seen meth users, and probably meth dealers. I’ve known and enjoyed the company of alcoholics and Valium addicts. I’ve cared for murderers and the murdered (albeit briefly in the case of the latter). I’ve been involved in the evaluation of sexual assault victims, car thieves, drunk drivers and child abusers. A meth lab is, in its own way, kind of small stuff.

What does it say about me? I don’t know. It may suggest that I’m cynical. Or it may mean that I’m cold. Or it may mean, as I suspect it does, that I’m just realistic. I know the world is full of drugs and brokenness. The ER, where I work, is just the place where all of it arrives in its fermented, fully concentrated, “contents under pressure” form. Read more »

*This blog post was originally published at edwinleap.com*

A Song About Ending Up In The Emergency Department

Somebody at Apple likes Goldfrapp. They’ve used her latest album for this tutorial and the sublime Seventh Tree was pictured on the first Apple descriptions of the Remote app. It’s nice when a monolithic institution shows a little personality. Of course, my interest in Goldfrapp is mostly professional: Who else has sung as well about ending up in an emergency department?

*This blog post was originally published at Blogborygmi*

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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