September 12th, 2011 by Edwin Leap, M.D. in Health Policy, Opinion
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Nostalgia for the house-call
Not too long ago, I made a house call. As a physician accustomed to working in the emergency department of a hospital, this was quite a change of pace. But it involved dear friends and their sick child, and it was a joy. We had spoken on the phone and I had some concerns about their infant, who was stricken with a high fever. When I went to their home I took only my stethoscope. That and my experience as a physician and parent of four.
When I walked through the door on Friday evening there were candles burning as dinner was prepared. There were no florescent lights. There was none of the chaos of a waiting room. No ambulances idled outside. No bloody, angry drunk screamed profanities. No one was stood by their exam room door, arms crossed in annoyance with waiting. It was a quiet place to be; and the child, on his worried mother’s hip, was quiet as well. He was in a place where he felt safe and was thus able to tolerate my poking and prodding.
I examined him and decided that he was not seriously ill. Because his mother had described him as lethargic when we spoke, I had been concerned that he might have meningitis. This was not actually the case. His parents and I were obviously relieved.
After he was dosed with ibuprofen and put to bed, I chatted a while with his mom and dad, then left for home. As I drove home I realized that Read more »
*This blog post was originally published at edwinleap.com*
September 8th, 2011 by Edwin Leap, M.D. in Opinion
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I think a lot about the slow, certain dissolution of medicine as we know it. Mental health issues crowd emergency departments, as few mental health clinics are available. Psychiatrists are in short supply. Drug abuse overwhelms the medical system, with either patients seeking pills or patients families hoping to get them off of pills.
Persons with little interest in their own health continue to smoke and drink, use Meth and eat poorly. Disability claims are skyrocketing as younger and younger individuals confabulate their misery in hopes of attaining a check, paid for by someone else.
The poor, with genuine medical problems, have increasing difficulty finding care as jobs, and insurance, fade away. Politicians, eager to be re-elected, eager to be loved, promise Read more »
*This blog post was originally published at edwinleap.com*
September 7th, 2011 by Linda Burke-Galloway, M.D. in News, Opinion
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Did you hear about the 17 year old teen that posed as a physician assistant at a Florida hospital for five days and got away with it? Are you surprised? I’m not.
It seems that Matthew Scheidt, had a summer job working part-time for a surgical supply company. He allegedly went to the Human Resources Department of the Osceola Regional Medical Center (ORMC) and convinced them that he was a Physician Assistant student at Nova Southeastern University and lost his identification badge. This is the hospital where many of my former patients were forced to go for medical care because they were either uninsured or received Medicaid. My former employer had a fiscal relationship with them. The use of the word “forced” is quite appropriate because my uninsured patients had no options. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
August 26th, 2011 by Edwin Leap, M.D. in Opinion
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This might sting a little…
When I was a child, I was often painted orange with Merthiolate. My grandmother, like every good grandmother, kept a bottle handy at all times. Merthiolate was an antiseptic, containing Mercury, that was marketed for cuts and scrapes.
A fall on the gravel, a slide on the pavement, a run through the briar patch and you’d be sitting on the kitchen table while grandma colored you orange with the magical elixir, which incidentally burned like fire!
On a recent emergency department shift, we were colluding about the general state of drug-seeking in America, which has been enabled by our ‘nothing should hurt’ ideology. One of my dear friends, Nurse Nancy, had a realization; an epiphany, really. Read more »
*This blog post was originally published at edwinleap.com*
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*
