by Your ER Doc on April 13, 2009
Perhaps my least favorite thing about my job is night shifts. As I get older, they get more and more painful. If I don’t get a nap before going in at 11pm, my brain gradually turns to oatmeal. Come 4am, and I’m hoping I don’t have to think very much. A sore throat or ear infection is about all I want to tackle.
One surprising side effect of night shifts is that the nurses start getting chatty, and all kinds of intense conversations spring up. Last night, I was working with some of my favorite nurses and we somehow started talking about religion. My usual rule is not to get into any debates about religion, because it never ends well. Unfortunately at 4 in the morning, it seems like you can really get to the bottom of these issues and solve them. You can’t. We spent a good hour sifting through all kinds of intense religious theory, wasting valuable charting (or napping) time. Huge waste. Luckily, I don’t think anyone was mad or offended by the end of shift.
by Your ER Doc on April 2, 2009
This is is not medical related but it is about change and I found it of interest.
I have talked about the inefficiencies in the medical industry. Here’s another industry that is also inefficient – the advertising industry.
I found this concept interesting and would like to share it with you too – visit
Our Seat at the Table - http://www.ourseatatthetable.com which explains the idea further.
by Your ER Doc on March 30, 2009
I just returned from an emergency medicine conference in San Diego. Outstanding place for a conference, depressing to leave actually. The prevailing theme at the conference was avoidance of law suits, and how to defend against them. I strongly feel that any efforts by our government to reform our health care system has to include liability reform. Every ER doc worries about this problem on a daily basis. Every patient is a potential plaintiff, every complaint a potential disaster. All of us are aware of cases where the ER doctor simply did their best job possible, and got sued anyway. There are many cases where juries award huge sums of money to plaintiffs simply because they felt sorry for the defendant, even if there was nothing wrong with the medical care. Plaintiff’s attorneys often file cases on contingency, so that the plaintiff doesn’t have to spend any money on the lawsuit, and the attorney is heavily motivated to acquire a large judgement.
As a result, physicians often practice defensive medicine–ordering lots of tests, CT scans, and admitting lots of patients who could probably be discharged home, for fear of liability. They also have to pay huge liability insurance premiums. On top of this, ER doctors are required by law to examine and stabilize any patient who arrives at their ER, regardless of the patient’s ability to pay. All of these factors result in increased costs to patients, and unhappy physicians. I know that unhappy ER docs are not a primary concern of the general public, or the government, but they should be. I for one, would like to have the best people available in the ER when I arrive with my heart attack, broken leg, stroke, or meningitis. I have personally seen many ER docs hang up their stethoscope for jobs with lower liability, where they can make more money. If the trend continues, quality will go down.
by Your ER Doc on March 17, 2009
When I was told recently that our emergency department would be getting a robot to help us, I must admit I was a little nervous. What exactly would this robot be doing, I wondered. Perhaps it has every medical fact from every specialty downloaded onto its hard drive, and a better bedside manner than me. Perhaps in a few weeks, my services will no longer be required. The day arrived, and the robot was delivered to the ER. It stands about 5 feet tall, and its head is a flat screen monitor. Two video camera lenses gape at you like oversized fish eyes.  There is a speaker in the center of its chest and it moves around on wheels.
Now here’s the good part. It can’t do anything without a doctor. Pheww! What happens is I call up another doctor who is not anywhere near the hospital, and he can talk to me (and presumably a patient) through the robot. That’s it. That means my job is safe. However, I don’t want to understate how valuable this tool could prove to be. If I need a specialist that we don’t have, I could get a consultation from a doctor anywhere in the world as long as they have an internet connection. Totally cool. Now if I could just figure out a way to see patients myself while I hang out in the hot tub I’ll be set.
by Your ER Doc on March 10, 2009
Don’t parents know that rashes can be caused by food? I had a young girl, about 4, brought in by her parents for a rash a while back. She had eczema, and had been suffering
from it pretty much her entire young life. I launched into my quick question mode and found out that no one had even considered various allergic causes of the rash. I asked if she seemed particularly sensitive to any foods, and the mom said, “Oh well when she drinks a glass of milk, she has terrible diarrhea and bloating, and maybe her rash gets worse.” Trying to lead them a bit, I asked if they thought she might be sensitive to milk or dairy. They weren’t sure. I asked if they had ever tried a dairy free diet. No.
It’s hard to imagine having a child with these symptoms, and not trying a couple diet changes to see if that would help. Unfortunately for this child she has suffered now from fairly severe allergic symptoms for several years that were most likely preventable.
