Back to the Bedside

November 30, 2015

When I survey our academic emergency physicians each year about what they most enjoy about their jobs, the number one answer is always “clinical care” or “taking care of ED patients.” It doesn’t matter whether they’re administrators, educators, researchers or primary clinician-educators. They were drawn to emergency medicine by the broad and deep challenges that roll or walk through our doors. Caring for ill and injured patients efficiently and compassionately requires establishing trust with patients and families. Developing a diagnosis and treatment plan begins with tending to the patient’s story and the findings on physical exam. They really love bedside medicine, but find themselves pulled away from time with their patients.

At the risk of sounding curmudgeonly, I think that many medical “advances” threaten the basic bedside connection that is so essential to being a good emergency physician. Were I to ask my colleagues in the ED, “How many of you think the EHR has made you a better doctor?” I suspect the silence would be deafening. The demands of the electronic health record (EHR) mean that emergency physicians spend much more time palpating a keyboard than an abdomen or injured extremity. The words that we might have been sharing with patients are now often dictated into a microphone or worse, become lost in a train of expletives directed at an illogical, unruly EHR.

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It’s Time for a Tune-Up

May 19, 2015

If I’m to take fashion advice from Maureen Dowd’s March 3 column, “Stroke of Fate,” a take-down of emergency medicine disguised as a recovery narrative of her niece, then I should exchange my white coat for grease-stained overalls.

In her column, a Harvard neurology professor who specializes in stroke describes the brain as the Rolls-Royce of the human body. When it comes to acute stroke care, he is quoted as saying, “would you run your Rolls-Royce into the local gas station?”

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The leaf blower/CT scan quandary

December 14, 2014

To critics who admonish emergency physicians like myself for our excessive use of CT scans, I’ll ask them to consider the leaf blower. I’m sipping my morning coffee on our front porch, a bright, idyllic autumn day in New England, the tranquility ripped apart by the landscapers across the street. For many jobs, a powerful leaf blower might prove superior to a rake or broom. But in my neighborhood known for smaller yards, the humble rake and broom would work as well, if not better.

I’m not a leaf blower person. Raking my yard takes hours. It leaves my muscles knotted and hands calloused. Not so the speedy landscapers, nonchalant with technology strapped to their backs. Laughing and screaming over noise that assaults my eardrums, they bully grass clippings and leaves into a dancing cloud that swirls onto the street, often finding refuge on my lawn.

Why should the status of lawn detritus, or my serene coffee moment, concern them? They’re responsible for my neighbor’s lawn, not the yards nearby. And if leaf blowers improve the speed and perhaps the quality of their work, why wouldn’t they take advantage of the opportunity? Imagine the following argument from a landscaper-philosopher: “What is a leaf blower anyway but a push of air, like a strong wind? You have a problem with the wind?”

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Side Effects of Sleep: The Perils of Treating Chronic Intoxicants in the ED

October 2, 2014

The glass doors to the emergency department (ED) part, and in rolls Mr. W, who was discharged only hours before. “Guess who’s back?” remarks EMS (Emergency Medical Services). It’s Mr. W’s third visit in the last twenty four hours, his sixth visit in two days, all for the same chief complaint: ‘alcohol intoxication.’  In the first half or 2014 alone, his list of ED visits fills three computer screens. He’s homeless and chronically intoxicated, and yet, his drunkenness works as an acute medical problem worthy of EMS transport.

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State of the State: Avoidable ER Visits

September 29, 2014

In his 2014 State of the State’s Health address to state lawmakers, the director of the Rhode Island Department of Health commented, “44% of all the emergency department visits in the state are preventable.” Unfortunately, I think these comments reflect a growing public perception of emergency medicine – that a large percentage of people use the ED inappropriately and as an expensive substitute for primary care.

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