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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Survival of the Fittest

November 19, 2015

An observation that I and many of my emergency medicine colleagues have made about vacations: we need them. We need them for wellness, to recharge, to recover. Great saves, terrible tragedies, we witness it all and it can wear on you. Unfortunately, when vacation plans are made, it is not uncommon to find oneself working even more shifts before the break to offset our absence on the schedule, making the time away absolutely critical by the time it rolls around.

And so after ten shifts in thirteen days, I find myself exhausted, unprepared, nervous, on a hot, humid bus that is supposed to be taking us to the dock but instead slows unexpectedly. A land iguana, a golden brown ancient dinosaur, creeps off of the road into the side brush. Piling off the bus, we are directed toward a concrete platform adorned with huge lounging marine iguanas. I gather my belongings and catch myself from stumbling, nearly stepping on an iguana’s whiplike tail that seems to have appeared right next to me. It spits salt water at me in retaliation but does not move. Sally lightfoots scuttle along the jagged shore, red as the lava the rocks once were. When I ask which boat is ours, I am interrupted by shouts of “Blue footed boobie!” causing me to forget the question I just asked. This is the first hour in the Galapagos.

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