Perspective While driving through the downtown of our small but not insignificant Midwestern city (there are corn fields five miles from the city center but we do have the state capital and a handful of miniature skyscrapers) I noticed a fat brown squirrel scampering down a tree and bounding across the street in the halting but graceful […]

Actual Patient Conversation: “Man, that Dilaudid didn’t even touch my pain.” “Uh, Okay.  Your CT was negative so you’re fine to go home.  I’ll ask your nurse to come discharge you.  Come back if you get light headed or start to vomit but otherwise, just take Motrin for your headache and you should be fine.” […]

Old School I admire the physicians of yesterday who practiced at a time before medicine became so technical but I don’t necessarily accept the premise that they were better doctors.  Certainly their physical exam skills were better honed than ours are today as this was often all they had to establish a diagnosis.  They also […]

(In reponse to some nervous emails, yes, every patient mentioned had a complete history, review of systems, and physical exam. I’m just distilling the salient elements of the conversation. Okay? -PB) Actual Patient Interaction Number Six: “So Mr. Smith, what brings you to the Emergency Department, a place where we handle medical emergencies, at 3AM.” […]

Actual Patient Interaction Number One: “So Mrs. Smith, how’s your pain?” “Oh doctor, it be paining me real bad. Can I get some Dilaudid.” “How about we start with some Nubain?” “What’s that?” “It’s a synthetic narcotic, kind of like Demerol.” “Is it any good?” “Sure, it works great and doesn’t give people the rush […]

Staying Power I suppose the only good thing about my patient’s twelve-hour wait in the Emergency Department waiting room before he even made it into a room, and his subsequent two-hour wait before he finally saw me, was that the results of the basic lab work ordered in triage where immediately available and, as his […]

(Another real question from a real reader, really sent to my real email address. -PB) Ian writes: “You’ve described what Emergency Medicine is like but what would you say are the ideal qualities of Emergency Medicine doctors? (I seem to handle stress and emotions very well and can easily remain calm in pressing moments)” Let […]

Field of Dreams There is a lot of Medicaid money floating around out there, particulary in the pediatric population where a large portion of the patients are covered by the Children’s Health insurance Program (CHIP). To legally acquire as much of this bonanza as possible, my hospital built a dedicated Pediatric Emergency Department which opened […]

(This is an another article directed more to people who are interested in a medical career than to those already involved.  Feel free to read along but I again offer my usual warning that there is nothing profound or exciting to follow and I cannot be held responsible for your boredom. I’m going to try […]

Read it and weep. 

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