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Demystifying Medicine One Month at a Time

Category: emergency room (page 1 of 2)

Biggest Health Stories of 2018

Happy New Year, GlassHospital readers.

The year’s end provides the opportunity to reflect on the year that was.

These few stories stuck out as some of the most impactful of the year–and what they portend for the future:

1. Gene editing: In November, at the International Summit on Human Genome Editing in Hong Kong, Chinese biologist He Jiankui shocked the world with his announcement that he had manipulated at least two embryos to change a trait (or more??) in twin baby girls. The reaction was mostly critical, including calls for a moratorium on the use of CRISPR gene-editing in humans.

The upshot: stories like this will be with us for the foreseeable future. While the power of CRISPR to remedy harmful genetic conditions seems hopeful and fantastic, there’s a whole history of eugenics movements that should guide us to avoid the hubris of selecting for ‘desirable’ traits in humans.

2. #ThisisOurLane: Also in November, an NRA staffer (to this point unknown) tweeted a response to an article in the Annals of Internal Medicine recommending that doctors ask patients about gun use and safety as a health measure. The tweet infamously suggested, “someone should tell self-important anti-gun doctors to stay in their lane.” This was met with a firestorm of response from doctors across the spectrum, particularly those that care for gunshot victims (ER docs, surgeons, etc.) who tweeted under the hashtag #ThisIsOurLane.

The upshot: It’s hard to quantify the cumulative impact of the conflict, which is sure to go on, but the Justice Department did just ban bump stocks.

3. Bill of the Month: NPR, in conjunction with Kaiser Health News, started a monthly series examining outrageous and inexplicable health care bills. It’s been one of their (repeatedly) biggest stories of the year, as exemplified by the (insured!) Texas teacher who faced a $108,951 hospital bill after treatment for a heart attack (he was taken by ambulance to an out-of-network hospital–hardly the time, it seems, to price compare).

The good news: His bill was lowered to $332 after the glare of national media attention.

Alex says, “I ALWAYS look to GlassHospital for keen insights.”

Triage

The following is a guest post from Dr. Sarah Fraser:

During my surgery rotation as a third year medical student, my resident sends me to the Emergency Department to assess a new consult. She tells me to “make it quick” and I hustle down to meet my patient.

Mr. Jones is a 64-year-old male who rarely goes to the doctor. He has been vomiting for two days and has a fever. His heart rate is up and his blood pressure is low; his belly is swollen up like a beach ball. When I examine his abdomen, he winces in pain with even the lightest touch. The x-ray shows a bowel obstruction and free air in the belly, a sign of intestinal perforation. I know he needs surgery.

Stat.

I text my resident who tells me I have five minutes to get the paperwork in order before transporting him to the operating room. As I am about to start writing my note, a frail, elderly woman emerges from a different room with a troubled expression on her face.

“I need help. My husband’s IV is beeping and we need to shut it off.” There is fear in her voice.

I quickly decide that her problem is not an urgent one. The IV is probably beeping because the fluid is done dripping in, or maybe the line is kinked. But the man with the busted bowels–that is urgent. I need to devote every ounce of my attention toward finishing my note and getting that man into surgery.

“I’m dealing with an emergency right now, but your nurse should be back shortly.”

“We need to stop the beeping!” She is on the verge of tears.

“It’s probably nothing serious. I’m really sorry but I can’t help you right now.” I put my head down and continue writing.

“The help here is awful,” she says, returning to her room with her sick husband and his beepy IV.

A knot forms in my stomach as I continue with my note.

Was there time to have helped her? Maybe, but I had a short deadline and was feeling the pressure. Relieving the concerns of this elderly lady would have taken away from the care I was providing for a the very sick Mr. Jones. So I prioritized, and in doing so, I failed to address her request, leaving her disappointed and probably scared.

Though I didn’t realize it at the time, when I ignored one person and prioritized a sicker patient, I was doing something called triaging. Every day in the Emergency Department, doctors and nurses are forced to choose who needs help and attention more critically.

Before entering the field of medicine, I remember sitting in the Emergency Department as a patient with a fever and chills, watching others who came in hours later being treated before me. Nobody likes to feel ignored. What the general public does not always realize is that there is a triaging system, where patients are given a score from one to five based on how sick they are. It is a system that helps us deal with the sickest first, though it can lead to long wait times for those with less serious issues.

Though I postponed dealing with the concern of the elderly woman that day, I also learned an important lesson. In medicine, you need to assess and assign degrees of urgency, and in doing so, you can’t please everyone all the time. And you have to be okay with that. What matters most is that you prioritize to the best of your ability, and do your part to keep everybody healthy, and most importantly, alive.

Dr. Sarah Fraser is an author, family physician and human rights activist in Nova Scotia, Canada. She is author of Humanity Emergency, a poetry collection about the need for more compassion in the field of medicine. Her work appears in the Canadian Family Physician, Ars Medica and the Journal of Academic Psychiatry, The Coast, Capital Xtra and on kevinmd.com

From the Mailbag

Yes, we’re baaaa-aack. Here’s a letter from one of our readers:

Dear GlassHospital,

media hysteriaWhile I am a firm believer in the infallibility of doctors and modern medicine, I am desperately struggling with the Dallas handling of an Ebola patient. Sure, sometimes there’s that perfect storm of things gone wrong, opportunities missed, etc (think about the assassination story of Archduke Franz Ferdinand – seems it was destined to happen) but the spread of infectious diseases need not be history-making-world-changing-events in today’s “modern” era, should it? Is there that much of a divide between the knowledgeable and the uninformed – a gap that rivals our economic disparity? Is politics playing a role here, like [Texas Gov. Rick] Perry won’t allow any federal coordinated oversight/CDC management?

I used to watch silly action movies (“Whitehouse Down” for example) and think, “that would never happen! there’d never be such a dumb-ass breach of security like that!” Now I question if I’m the silly dumb-ass who believed there was a working system in place.

So tell me Dr. Glass: while I retain confidence in individuals and continue to hold doctors in high esteem, should I/can I trust hospitals?

Sincerely,

A Lost Patient

“Rampart, this is Squad 51…”

Fans of the 1970s TV show Emergency! will remember that famous radio call. The show was the first to serialize and glamorize paramedics as first responders in crises large and small.

Building a culture of heroism for civil servants…

With the cleanup from Hurricane Sandy no longer a front page news story, it’s worth appraising a couple of aspects about disaster preparedness:

First, I found it heartening that the Northeast region was able to get the word out and communicate so effectively in terms of pre-storm evacuations and service closures to avoid mishaps and fatalities during the storm. I have no doubt that hundreds of lives were saved by these actions.

Secondly comes word that as far as first-responder communication, we still have a way to go to ensure that first responders have their own bandwidths on which to seamlessly communicate with one another.

NY and NJ first responders had success in communicating at the push of a button, but teams from outside the region that had come to provide extra help were left with dialing cell phone numbers on the usual 4G network–subject to the same dropped calls and network outages as the rest of us.

Haven’t we learned from 9/11 and Hurricane Katrina? The government has created FirstNet, an independent federal agency, to set up a national emergency responders network, in addition to setting aside a portion of the broadband spectrum to create such an entity. But the FCC isn’t planning on auctioning off this part of the spectrum until 2014 at the earliest due to resistance on the part of broadcast networks and other government agencies, according to a NYT piece by Edward Wyatt.

Hopefully with the election season out of the way, the President can prioritize full establishment of a secure and strong emergency communication network during his second term–and leave us all a little safer for it.

Call Now to Reserve Your Spot in the E.R.

Emergency Rooms are a bellwether of the U.S. Health Care “system.”

I’ve explained in other posts why the E.R. is a tough place to work and a tougher place to be a patient.

Now comes news that some Florida-based hospitals are piloting an E.R. reservation system. The goals are intuitive:

  1. Minimize patient waiting times, thereby
  2. increase patient satisfaction.
  3. Improve the working and waiting environments for staff and patients, and
  4. boast about the new idea, providing the for-profit hospital chain (Tenet) a marketing advantage.

Ding! The old-fashioned way.

All it costs is $9.99. No joke. You have to put the money down on a credit card to reserve your spot, which guarantees that you’ll be seen within fifteen minutes of the appointment time that you are given.

And what If you’re not seen in fifteen minutes? Money back guarantee!

So these hospitals are going to let us reserve a spot in the often horridly long E.R. queue? That’s ten bucks I’d be glad to spend. What’s not to like?

According to the article, the system works well for those whose health situations are not true emergencies. But for those with serious issues like heart attacks or strokes, waiting for your reservation time can be a big mistake.

“Time is tissue,” we are taught in medical school.

Come to think of it, isn’t making an appointment for the E.R. kind of like what you’re supposed to do at your doctor’s office?

If you can make an appointment in the E.R for the same day and be seen in fifteen minutes of that time guaranteed, why bother with a primary care office that makes you wait anywhere from two to six weeks for an appointment with your doctor?

Makes me wonder…

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