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Emergency Medicine

This page shows you the most recent publications within this specialty of the MedWorm directory.

The pressure to admit patients from the ER will only grow
Once again government regulators have put in place well-meaning rules without anticipating the consequences. We all hate sitting around in the emergency department waiting to be seen and to be treated. On October 15, 2014 as part of the new Affordable Health Care Act and the patient satisfaction portion, hospital ERs will have about 180 minutes from the time you arrive and sign in to evaluate you , treat you and make a disposition or decision. The game starts on October 15th but already hospital administrators have their systems operating to prepare to comply. If you fail to comply the hospital will be punished financially...
Source: Kevin, M.D. - Medical Weblog - September 21, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Primary care Source Type: blogs

FACEMs at Night: A Mattress Stuffed with Flaw
This is the second of two perspectives on whether FACEMs should work night night shifts, for the first, see Anand Swaminathan’s ‘FACEMs at Night: An American Perspective‘. Let us take ourselves one fact. One, simple, undeniable fact. One cannot, after all, dispute a fact. A fact, according to most reputable definers of words (and a few, which are my more preferred sources, disreputable ones) is a truth. A thing that is universally known to be true. Merriam-Webster (American, I know, but in light of it’s lexicographically poetic etymology, we must forgive its murderous spelling) defines it as ‘a true ...
Source: Life in the Fast Lane - September 21, 2014 Category: Emergency Medicine Authors: Michelle Johnston Tags: Australia Emergency Medicine consultant emergency physician FACEM night-shift Source Type: blogs

FACEMs at Night: An American Perspective
This is the first of two perspectives on whether FACEMs should work night night shifts, for the second, see Michelle Johnston’s ‘FACEMs at Night: A Mattress Stuffed with Flaw‘. My father, an active general surgeon who has been in practice for almost five decades often recounts stories of “the good ‘ole days” when it was interns and junior residents who cared for patients most of the day. Supervising physicians were uncommonly found in patient care areas (except the operating room). Residents made critical decisions, often without the necessary training, and they and their patients lived (or died) wi...
Source: Life in the Fast Lane - September 21, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Australia Emergency Medicine anand swaminathan consultant emergency physician FACEM night-shift Source Type: blogs

Cost-benefit analysis: A case where conservative management wins
We speak of everyday decisions in terms of cost-benefit analyses. Many of our patients can’t afford a healthy meal, let alone a hefty hospital bill, thus making cost awareness increasingly relevant. But on the day that I met Mr. R., it wasn’t the financial aspects of his care that concerned me. I was thinking about the patient, his family, and two roads diverged in a hospital ward. I was thinking of the road less traveled, and the greener pasture oft overlooked. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M...
Source: Kevin, M.D. - Medical Weblog - September 20, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Palliative care Source Type: blogs

MKSAP: 72-year-old unconscious woman in the ER
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated in the emergency department for loss of consciousness. Her son, who brought her in, says she seemed confused and agitated when he spoke to her on the telephone less than 2 hours ago. The patient has an 8-year history of type 2 diabetes mellitus. She had strict glycemic control (average hemoglobin HbA1c level, 6.2%) until last month when she had an infected ulcer between the third and fourth toes of the right foot that resulted in amputation of the middle toe 1 week ago. According...
Source: Kevin, M.D. - Medical Weblog - September 20, 2014 Category: Journals (General) Authors: Tags: Conditions Diabetes Emergency Endocrinology Source Type: blogs

Different Parts Of The Same Elephant: Medicaid Research And State Expansion Decisions
Debates about Medicaid expansion betray an underlying fundamental disagreement not only about the Affordable Care Act (ACA) but about the Medicaid program itself. Medicaid, unlike Medicare, lacks the near-universal buy-in to the fundamental value of the program to beneficiaries’ health and well-being. As a means-tested (read welfare-related) program, Medicaid raises concerns and disagreements regarding work (dis)incentives, labor market effects, the “deserving” poor, and how this relates to the construct of health care as a right and a public good. The Medicaid program serves as a centerpiece of the ACA and of the na...
Source: Health Affairs Blog - September 19, 2014 Category: Health Management Authors: Donna Friedsam Tags: All Categories Medicaid Policy States Source Type: blogs

Pacemaker Panic #2
ECG Exigency 016 A 68-year old woman presents by ambulance to the Emergency Department. Per the ambulance crew, she was brought from home after experiencing 7 out of 10 chest discomfort and weakness. She has a history of hypertension that is well controlled with furosemide, and has a pacemaker because her “heart used to go funny.” The ambulance crew are basic life support only, so the patient has received 324mg of aspirin, and oxygen by nasal cannula. Upon arrival she is seated upright on the stretcher breathing rapidly, with the following vitals: heart rate 107, blood pressure 180/110, respirations 20 and slightly lab...
Source: Life in the Fast Lane - September 19, 2014 Category: Emergency Medicine Authors: Mat Goebel Tags: Cardiology Clinical Case ECG Education Emergency Medicine EKG failure hyperkalaemia hyperkalemia pacemaker pacer pacing ppm Source Type: blogs

Prolonged (63 minutes) Ventricular Fibrillation, Followed by Unusual Cardiogenic Shock
In this study, 5% of VF arrest was due to PE: V fib is initial rhythm in PE in 3 of 60 cases.  On the other hand, if the presenting rhythm is PEA, then pulmonary embolism is likely.  When there is VF in PE, it is not the initial rhythm, but occurs after prolonged PEA renders the myocardium ischemic.--Another study by Courtney and Kline found that, of cases of arrest that had autopsy and found that a presenting rhythm of VF/VT had an odds ratio of 0.02 for massive pulmonary embolism as the etiology, vs 41.9 for PEA.         (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - September 19, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Pediatric Asthma: An Opportunity In Payment Reform And Public Health
Editor’s note: The post is informed by a case study, the third in a series made possible through the Merkin Initiative on Physician Payment Reform and Clinical Leadership, a special project to develop clinician leadership in health care delivery and financing reform. The case study will be presented on Wednesday, September 24 using a “MEDTalk” format featuring live story-telling and knowledge-sharing from patients, providers, and policymakers.  The Clinical Challenge: A Chronic, but Manageable Illness Asthma affects 7 million children – more than 10 percent of kids in the U.S. – and is the most common chronic ch...
Source: Health Affairs Blog - September 18, 2014 Category: Health Management Authors: Kavita Patel, Steve Farmer, Meaghan George, Frank McStay, and Mark McClellan Tags: All Categories Children Chronic Care Health Care Costs Health Care Delivery Health Reform Medicaid Medicare Nonmedical Determinants Payment Policy Public Health Quality States Source Type: blogs

This is what population health looks like
It is a beautiful day here in my little college town. The sun is shining and at 11 a.m. it is about 78 degrees with a barely perceptible breeze. People are out walking on Main Street and riding their bikes. The mountain nearby calls: I can go for a hike today with my dog and still be within 20 minutes or so of the hospital to respond to calls. There are two patients on the hospitalist service in our fine critical access hospital, and one of them is going home later this morning. She is bright and cheerful, with progressive Alzheimer’s disease and chronic lung disease from a long gone habit of smoking 3 packs of ciga...
Source: Kevin, M.D. - Medical Weblog - September 18, 2014 Category: Journals (General) Authors: Tags: Policy Hospital Hospitalist Primary care Source Type: blogs

Value Extractors, "Super-Managers," Vampires and the Decline of the US and US Health Care
Appearing during the last few weeks were a series of articles that tied the decline of the US economy to huge systemic problems with leadership and governance of large organizations.  While the articles were not focused on health care, they included some health care relevant examples, and were clearly applicable to health care as part of the larger political, social, and economic system.  The articles reiterated concerns we have expressed, about leadership of health care by generic managers, perverse executive compensation, the financialization of health care, in part enabled by regulatory capture, and the abando...
Source: Health Care Renewal - September 18, 2014 Category: Health Management Tags: boards of directors executive compensation financialization generic managers Pfizer regulatory capture Renaissance Technologies Source Type: blogs

Another Example of Defensive Medicine
The ultrasound images above show a circular clot in the superficial femoral vein. The image on the left is without compression and the image on the right is with compression. Normally blood vessels flatten out when compressed. Since the vessel did not flatten with compression it confirmed the presence of a blood clot. While discussing a case with one of the nurses with whom I work, I saw how once again defensive medicine had affected my medical practice. I gave a few examples of defensive medicine in a post several years ago and I also mentioned how sometimes doctors have to prove a negative when dealing with patients. Bot...
Source: WhiteCoat's Call Room - September 18, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Defensive Medicine Patient Encounters Source Type: blogs

Top stories in health and medicine, September 18, 2014
From MedPage Today: I, Intern: New Questions, New Mistakes. It feels surreal to Emily Lu, MD, when she discharges patients from the emergency department at San Francisco General Hospital and tells them to see her in a month. U.S. Ebola Response: Troops, Training, Supplies. Calling the Ebola epidemic in West Africa a “potential threat to global security,” President Barack Obama said the U.S. will send 3,000 military personnel to help combat the outbreak. New Inflammatory Diseases Seen. Two previously unrecognized autoinflammatory syndromes characterized by periodic fevers and other systemic symptoms have been ...
Source: Kevin, M.D. - Medical Weblog - September 18, 2014 Category: Journals (General) Authors: Tags: News Diabetes Endocrinology Infectious disease Source Type: blogs

Who should be receiving therapeutic hypothermia?
Thanks to the popularity of medical television shows, most people have witnessed hundreds of fictional cardiac arrests in their lifetime. In most of these scenes, the patient loses consciousness, and the medical team rushes to the bedside: “He’s in v-fib.” “Get me the paddles.” The team performs urgent chest compressions for a few seconds.  Then they place the metal paddles on the victim’s chest: “Clear!”  Kathump. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 17, 2014 Category: Journals (General) Authors: Tags: Conditions Emergency Neurology Source Type: blogs

The death certificate didn’t say enough
August 17, 2010. Maris is a 57-year-old woman in excellent health.  She has not seen a doctor in years. Divorced, she lives by herself, but spends occasional evenings with her daughter and son-in-law.  A successful businesswoman, Maris gardens, serves on the board of a community theater and plays a mean game of bridge. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 17, 2014 Category: Journals (General) Authors: Tags: Physician Cancer Emergency Source Type: blogs

Why is there an influx of physician job offers in my inbox?
If you’re a 3rd- or 4th-year resident, chances are you’re no stranger to unsolicited job offers showing up in your email inbox. Maybe it’s a few a week, or maybe it’s a few a day, but they are always there. The emails find you. I’ve been out of residency for years and I’m still getting them. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 17, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

PhRMA and DOJ Go Back and Forth Over Off-Label Speech and the First Amendment
A whistleblower’s False Claims Act (FCA) suit in the Eastern District of California has caught the attention of the Pharmaceutical Research and Manufacturers of America (PhRMA) and subsequently the Department of Justice, both of whom have filed amicus curiae briefs in the federal court. PhRMA re-responded to DOJ just last week, underscoring the case's importance. See that response here: PhRMA-Brief-Solis-v-Millennium.  Whistleblower Complaint Frank Solis, a former sales rep at Schering-Plough (now part of Merck) and Millennium Pharmaceuticals, alleged that the two manufacturers illegally marketed ...
Source: Policy and Medicine - September 17, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Observations from being “the family.”
It’s been a trying week for our family. You learn things when your people need healthcare. It’s an entirely different perspective. I am doctor; I’ve been a patient, but this was the first time being “the family.” Without going into details, (see her guest post), my wife Staci came to need the best that American healthcare has to offer. Let’s say it was a non-preference-sensitive decision to proceed with a major surgery. As I write this, things are stable and well here at home. Here are some observations of the experience: People in the business of delivering healthcare are good people. Early on in the course, b...
Source: Dr John M - September 16, 2014 Category: Cardiology Authors: Dr John Source Type: blogs

Research and Reviews in the Fastlane 048
This study looked at one institution’s discrepancy rate between EP and radiologist plain film reads over 10 years. They found overall an ~3% discrepancy rate on all plain films. This of course does not mean the radiologist was correct in every discrepancy. But it does show we agree most of the time. Most interestingly, the rate of discrepancies requiring emergent change in management was a mere 0.056%! Recommended by: Zack Repanshek Prehospital/Retrieval Braude D et al. Air Transport of Patients with Pneumothorax: Is Tube Thoracostomy Required Before Flight? Air Med J. 2014 Jul-Aug;33(4):152-6. PMID: 25049185 C...
Source: Life in the Fast Lane - September 15, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Education Emergency Medicine Pediatrics Pre-hospital / Retrieval Public Health Respiratory Resuscitation Toxicology and Toxinology critical care Intensive Care literature R&R in the FASTLANE recommendati Source Type: blogs

Why I Still Don’t Hate Being A Doctor
Judging from recent articles, surveys, and blog posts, the medical profession is remarkably demoralized. Typical complaints range from “feeling like a beaten dog” to “living in humiliating servitude,” to being forced to practice “treadmill medicine.” Interestingly, the public response to these complaints is largely indifferent. The prevailing attitude (if the “comments sections” of online articles and blog posts are representative) seems to be unsympathetic: “Poor doctors, making a little less income and not being treated like gods anymore? You have to do extra paperwor...
Source: Better Health - September 15, 2014 Category: American Health Authors: Dr. Val Jones Tags: Opinion Concierge Medicine Demoralization Direct Pay Doctors Dr. Jauhar Hate Medicine Job satisfaction Locum Tenens Patient Satisfaction Physicians Quit Medicine Work Environment Source Type: blogs

An Apple a Day: What the iPhone Can Teach Us About Health Care
What took Apple so long to get in to health care? Here’s my suggestion from 5 years ago: The day before my daughter Elise’s 15th birthday, the new iPhone went on sale.  My birthday was 4 days later.  So Elise figured out we should buy each other an iPhone to mark our big days.  She planned (and saved) for months.  She spent weeks talking to friends, researching apps on line, planning for such accessories as protective covers, and educating herself on how to maximize her minutes. When the big day came, we made our way to the Apple store and stood shoulder to shoulder with hundreds of others waiting on a ver...
Source: Disruptive Women in Health Care - September 15, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Uncategorized Source Type: blogs

Healthcare Update Satellite — 09-15-2014
This study should be required reading in every emergency medicine residency in this country. In fact, the concepts in the studies should be tested on the emergency medicine board exams. Now if the study only compared the type of a patient’s insurance with the likelihood of emergency department recidivism. How else can the media try to tarnish this guy’s reputation? The doctor who oversaw Joan Rivers’ fatal endoscopy was once *sued* 10 years ago. Gasp. The former patient’s attorneys are really trying to create their 15 minutes of fame. They alleged that 10 years ago the patient received no informed ...
Source: WhiteCoat's Call Room - September 15, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Ebola Update from CDC Director Thomas Frieden
Thomas Frieden, MD The Ebola outbreak in West Africa is an international public health emergency. As the world responds, there is a risk that American responders working on the ground may be exposed to the virus or become ill. This summer, two American health care workers infected with Ebola while working in West Africa were successfully […] (Source: The Health Care Blog)
Source: The Health Care Blog - September 14, 2014 Category: Consumer Health News Tags: THCB Ebola Environmental infection Infection control procedure Norovirus Water Source Type: blogs

What is a gomer? And why should you know about it?
Ever wonder what a “gomer” is? While certainly passé and unprofessional, does it shed light into the frustrations both doctors and patients have with end-of-life care? Emergency physician and author Brian Goldman explains the origins and use of such medical slang in his book, The Secret Language of Doctors. Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 12, 2014 Category: Journals (General) Authors: Tags: Video Hospital Palliative care Source Type: blogs

Same Care No Matter Where She Gives Birth: Addressing Variation In Obstetric Care Through Standardization
This study, along with other disturbing statistics, underscores the significant need for improvements in maternity care. Maternal Morbidity and Disparities Since 1990, the maternal mortality ratio in the U.S. has more than doubled. We now rank 64th in the world, with 28 maternal deaths per 100,000 live births. American women are also suffering severe maternal morbidities at higher rates: more than 60,000 women a year experience a life-threatening condition during childbirth. Potential explanations for these troubling trends include improved reporting mechanisms and escalating rates of chronic health conditions like obesity...
Source: Health Affairs Blog - September 12, 2014 Category: Health Management Authors: Priya Agrawal Tags: Access All Categories Disparities Hospitals Public Health Source Type: blogs

CDC Update for Health care workers: Ebola Environmental Infection Control Procedures
Thomas Frieden, MD The Ebola outbreak in West Africa is an international public health emergency. As the world responds, there is a risk that American responders working on the ground may be exposed to the virus or become ill. This summer, two American health care workers infected with Ebola while working in West Africa were successfully […] (Source: The Health Care Blog)
Source: The Health Care Blog - September 12, 2014 Category: Consumer Health News Tags: THCB Ebola Environmental infection Infection control procedure Norovirus Water Source Type: blogs

Mortality Rate Increases With Emergency Department Closures
This article begins to look at the substantial potential effects of ED closures on actual patient outcomes and adds important evidence that should spark debate among policy makers, inform decisions, and hopefully prompt further investigation. (Source: Health Affairs Blog)
Source: Health Affairs Blog - September 11, 2014 Category: Health Management Authors: Jason Shapiro and Lynne Richardson Tags: All Categories Emergency Medicine Hospitals Public Health States Source Type: blogs

Five Absurd Overreactions to the Surge in Child Migrants
Alex Nowrasteh The surge of unaccompanied migrant children (UAC) that dominated the news cycle in June and July of this year has receded – so much so that many emergency shelters established to handle the inflow are shutting down.  At the height of the surge, many commentators and government officials expected 90,000 UAC to be apprehended by the end of the fiscal year (FY).  As the end of the FY approaches, the number of apprehended UAC stands at roughly 66,000 - far below the estimates. Now that the surge has receded, here are some of the most absurd overreactions to it.  Never before...
Source: Cato-at-liberty - September 11, 2014 Category: American Health Authors: Alex Nowrasteh Source Type: blogs

Crowding in emergency departments
The College of Emergency Medicine -This guideline is to assist managers and clinicians who are trying to reduce crowding in their hospital emergency departments. The guideline explains the causes and consequences of crowding and offers suggestions to reduce the effects of crowding and improve the safety of an emergency department. Guidance The College of Emergency Medicine - press release (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - September 11, 2014 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Patient safety Quality of care and clinical outcomes Source Type: blogs

2014 PhRMA Research and Hope Awards Celebrate Groundbreaking Achievements in HIV/AIDS, While Recognizing the Continued Work Needed for a Cure
Last night, the Pharmaceutical Research and Manufacturers of America (PhRMA) honored individuals and organizations for their work in the field of HIV/AIDS at the 2014 PhRMA Research and Hope Awards.  The event served as both a celebration of groundbreaking achievements as well as a call to continue the hard work that is still required to put an end to HIV/AIDS. The evening featured a conversation with President George W. Bush and PhRMA president and CEO, John Castellani. During President Bush’s time in office he launched an initiative to combat AIDS in Africa called the President’s Emergency Plan for AIDS Relief ...
Source: Policy and Medicine - September 11, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Birth Control Pills Should Be Available Over The Counter, But That’s No Substitute For Contraceptive Coverage
In recent weeks, some opponents of the Affordable Care Act’s (ACA) contraceptive coverage guarantee have promoted the idea that oral contraceptive pills should be available to adult women without a prescription. Sens. Kelly Ayotte (R-NH) and Mitch McConnell (R-KY), for example, recently introduced the so-called Preserving Religious Freedom and a Woman’s Access to Contraception Act, a bill that would urge the Food and Drug Administration (FDA) to study whether to make contraceptives over the counter (OTC) — though for adults only. Making birth control pills available over the counter, if done right, would meaningfully...
Source: Health Affairs Blog - September 10, 2014 Category: Health Management Authors: Adam Sonfield and Sneha Barot Tags: Access All Categories Coverage Health Care Costs Health Reform Insurance Pharma Policy Source Type: blogs

Feticide laws force birth and punish women
A 33-year-old woman in Indiana, Purvi Patel, presented to an emergency room with vaginal bleeding and when it was obvious that she had very recently delivered a baby the doctors on call notified the authorities. The body of her 28-week gestation infant was recovered. The pathologist believed the baby had taken a breath so Ms. Patel was with charged with neglect of a dependent. Sometime later the police realized she had purchased two “prescription” medications online for abortion and feticide charges were added. As an OB/GYN I see this case very differently than the prosecutor in St. Joseph’s county. Here’s why. ...
Source: Kevin, M.D. - Medical Weblog - September 10, 2014 Category: Journals (General) Authors: Tags: Physician OB/GYN Source Type: blogs

The Hospital Discharge Race: is Sooner Always Better?
They say that if you can remember the 1960s, you weren’t there. I do remember this about 1966, however:  I spent my birthday that year in a hospital bed, where I’d been a patient for a full month recuperating from a ruptured appendix and a nasty case of peritonitis.  Back then during the dawn of civilization, it was common for patients to spend far longer in hospital than we ever would now. For example: For North American maternity patients during the same era, the average length of stay in hospital for uncomplicated vaginal deliveries was about seven days. Today, that stay is more likely to be just 1-2 days(1). F...
Source: Disruptive Women in Health Care - September 10, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Uncategorized Source Type: blogs

What’s it like to be an oncologist? This is just one day.
7:00 a.m. Lights on.   Coffee, black and a banana. Paperwork.  27 patient visits, 3 emergencies, 35 phone calls.  Lots of computer time. Some laughs and a few tears. Paperwork.  Last family meeting.  Coffee, black.   In between: Thursday. Was not completely successful in explaining to my frantic patient with the multi-page lab printout, how the problem was not that her tests were bad, but that the computer had used the wrong “normal” range to decide what to flag bright scary-red.  The lab company is going to issue a new report. Continue reading ... Your patients are rating you online: How to respond. Manage y...
Source: Kevin, M.D. - Medical Weblog - September 10, 2014 Category: Journals (General) Authors: Tags: Physician Cancer Source Type: blogs

Doctors must speak like accountants
You have to think fast in medicine. Not that most doctors handle life and death emergencies all day long, but even seemingly mundane clinical situations require a lot of rapid gathering of data, processing of applicable information and attention to detail in formulating a plan. I have always been bemused by the so called E&M (evaluation and management) coding that dictates payment by requiring documentation of how doctors think. Ironically, the AMA defines this work and thereby has been a major contributor to physicians now spending more time on documentation than on doctoring. The documentation, even with EMR template...
Source: Kevin, M.D. - Medical Weblog - September 9, 2014 Category: Journals (General) Authors: Tags: Physician Primary care Source Type: blogs

When patients attack: How safe are health care workers?
I came across an interesting article in the New Yorker last week: “Why Chinese patients are turning against their doctors.” It is a fascinating account of the evolution of the health care system in China, highlighting the major changes that have led to increased patient-doctor homicides. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 9, 2014 Category: Journals (General) Authors: Tags: Policy Emergency Source Type: blogs

School Bureaucracy and the Death of Common Sense
Jason Bedrick If you needed more proof that bureaucracy induces the sacrifice of common sense to rigid rules, there’s this forehead-slapping story from the Washington Post’s Petula Dvorak: Avery Gagliano is a commanding young pianist who attacks Chopin with the focused diligence of a master craftsman and the grace of a ballet dancer. The prodigy, who just turned 13, was one of 12 musicians selected from across the globe to play at a prestigious event in Munich last year and has won competitions and headlined with orchestras nationwide. One would expect that she’d be the pride of her ...
Source: Cato-at-liberty - September 9, 2014 Category: American Health Authors: Jason Bedrick Source Type: blogs

Don’t forget to feed the doctors and nurses
This article originally appeared in Emergency Medicine News. Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 9, 2014 Category: Journals (General) Authors: Tags: Physician Hospital Source Type: blogs

Improving Access To High Quality Hospice Care: What Is The Optimal Path?
TweetEditor’s note: This post is part of a periodic Health Affairs Blog series on palliative care, health policy, and health reform. The series features essays adapted from and drawing on an upcoming volume, Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform, in which clinicians, researchers and policy leaders address 16 key areas where real-world policy options to improve access to quality palliative care could have a substantial role in improving value. High quality hospice care is consistent with the country’s stated health care reform goals: hosp...
Source: Health Affairs Blog - September 9, 2014 Category: Health Management Authors: Melissa Aldridge and Jean Kutner Tags: Access All Categories Health Reform Palliative Care Policy Source Type: blogs

Improving Access To High Quality Hospice Care: What Is The Optimal Path?
Editor’s note: This post is part of a periodic Health Affairs Blog series on palliative care, health policy, and health reform. The series features essays adapted from and drawing on an upcoming volume, Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform, in which clinicians, researchers and policy leaders address 16 key areas where real-world policy options to improve access to quality palliative care could have a substantial role in improving value. High quality hospice care is consistent with the country’s stated health care reform goals: hospice i...
Source: Health Affairs Blog - September 9, 2014 Category: Health Management Authors: Melissa Aldridge and Jean Kutner Tags: Access All Categories Health Reform Palliative Care Policy Source Type: blogs

The LITFL Review 151
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. Welcome to the 151st edition, brought to you by: Anand Swaminathan [AS] (EM Lyceum, iTeachEM) Brent Thoma [BT] (BoringEM and Academic Life in EM) Chris Connolly [CC] Chris Nickson [CN] ( iTeachEM, RAGE, INTENSIVE and SMACC) Joe-Anthony Rotella [JAR] Kane Guthrie [KG] Mat Goebel [MG] Segun Olusany...
Source: Life in the Fast Lane - September 9, 2014 Category: Emergency Medicine Authors: Kane Guthrie Tags: LITFL review LITFL R/V Source Type: blogs

Research and Reviews in the Fastlane 047
In this study, the research team collected pooled urine (read many people used the urinal they collected from) from a popular nightclub area in London and analyzed the specimens for the presence of illicit drug compounds. The goal was to determine whether this method could be used to track patterns and monitor trends in recreational drug use.  Recommended by: Anand Swaminathan Emergency Medicine, Critical Care, Anaesthetics Hindman BJ et al. Intubation Biomechanics: Laryngoscope Force and Cervical Spine Motion during Intubation with Macintosh and Airtraq Laryngoscopes. Anesthesiology. 2014; 121(2):260-71. PMID...
Source: Life in the Fast Lane - September 9, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Clinical Research Education Emergency Medicine R&R in the FASTLANE critical care Intensive Care literature recommendations Research and Review Source Type: blogs

Healthcare Update Satellite — 09-08-2014
Think a patient is faking alcohol withdrawal tremors? Yeah. There’s an app for that. Canadian researchers develop app that uses iPod’s built-in accelerometer to determine whether or not tremors are more than seven cycles per second. 75% of true alcohol withdrawal tremors have rates faster than that. Only one in six volunteers could fake tremors that fast. Malpractice fees in British Columbia set to double. Physicians pay anywhere from $2,000 (for family physicians) to $20,000 (for obstetricians) in a defense fund every year in order to offset the costs of malpractice defense. The reserve requirements for the fu...
Source: WhiteCoat's Call Room - September 8, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Think and Act Globally: Health Affairs’ September Issue
TweetThe September issue of Health Affairs emphasizes lessons learned from developing and industrialized nations collectively seeking the elusive goals of better care, with lower costs and higher quality. A number of studies analyze key global trends including patient engagement and integrated care, while others examine U.S.-based policy changes and their applicability overseas. This issue was supported by the Qatar Foundation and World Innovation Summit for Health (WISH), Hamad Medical Corporation, Imperial College London, and The Commonwealth Fund. The U.S. leads the global pack in hospital bureaucracy, no matter what t...
Source: Health Affairs Blog - September 8, 2014 Category: Health Management Authors: Chris Fleming Tags: All Categories Emergency Medicine Global Health Health Reform Hospitals Source Type: blogs

CCC Update 008
As you know, the LITFL Critical Care Compendium is a living resource built around the knowledge base needed for the FCICM exam, but extends far beyond those conservative boundaries. Plugging away on this project is where I spend most of my time ‘living in the fast lane’. The pages are built into the back end of LITFL — they don’t enter the blog feed — hence the need for updates to make sure you are not missing out on anything important… like leptospirosis, which featured in CCC Update 007 and within 2 weeks appeared in the FCICM Part II exam (or so I have been told)… Here is what is new ...
Source: Life in the Fast Lane - September 8, 2014 Category: Emergency Medicine Authors: Chris Nickson Tags: Critical Care Compendium Emergency Medicine FCICM Fellowship Intensive Care CCC update FCICM exam Source Type: blogs

Physician Payments Sunshine Act: Organizations Respond to CMS
  September 2nd marked the last day for comments on CMS’ proposed rule to eliminate the accredited continuing medical education (CME) exemption from Sunshine Act reporting.  In an overwhelming display of support for the exemption, over 800 comments were submitted encouraging the agency to either maintain or expand the current exclusion. -Total comments supporting maintenance or expansion of the CME exemption:  820 -Total comments supporting elimination of the CME exemption:  approximately 20 -Percentage of comments supporting the CME exemption: 98% We have followed this issue closely, and recentl...
Source: Policy and Medicine - September 8, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

The human cost of physician burnout is almost unfathomable
Adapted from a keynote address given to the graduating medical class at the University of Toronto. When I was asked to give the keynote to graduates of the class of ’14, it was an honor that nevertheless filled me with terror and a bit of wistfulness. My sense of fear in giving advice to these amazing young doctors comes from not being sure I belong in the same company. They are whip smart, talented, and ambitious beyond anything I could muster. The competition for a place in med school is past daunting; out of 3,000 wannabes, just 250 make the cut. The thought crossed my mind that if I was starting out today, I’m not...
Source: Kevin, M.D. - Medical Weblog - September 7, 2014 Category: Journals (General) Authors: Tags: Education Emergency Medical school Source Type: blogs