MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'encouragement'. Sat, 03 Sep 2011 02:21:24 +0100 http://www.medworm.com/index.php?rid=5181815&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1841 : ‘Not now.’ (This column first appeared in the Greenville News, but I re-wrote and expanded  it for my EMN readers in the September edition.  So here it is with a few special thoughts for the medical community.) Here’s the link to the EMN online edition as well: http://journals.lww.com/em-news/Fulltext/2011/09000/Second_Opinion__Two_of_the_Worst_Words_of_All__Not.8.aspx If you were watching me, secretly, you would see that I sometimes do things that are decidedly non-adult. I can be seen dancing across the hardwood floor with my daughter, with no music audible (except inside her lovely head). She apparently aspires to be a choreographer, and though I am no dancer, I am the only male in the house who will dance with her. When she asks, what can I say? I know many l... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=5181815 Thu, 01 Sep 2011 13:02:36 +0100 5181815 http://www.medworm.com/index.php?rid=5181816&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1837 I think a lot about the slow, certain dissolution of medicine as we know it.  Mental health issues crowd emergency departments, as few mental health clinics are available.  Psychiatrists are in short supply.  Drug abuse overwhelms the medical system, with either patients seeking pills or patients families hoping to get them off of pills. Persons with little interest in their own health continue to smoke and drink, use Meth and eat poorly.  Disability claims are skyrocketing as younger and younger individuals confabulate their misery in hopes of attaining a check, paid for by someone else. The poor, with genuine medical problems, have increasing difficulty finding care as jobs, and insurance, fade away.  Politicians, eager to be re-elected, eager to be loved, promise more and supply le... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=5181816 Wed, 31 Aug 2011 14:14:08 +0100 5181816 http://www.medworm.com/index.php?rid=5139757&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1811 On a scale of one to ten, What is your loneliness? Think of one as a day when your Family was out shopping, Laughing, going to movies, but You were sick in bed. Ten is Like everyone you knew Perished, or decided you were Worthless and abandoned you. What about your fear? Ten is the worst, one is the least. Be candid; maybe we can help. One is when you reach Into your desk drawer and Find a rubber spider, a ridiculous Fuzzy black joke that Makes you fall out of Your swivel chair while across The divider coworkers laugh. Five is the idea that everyone In the world knows your thoughts, Knows your hopes and how to Shatter them. Eight that everyone Knows what you think of them, Including her. Ten is that nothing about you Is a secret to anyone. Tell me about your sadness. Ten is the memory ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=5139757 Thu, 18 Aug 2011 15:28:20 +0100 5139757 http://www.medworm.com/index.php?rid=5103350&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1773 The American College of Graduate Medical Education has enacted further restrictions on resident work hours.  No more than 80 hours per week of work for resident physicians, averaged over one month.  And no more than 16 hours of continuous work for first year residents (24 after that), which includes patient care, academic lectures, etc. Whenever they do this sort of thing, everyone seems excited that it will make everyone safer.  After all, residents won’t be working as much, so they’ll be more rested and make much better decisions.  It’s all ‘win-win,’ as physicians in training and patients alike are safer. I guess.  The problem of course is that after training, work hours aren’t restricted.  There is no set limit on the amount of work physician c... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=5103350 Sat, 06 Aug 2011 03:31:30 +0100 5103350 http://www.medworm.com/index.php?rid=5096221&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1769 We are called by Christ, among other things, to mourn with those who mourn, to weep with those who weep. This sometimes happens, suddenly and briefly, in the emergency room.  I was sitting at my desk one quiet morning recently.  EMS traffic caught my ear and I learned that there had been a terrible accident not far from the hospital.  However, far enough that the regional helicopter had been called to the scene. One patient would fly out.  One patient, one poor girl, one daughter, would not fly out.  And she would not come to me for care.  She died on the road at about 7:15 am.  She died on the road I sometimes drive to work, about 20 minutes after I would have passed the exact place she passed from this life. I was stricken, I was saddened.  Father of four, I was nauseated and hea... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=5096221 Wed, 03 Aug 2011 02:42:20 +0100 5096221 http://www.medworm.com/index.php?rid=5097171&cid=t_132549_180_f&fid=38603&url=http%3A%2F%2Fzenhabits.net%2Fbasics%2F Editor’s note: This is a guest post from Chris of Zen to Fitness. Health and Fitness have always been meaningful to me as I work in the industry and have always been fascinated by the topic. Nowadays I see too many people push themselves too hard, use bad form and quite simply overdo it with exercise or trying to be healthy in the quest to be fit. We also have a tendency to make health and fitness much too complicated … From this I came to think about a few fundamentals – things I find really important in living a healthy lifestyle. I came up with just four, sure there are others but these are the ones I feel everyone who wants to live a healthier lifestyle or be fitter should know. Bodyweight is King. The Squat and Pushup should be mastered before you move onto other weight... Zen Habits blogs http://www.medworm.com/rss/comments.php?id=5097171 Tue, 02 Aug 2011 15:00:17 +0100 5097171 http://www.medworm.com/index.php?rid=5069485&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1750 Last night I was contacted by a physician in the local urgent-care.   I like him, and we made polite, but brief, conversation.  ‘So, are you guys busy?’ I gave him the status report.  ‘Well, yeah.  We have about 25 people waiting to be seen the waiting room is full and every patient room is full.  Also, we just received a gun-shot wound to the head by EMS.’ ‘Wow, sounds terrible!  So, here’s what I need to send you…’ What he sent was, in fact, reasonable.  A young woman with signs and symptoms of meningitis (who was treated earlier in the day for and upper respiratory virus…with Amoxicillin, of course.) She needed a lumbar puncture, which I performed and which was  negative. But I had this thought.  I could probably have said,... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=5069485 Tue, 26 Jul 2011 14:35:39 +0100 5069485 http://www.medworm.com/index.php?rid=5062255&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1745 Good news on disability:  or should I say ‘disability.’ Anyone working in social services or medicine (well, anyone with half a cerebrum and some rational thinking capacity mixed in with their compassion) knows that the disability system in the US is completely out of control.  We routinely see patients who say, when queried about their disability, ‘well doc, honestly, I don’t know why I’m on disability!’  Which is fine if you’ve had a serious head injury or stroke, but if your complaint is ‘injured back while using chain-saw,’ maybe disability is a little generous. So, here’s some light in the darkness: http://lsolum.typepad.com/legaltheory/2011/07/pierce-on-administrative-law-judge-disability-decisionmaking.html Hallelujah! ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=5062255 Mon, 25 Jul 2011 17:03:37 +0100 5062255 http://www.medworm.com/index.php?rid=5050603&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1737 Leap’s quotient   The number of F-bombs used is inversely proportional to the chance of receiving narcotic analgesics in the emergency department.   That is,  # F-bomb=1/narcotic Rx (Source: edwinleap.com) edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=5050603 Thu, 21 Jul 2011 14:50:28 +0100 5050603 http://www.medworm.com/index.php?rid=5050607&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1728 For years now, we’ve all heard the drum-beat.  Bill-boards in cities have proclaimed it.  Various medical associations have touted it’s importance.  Stroke symptoms have to be treated immediately!  Give clot-busting drugs, also known as ‘thrombolytics!’ Until, of course, those in favor of giving the drugs (namely neurologists)  realized that a)  Not everyone with a stroke, aka ‘brain attack’ has insurance and b) people have a very inconsiderate habit of having said strokes at the most inconvenient of hours.  For instance, after 5PM, on the weekend, on holidays.  The nerve! So across the country, physicians in emergency departments like mine are finding themselves expected by the court of public opinion to give a potentially dangerous drug (albeit... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=5050607 Tue, 19 Jul 2011 01:27:57 +0100 5050607 http://www.medworm.com/index.php?rid=5036511&cid=t_132549_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2011%2F07%2Frepetitious-light.html Therefore encourage one another and build up one another... I Thessalonians 5:11aCourthouse stairwellFew have mastered it: not only leaving their spiritual life as a light on a lampstand, but lighting other souls with the fire burning in that lamp. In public especially, it is hard to know how much to fit in, and how much to allow yourself to be different because of Jesus' transforming power.Let me be the mirror, a reflection of Jesus as I walk through the world in another culture these next two weeks. Although the reflection is darkened and defused by all the corners it goes around in my soul before emerging for the world to see, let me be marked by my stalwart faith in my Maker rather than a dispassionate faith.If there’s a man with a vision to recognize beautyin places and faces the re... Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=5036511 Sat, 16 Jul 2011 13:14:00 +0100 5036511 http://www.medworm.com/index.php?rid=4992698&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1713 Today is the day that new resident physicians begin their training all across the United States.  Today, our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (OK, not really a specialty, just a side-line) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school.  Anxiety-filled and debt-ridden, they will embark on four to seven (or even more) years of training to make them knowledgeable, technically proficient physicians. I will occasionally wax poetic and philosophical for their benefit.  But not today.  Today there are practical matters.  Today I want to give them a few pointers, to ease their transition into ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4992698 Fri, 01 Jul 2011 23:49:38 +0100 4992698 http://www.medworm.com/index.php?rid=4992699&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1711 This is my column in July’s EM News.  Have a restful day! http://journals.lww.com/em-news/Fulltext/2011/07000/Second_Opinion__A_Rest_for_the_Heart.10.aspx We travel to Hilton Head, SC, every spring for an ‘end of school-year’ vacation. It is a tradition that started several years ago; one which our family treasures. We plan months ahead, when we arrange lodging. Then, as the date draws closer we have to restrain ourselves from jumping up and down at odd, inappropriate times. The beach calls to us in an inexplicable way. We live in a beautiful county, surrounded by mountains and lakes. It is, in itself, a worthy destination, perfect for biking, hiking, fishing and/or kayaking. But when May rolls around, our eyes turn to the east, and we long for the sand and sea. It is on... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4992699 Fri, 01 Jul 2011 22:24:09 +0100 4992699 http://www.medworm.com/index.php?rid=4975876&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1706 Trained as an emergency physician, my entire career has been spent pondering, searching for, often finding and managing the worst possible eventualities in my patients.  Chest pain is, first and foremost, a heart attack or pulmonary embolus.  Abdominal pain is appendicitis, a ruptured tubal pregnancy.  Fever with headache is meningitis.  And neck pain from a car wreck is an unstable cervical spine fracture. So it has taken enormous effort to ‘dial-down’ my response to my wife’s recent cancer, treatment and recovery.  I drive her to distraction with ‘how are you feeling?’  I pester her endlessly to eat.  I have imagined every bump or cough a metastasis.  I have envisioned all the worst outcomes imaginable.  I endlessly ‘catastrophize,’ as o... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4975876 Tue, 28 Jun 2011 21:01:30 +0100 4975876 http://www.medworm.com/index.php?rid=4976151&cid=t_132549_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2011%2F06%2Fshe-sees-me.html Anne of Green Gables called them "bosom friends". I have several. Count me among the lucky. All have helped me through this maze of depression, validating my feelings and helping me cope.Last night, I was a complete mess. My face covered in tears, I listened to the voice at the other end of the telephone telling me how to pull myself out of a flashback or a panic attack. She spoke wisdom. I'm going to follow it.Are these moments of transparency a gift from God?  Honesty that makes the soul of the other translucent, pink faces of flower shining but brief, looking through each others souls.Two ships sinking bind their brokenness with the cords of compassion. The sweetness of her voice lingers in my ear this morning, a reminder that, despite differences, we all share or deny love. Thank ... Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=4976151 Tue, 28 Jun 2011 12:52:00 +0100 4976151 http://www.medworm.com/index.php?rid=4968505&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1704 Last night, working in the emergency department, I realized yet again that EMR is a problem.  While governmental bodies and consulting firms endlessly praise the utility and wonders of electronic medical records, the hard reality ‘on the ground’ is that entering electronic data, for every patient encounter, is a productivity killer. In fact, I realized that I spend far more time looking at the screen, clicking the mouse and typing the history for the patient counter than I ever spend actually talking to, and touching, the patient. I believe that EMR, while having some utility, has simply caused us to obtain and store more data than ever, most of which is unnecessary at best, and at worst, damning and confusing.  (Damning because if my vast chart conflicts with the nurse&#8217... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4968505 Thu, 23 Jun 2011 20:26:51 +0100 4968505 http://www.medworm.com/index.php?rid=4960075&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1693 I haven’t worked a night shift in many months.  For a time, years ago, I worked full-time nights.  I did it for about seven years, at which time my wife told me I was acting depressed and should move to a daytime schedule.  Still, the vagaries of the ER require that we sometimes be here all night.  Blech.  So, I thought I’d take this opportunity to chronicle my thoughts through the night.  Please be patient if my thought processes seem to ramble. 1)  I had, in my lunch container, a cheeseburger, two packs of Swiss Cake Rolls, and a turkey, pepper-jack and honey-wheat bread sandwich.  I arrived at 2250.  It is 2330.  I have consumed one turkey sandwich and one pack of Swiss Cake Rolls.  It may be a long night. 2)  I came to work without sleeping much.  I simply coul... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4960075 Thu, 23 Jun 2011 04:26:16 +0100 4960075 http://www.medworm.com/index.php?rid=4952864&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1681 For all of you fans of electronic books (which have finally out-sold print books), my latest book, The Practice Test, is available as an e-book.  Here’s the link! http://booklocker.com/books/5196.html Thanks for your support! Edwin (Source: edwinleap.com) edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4952864 Sat, 18 Jun 2011 17:18:09 +0100 4952864 http://www.medworm.com/index.php?rid=4893558&cid=t_132549_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F06%2F02%2F9-tips-to-find-a-fulfilling-work-life-balance%2F Recently, I had the pleasure of interviewing several amazing women on how they juggle all the responsibilities that come with their professional and personal lives. (Stay tuned for the article in our mental health library!) In addition to sharing what works for them, they provided a slew of solutions for readers, too. Here’s what they had to say… 1. Challenge society’s standards. In our society, productivity is prized and praised. We reward workaholic ways, even though this is both emotionally and physically unhealthy. As such, productivity coach Laura Stack, MBA, suggested “challenging the social acceptance — even society’s encouragement — of these common phrases: ‘Look how productive you’re being. You are accomplishing great things’ ‘After all, you posses... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4893558 Thu, 02 Jun 2011 12:07:08 +0100 4893558 http://www.medworm.com/index.php?rid=4872107&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1631 How many times have you heard this on the radio: Base, this is Medic 3, and we’re 15 minutes from your facility with a 38-year-old white male with, uh, some chest pain, numbness all over, headache, and anxiety, as well as some bruises from a fall. He says his pain radiates from his earlobes to his nipples, and well, we’ll just give you more details on arrival, base. This is Medic 3 clear. God love those paramedics. The truth is, if we doctors were on the truck ourselves, we still wouldn’t know what the diagnosis was. Frequently, when I discharge people from the emergency department, I still don’t know the diagnosis. Thank heavens for medical screening exams because that’s about the best I can do some nights. But I have come to realize that if the medics can&#8... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4872107 Fri, 27 May 2011 16:37:55 +0100 4872107 http://www.medworm.com/index.php?rid=4847967&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1610 Kindness as Medical Treatment (This originally appeared as one of my columns in Emergency Medicine News, in 2001.) Before me on the exam table was a young woman in her mid- to late 30s. She was a little anxious. Her chart indicated that she had back pain, neck pain, headache, chest pain, and insomnia. I took a deep breath, rolled my eyes, and began to take a history. I tried my best to tease out what things might be serious and what was not. No injuries, no weakness, no shortness of breath, no history of heart disease, no thunderclap headaches, no, no, no. Her exam was almost as unremarkable. Until we went a little further. As her history continued and she opened up, I learned that she was working third shift at a local factory, raising three small children and caring for a husband on dia... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4847967 Fri, 20 May 2011 03:09:05 +0100 4847967 http://www.medworm.com/index.php?rid=4841490&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1599 Heck, if we have to see patients for free, at least we could bill for a dating service.  Couldn’t we? http://www.xtranormal.com/watch/11938527/emergidate-the-er-matchmaking-service (Source: edwinleap.com) edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4841490 Thu, 19 May 2011 03:11:49 +0100 4841490 http://www.medworm.com/index.php?rid=4813303&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1586   Ordinarily, I’m wary of all things dental.  I had too many cavities as a child.  As a young man, I had a root canal done on the wrong tooth, followed immediately be the correct one.  My dental memories are a bit tainted.  Not an indictment of the entire profession so much as a kind of PPSD…post procedure stress disorder. But when I moved to South Carolina, my wife and I found a wonderful general dentist in Dr. Ronald Moore, in Seneca, SC.  Rarely would I ascribe the words ‘painless dentistry’ to one of the practitioners of that esteemed profession.  But I have to give credit where credit is due.  His hygenists, and Dr. Moore, have all been the pinnacle of gentility.  Even my children aren’t afraid to go for cleanings.  And when I need anesthesia, w... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4813303 Wed, 11 May 2011 17:57:24 +0100 4813303 http://www.medworm.com/index.php?rid=4789263&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1576 Years ago I had a conversation with a surgeon at our facility.  He was unhappy that a seriously injured trauma patient came to our facility after an MVC.  ‘These patients shouldn’t come here Ed, they should go to a trauma center!’ Fair enough; we aren’t a trauma center.  Not a Level I, not a Level II or III; not even a level 0.5!  But we are the only hospital in a large rural county, and the closest, largest facility for portions of a few other counties nearby.  The nearest hospital with neurosurgery and thoracic surgery is at least 30 minutes further away. The problem is, torn blood vessels, crushed spleens,  collapsed lungs, swollen brains don’t look at the clock, and cars aren’t designed to wreck only near trauma centers, any  more than assaila... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4789263 Wed, 04 May 2011 14:43:20 +0100 4789263 http://www.medworm.com/index.php?rid=4771028&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1567 Paying hospitals for quality…and good patient satisfaction scores.  Are you kidding me? http://www.acep.org/Content.aspx?id=78862 So now, in addition to the many other bits of medical meddling we have from CMS, there’s this. Reimbursements to hospitals, from Medicare, will be partly tied to patient satisfaction scores. We’ve seen payments already being tied to ‘quality indicators,’ as dictated by the federal government; rewards for doing a better job on care for heart attacks, pneumonia, etc.. At least that’s quantifiable, whether scientifically correct or not. But patient satisfaction scores? These scores, part of the constant ‘customer satisfaction’ trend in medicine, are fraught with peril. And despite the validation and complex statistic... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4771028 Sat, 30 Apr 2011 20:58:08 +0100 4771028 http://www.medworm.com/index.php?rid=4723853&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1512 Our emergency department was very busy recently. The hospital was full and we were holding patients. Three had been in the ER many hours; one waiting for a bed for six hours, another eight hours, and still one more for eleven hours. Of course, ambulance traffic hadn’t stopped and the waiting room was full, with patients waiting too long to be seen. (And we all know that the media loves to highlight bad outcomes from the ER waiting room!) Administration set up a ‘command post’ to try to arrange beds, discharges and moves. At one point I asked one of our administrators to move those waiting the longest to hallway beds up on the patient floors. He told me that he couldn’t because each of the two floors in question already had one patient in the hall. And besides, it wo... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4723853 Sun, 17 Apr 2011 22:56:03 +0100 4723853 http://www.medworm.com/index.php?rid=4693300&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1493 I have a suggestion for all of those federal workers who are concerned about a government shutdown, who are concerned that they won’t be paid if a budget compromise isn’t reached. To all those who already have better insurance and better benefits than most in the private sector; for all those whose jobs pay more than equivalent private sector jobs for the same activities. Do what hospitals do. ‘Go to your jobs, and do the necessary work anyway.’ It is ironic, but hardly surprising, that the government suddenly so concerned with being unfunded continually demands unfunded work from hospitals and medical providers. Or at best, expects underfunded work. I ask you, friends and colleagues in the world of medicine, how many physicians see patients at the markedly reduced ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4693300 Fri, 08 Apr 2011 16:16:20 +0100 4693300 http://www.medworm.com/index.php?rid=4684360&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1491 I sometimes see men and women who come to the emergency department and tell me about their PTSD, caused by service in Iraq or Afghanistan.   I believe some of them; others I doubt, since their PTSD seems directly connected to a desire for Percocet, Lortab, MS-Contin or other prescriptions for back pain.  Sadly, the VA system does not lend itself to inquiry by outside physicians, so in many instances I am treating them in an information vacuum. However, as I contemplate their allegations of PTSD, I wonder how many physicians and nurses from emergency departments have the disorder.  I’m no psychiatrist, but it just seems probable that the years of cummulative stress, the years of sleeplessness and snap decisions, the untold shifts filled with unpredictable chaos, pain, threats, dea... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4684360 Tue, 05 Apr 2011 14:26:21 +0100 4684360 http://www.medworm.com/index.php?rid=4676805&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1489 Dr. Gretchen is a friend of mine who used to be a paramedic at our hospital, Oconee Medical Center (then Oconee Memorial Hospital).  She graduated from Clemson University, then from the Medical University of South Carolina and was an operational physician in the Navy before doing a family medicine residency.   She has carved herself a niche as a media physician, and I’m happy for her!  Tomorrow she’ll be on the Dr. Oz show. Take a look!  Here are links to the show teaser, and to her website. http://www.doctoroz.com/videos/tuesday-dr-oz-show http://www.doctorgretchen.com/index.html Edwin (Source: edwinleap.com) edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4676805 Mon, 04 Apr 2011 16:25:32 +0100 4676805 http://www.medworm.com/index.php?rid=4670122&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1484 Here’s my column in April’s Emergency Medicine News, on the problem of what I call, ‘moral diversion.’ Edwin Our specialty has long struggled with the problem of diversion, in which overwhelmed emergency departments attempt to divert EMS patients to other facilities. It raises many questions, professional, financial and ethical. Therefore, most medical centers choose to accept all patients and live with overwhelmed, understaffed departments, with the intent of simply doing the right thing. (And avoiding the risk of litigation to boot!) But recently, I began to contemplate the other form of diversion that is systematically crushing the emergency care system. A kind of diversion that impacts finances, staffing and ultimately the proper care of the sick, injured and dy... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4670122 Fri, 01 Apr 2011 20:11:36 +0100 4670122 http://www.medworm.com/index.php?rid=4642612&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1476 So I have a Droid.  I purchased it in July, not long after taking my old flip-phone for an oceanic bath at Hilton Head, SC.  I waffled for a long time.  In fact, I almost purchased a Casio phone that was marketed as water and impact resistant.  ‘Mil-spec,’ was the phrase used…a phrase which appeals to me as a one-time Air-Guard flight surgeon.  What it meant to me was, ‘you can’t hurt it.’ Still, I was attracted by medical applications and the assorted other cool things a Droid can do.  I mean, my old phone didn’t have a Magic 8 Ball, for crying out loud!  More to the point, my old phone didn’t have Epocrates, or the Emergency Medicine Residents Association Guide to Antibiotic Therapy.  It lacked a flashlight, an mp-3 player, a protra... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4642612 Mon, 28 Mar 2011 19:33:17 +0100 4642612 http://www.medworm.com/index.php?rid=4615114&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1467 My column in Sunday’s Greenville News. ‘Medical education shouldn’t cost an arm and a leg.’ I was talking to a young man who is starting medical school this fall. His tuition at one of South Carolina’s newer schools will be $40,000 per year. That’s admittedly on the high end. On the low end, it runs a paltry $33,000 per year. And this is all after college, of course. He and others like him are taking out loans to the tune of $240,000 to pay for their medical educations. Another young woman I recently met is in residency and her loan payments are around $2000 per month. Thinking back on my own medical education, it seems my tuition was around $5000 per year. But then, what with all the Saber Toothed Tigers, Neanderthals and stone surgical tools, things ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4615114 Mon, 21 Mar 2011 03:14:49 +0100 4615114 http://www.medworm.com/index.php?rid=4580907&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1463 For anyone who didn’t see my post a few weeks ago, here’s the link to my latest book.  It’s about finding sanity and perspective in the practice of medicine.    As it’s my blog, I can shamelessly self-promote with relative impunity. Makes a great graduation present for everyone from pre-med students to those graduating residency. Thanks! Edwin http://edwinleap.com/blog/?p=1460 (Source: edwinleap.com) edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4580907 Mon, 14 Mar 2011 03:02:34 +0100 4580907 http://www.medworm.com/index.php?rid=4565911&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1458 Thank you, first of all, for your prayers and love.  Jan’s last radiation therapy was last Monday and her last chemotherapy was last  Thursday.  While those are happy, hopeful things, she still feels miserable.  She is having copious secretions from her throat, vomits periodically and is extremely weak as yet.  However, she did get up today and do our bills…which probably made her want to faint dead away! One of her chemo nurses said that after this therapy, the subsequent two weeks can still be pretty tough.  It appears she was absolutely right.  I hate that Jan is still nauseated and fatigued, but I believe that better days are coming.  It’s a horrible feeling, this sense of being powerless to stop the  misery of one we love.  As a ‘fixer,’ it&#821... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4565911 Wed, 09 Mar 2011 02:15:30 +0100 4565911 http://www.medworm.com/index.php?rid=4532219&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1455 Here’s my column in the March Emergency Medicine News. ‘Everyone is a drug seeker. Why does everyone want to be on disability? I’m so tired of lies. Great, another lousy shift. I wonder who will die tonight? I’m so sick of suffering. I’m so weary of misery and loss. I hope this never happens to my family. I’ll probably get sued. Being sued nearly drove me crazy. This job never gets easier, only harder. I have to find something else to do; I can’t go on this way. I think I’m going crazy. I don’t have any more compassion. People hate me now.’ These are only a few of the wonderful thoughts that float through the minds of emergency physicians these days. Sure, not every physician has them. But I know our specialty, I know our colleag... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4532219 Tue, 01 Mar 2011 02:52:57 +0100 4532219 http://www.medworm.com/index.php?rid=4527740&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1453 This is my column in today’s Greenville News. Sickness can show the depth of a couple’s love When I met my wife at a college Halloween Party, we were 19 years old. She was a black-haired, blue eyed beuaty dressed as a mime. I was dressed as a doctor. (I was a big pre-med nerd.). After the party, our group of friends spent all of our free-time together, in and around our dorm at Marshall University. Several months later, after a day when the school was closed by snow and we went sledding, a fire began to flicker between us. Soon we went on our first date. We were poor, skinny college kids who loved to laugh and eat cheap pizza. We went to free movies on campus and met one another between classes. I still see her, bouncing across the grass, a red hat and cape on a cold day, wal... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4527740 Sun, 27 Feb 2011 22:42:03 +0100 4527740 http://www.medworm.com/index.php?rid=4450300&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1446 If you’re a physician on Sermo, please read this link!  It’s a piece I wrote about security in hospitals.  ‘The News from Firebase ER.’ https://app.sermo.com/posts/posts/75109 Thanks, Edwin (Source: edwinleap.com) edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4450300 Tue, 08 Feb 2011 20:18:47 +0100 4450300 http://www.medworm.com/index.php?rid=4419148&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1439 It’s Probably Nothing! The lessons of bad news, fear, love and hope. http://journals.lww.com/em-news/blog/BreakingNews/pages/post.aspx?PostID=25 It’s probably nothing. That’s what we heard over and over. My wife, Jan, had a swollen lymph node on the left side of her neck, just under the angle of her mandible. That’s what I told myself when she first complained of it a few months ago. A tender, swollen lymph node after all of us had colds, sore throats, and fever. Probably nothing. In November, it was more painful. (Painful node; probably nothing, right?) So it was off to the ENT. A cautious, competent surgeon, he said it was probably nothing, but it needed to be evaluated. The CT scan showed an enlarged node. Nothing else was visible. No other adenopathy. We figure... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4419148 Tue, 01 Feb 2011 01:43:49 +0100 4419148 http://www.medworm.com/index.php?rid=4414526&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1435 My partners and I have long struggled with the lack of specialty back-up at our hospital. Semi-rural hospitals, out of the way facilities, just can’t always attract specialists. So, we’re happy to have cardiologists every night, but understand that we only have an ENT every third night. We’re thankful to have neurologists, even if they don’t admit anyone. We’re glad to have radiologists, even if they don’t read plain films after 5PM on weekdays. Still, I continue to scratch my head about why only three of seven community pediatricians take call, such that family physicians have to admit their patients. I was bumfuzzled that our neurologists were previously going to require us to use telemedicine for stroke evaluation, when their offices were close by th... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4414526 Sat, 29 Jan 2011 04:38:12 +0100 4414526 http://www.medworm.com/index.php?rid=4414527&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1430 Just a little reminder that my latest book is available at booklocker.com.  If any of you ordered but have not received it, it was a glitch on my end.  I hadn’t approved sales with the printer.  Should be on its way now! http://booklocker.com/books/5196.html http://booklocker.com/books/5196.htmlhttp://booklocker.com/books/5196.html (Source: edwinleap.com) edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4414527 Sat, 29 Jan 2011 03:50:40 +0100 4414527 http://www.medworm.com/index.php?rid=4382770&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1425 You might like this interview I recently did with Christian Devotions.  Thanks to Scott McClausey, who graciously invited me and let me speak about my faith, my family, my career and writing! http://christiandevotions.us/2011/01/18/christian-devotions-speak-up-with-dr-edwin-leap/ (Source: edwinleap.com) edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4382770 Fri, 21 Jan 2011 03:50:16 +0100 4382770 http://www.medworm.com/index.php?rid=4360996&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1417 Well, here it is at long last!   My third book.  It’s called The Practice Test, and it’s about how we can face the struggles of medical practice with more balance and perspective.  How many docs knew every scientific and clinical question necessary to pass board, but were never prepared for life as a doctor?  Most, I’d say. My book is set up like a parody of board exam questions, and it’s suitable for aspiring physicians, retiring physicians, practicing physicians, medical students, residents, medical spouses, educators, policy-makers and even patients who want to understand their doctors a little better.  And if they want to buy one for their physicians, I won’t mind a bit! Here’s a link to read about it, look inside and  order it if you desire. h... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4360996 Tue, 18 Jan 2011 18:03:17 +0100 4360996 http://www.medworm.com/index.php?rid=4318341&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1410 Theologically questionable; still pretty funny! Living and working in ‘Smite-ville.’ My partner, the sagacious Dr. Doug McGuff, has many words of wisdom.  I hope that he will one day collect them in a book, because generations of people will benefit. One of his pearls of wisdom is that, in emergency medicine (indeed, medicine in general), we live and work in ‘Smite-ville.’   That is, it always seems as if we care for patients who have been smitten by some terrible event, some awful disease.  His point was not that we are witnessing punishment, or even that the world is necessarily more horrible than we thought, but that we who work in emergency rooms and hospitals often see the worst of everything.  Emergency departments and hospitals are where horrors come to ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4318341 Thu, 06 Jan 2011 15:08:51 +0100 4318341 http://www.medworm.com/index.php?rid=4214129&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1373 Gifts for my colleagues, near and far This is my column in December’s EM News Merry Christmas! I like to think back on favorite Christmas gifts I have received down the years. I don’t think I can do any better than the children of mine who were born around Christmas. Three of the four came within one month of Christmas day. One came on December 23rd;. What wonderful presents! Going farther back, I recall sitting by the Christmas tree at my childhood home, or the homes of my grandparent’s. I found toy soldiers, toy horses, Matchbox cars, pocket-knives and many other little boy wonders. I remember the beautiful wooden stock and golden trigger of my first shotgun, and how it pulled me irresistably into a sense of impending manhood to know that my father and mother trusted m... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4214129 Wed, 01 Dec 2010 03:37:03 +0100 4214129 http://www.medworm.com/index.php?rid=4139248&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1341 When we physicians don’t get our way, or don’t get the response we desire, we can be intimidating.  I have seen this play out many different ways.  I have been treated rudely by other physicians.  I was once threatened by a very prominent one, who told me (in response to the fact that I dared question his tone), ‘be careful son, you’re digging yourself a deep hole.’  I don’t know what kind of hole, or where it would have taken me, but he was certain I was digging it.  Oddly enough, I rather like digging holes.  (Very zen.) Physicians yell at one another, or curse.  Physicians stomp and slam down charts.  I don’t like it at all.  I think it suggests immaturity.  I always tell students and residents that in the ER, especially, the physician... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4139248 Fri, 05 Nov 2010 01:37:42 +0100 4139248 http://www.medworm.com/index.php?rid=4097954&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1312 Many mornings, Jan and I make breakfast for the children.  Because they are home-schooled, we have the time to eat with a bit of leisure.  Today, as so often, we had chocolate chip pancakes, bacon and (for the Mama) a BLT.  Cups of hot tea followed. It is a small thing, breakfast, and food in general; but not so small.  One of the things I was taught in my training was to offer food or drink to agitated or mentally unstable patients.  I’ve done it many times, and have had remarkable success. Sometimes, a soda, a cup of coffee, some crackers and peanut-butter have as much benefit as any pharmaceutical product ever could.  In the midst of their anger, their frustration, I get up to leave the room to order labs or make phone-calls and I turn, ‘can I get you some coffee?  So... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4097954 Thu, 21 Oct 2010 14:45:27 +0100 4097954 http://www.medworm.com/index.php?rid=4074081&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1309 Is anyone aware of the tragedy of ‘Workamyalgia?’  The condition wherein work leads to extreme discomfort, sore muscles, fatigue and limited time for web-surfing and television watching? I’ve seen it, and let me say (professionally speaking) it is horrible to behold.  The victims develop frequent, but fortunately minor, illnesses and injuries that are sufficiently inconvenient that they are unable to continue to expose themselves to the horrors of consistent, mundane, money-producing labor. Over time, these illnesses (especially nefarious due to their objectively unverifiable nature) result in near total impairment.  And cause the victim to stare ‘like a deer in the headlights’ at any offer of full-time, gainful employment. Fortunately, a cure exists.  Tha... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4074081 Thu, 14 Oct 2010 17:53:36 +0100 4074081 http://www.medworm.com/index.php?rid=4031252&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1295 Here’s my column in this month’s Emergency Medicine News http://journals.lww.com/em-news/Fulltext/2010/10000/Second_Opinion__How_to_Have_a_Successful_Practice,.6.aspx I have practice with the same group, in the same hospital, for 17 years. Because we have been together so long, our group is a family. So it was with enormous grief that we buried our founder, Dr. Jack Warren, 11 years ago after a tragic car crash. That wound is still open, but we still tell stories about his humor, his compassion and his grace. As I write this, I am tending another wound; or I should say, our group is tending another. A second partner passed away last week. Unlike the sudden horror of the first death, the second was progressive, as our friend and partner, Dr. Howard Leslie, left us by degrees, th... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4031252 Mon, 04 Oct 2010 16:42:45 +0100 4031252 http://www.medworm.com/index.php?rid=3993928&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1288 Doctor Dagger Carves Up and Serves the Benefits of Rural EM Practice An Interview with Edwin Leap, MD, Featured Speaker at 2010 Scientific Assembly Rural Section Meeting Randolph Knight, MD July 21, 2010 The alternating rise and fall of the bellows, steady airflow of a hand-cranked blower and sudden metallic clangs do not mean that this rural Emergency Medicine physician is using steam-engine technology to ventilate a critical patient. Dr. Edwin Leap is just having fun with his children, in a way that only a small-town practice could provide.  In his free time away from a full-time position at Oconee Medical Center in Seneca, South Carolina, Leap enjoys blacksmithing in the forge he has erected on his 60-acre farm.  He lives on the farm with his wife Jan and four children and a number of... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3993928 Wed, 22 Sep 2010 14:37:42 +0100 3993928 http://www.medworm.com/index.php?rid=3993930&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1284 C-130 spraying daily Inapsine dose over large city The end is near! Written on our dry-erase board at the nurses’ station is the following tragic message: ‘OUT OF INAPSINE.’ For those of you unfamiliar with this wonder-drug, its actual name is Droperidol.  It has been used over the years for pre-sedation, for nausea, for migraines and for behavior control of agitated, violent and/or psychotic individuals. A few years ago, it received a dreaded ‘Black Box Warning,’ from the FDA for QT prolongation.  That is, in lay terms, it could cause dangerous or fatal cardiac rhythms. This was news to those of us who grew up as physicians, administering the stuff in liter doses.  (Oddly, it coincided with the release of a competing nausea medication, Zofran, which was ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3993930 Wed, 22 Sep 2010 14:09:57 +0100 3993930 http://www.medworm.com/index.php?rid=3980835&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1282 This is my column in today’s Greenville News.  It’s a follow-up to a recent column I wrote on the mental health ‘crisis’ in America, as seen in our emergency rooms. My last column addressed the unfortunate truth of the overwhelmed mental health system in South Carolina, and indeed in much of the US. While I lament the fiscal condition of our mental health system, and while I feel for those who truly need the help we are often powerless to supply, I would be a poor observer if I didn’t report the truth. And the second truth we must face is that much of what we call mental illness is neither truly ‘mental,’ nor even ‘illness.’ Let me first state the obvious; the brain is an organ. It is incalculably complex and truly a wonder of design and engineering. But... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3980835 Fri, 17 Sep 2010 21:04:41 +0100 3980835 http://www.medworm.com/index.php?rid=3938338&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1273 Is there any point asking about the pain scale anymore?  Everyone is a ten.  And even when our patients are moving through life with prescriptions for Fentanyl and Methadone for ‘chronic pain,’ they still come to the emergency department  pleading that they can’t help that they’re out of their narcotic a few days earlier.  Stating that they called their physician who wouldn’t refill them, but said, ‘if you need pain medicine, you’ll have to go to the ER.’ Pain being, allegedly, the 5th vital sign, we are encouraged to treat it, not disbelieve it.  And thus, emergency department patients with a ‘high tolerance’ for pain medication end up with enough narcotic to put down a bull elephant, all the while whispering and slurring th... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3938338 Mon, 06 Sep 2010 13:24:51 +0100 3938338 http://www.medworm.com/index.php?rid=3924912&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1263 A few things hit me yesterday, so I thought I’d share them with you. 1)  We have a new rule in the hospital.  No ultrasounds after 5PM unless it’s for testicular torsion, ovarian torsion or ectopic pregnancy.  (Things which can result in loss of an organ with resultant infertility,  or death in the case of ectopic).  Why?  The ultrasound techs are a scarce commodity and are tired of being called in too often.  Mind you, we can only do very limited ultrasound ourselves, and aren’t allowed to bill for ultrasound as ER docs, because our radiologists ‘have an exclusive contract.’  So, if you need an ultrasound for, say, blood clot in the leg (DVT), you have to wait until morning. There’s a lesson here, as we ask ‘why aren’t there more doc... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3924912 Wed, 01 Sep 2010 14:28:24 +0100 3924912 http://www.medworm.com/index.php?rid=3915013&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1256 Help me Lucy! You're our last hope! Here’s my column from the Greenville News, yesterday, 28 September. I remember an ad for a national chain of psychiatric hospitals that ran many years ago. It said: ‘If you don’t get help at Megahospital Inc, please, get help somewhere.’ Of course, the subtext was: ‘If you can’t afford help at Megahospital Inc., good luck.’ Capitalist that I am, I’m not opposed to private hospitals and their financial incentives. But it made me laugh. Psychiatric care in America has always been a scarce commodity, even when state and county facilities could bear some of the burden. Fast forward to our current economic situation, and ‘get help somewhere,’ now means hospital emergency rooms. Our hospital, and... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3915013 Mon, 30 Aug 2010 14:56:17 +0100 3915013 http://www.medworm.com/index.php?rid=3907612&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1254 Last night I was an emergency medicine physician.  Last night, I responded to a Code Blue in the intensive care unit of our hospital and intubated a patient.  Last night, I cared for a confused elderly patient with profound heat-stroke.  I sedated a child and opened a large abscess in her leg.  I diagnosed and transferred a patient with an aortic dissection.  (In which the wall of the aorta fills with blood and tears down its length.) I closed some lacerations and reassured some parents.  I did what I was trained to do. I did not:  refill a lost prescription for Percocet, Xanax or Klonopin (popular drugs of abuse).  I did not argue with anyone who wanted long term disability for an insect bite.  I did not have to pretend I was a  psychiatrist.  I did not have to deal with questi... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3907612 Thu, 26 Aug 2010 14:23:29 +0100 3907612 http://www.medworm.com/index.php?rid=3899403&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1250 Last week a trailer less than a mile from our house experienced a small explosion.  Trailers, which seldom explode on their own (without undiscovered volcanoes or CIA drones with missiles) was concealing a Meth lab. What can you say?  If I weren’t an emergency physician, I’d say ‘Shocking!  Ghastly!  Unbelievable!’  But I do what I do, so I say, ‘huh, how about that.” I’ve lost much of my capacity to be shocked.  I have seen Meth users, and probably Meth dealers.  I’ve known and enjoyed the company of alcoholics and Valium addicts.  I’ve cared for murderers and the murdered (albeit briefly in the case of the latter).  I’ve been involved in the evaluation of sexual assault victims, car thieves, drunk drivers and child-abus... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3899403 Wed, 25 Aug 2010 03:40:40 +0100 3899403 http://www.medworm.com/index.php?rid=3876716&cid=t_132549_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F08%2F17%2Fbest-of-our-blogs-august-17-2010%2F I was touched by a Facebook fan’s message today. Mostly because a seemingly benign update affected her in such a way that it in turn had an impact on me. It made me appreciate all the different stages of life that we’re in. Some of you are going through heartbreak while others are celebrating personal victories. I hope that we can all meet somewhere in the middle and provide support, empathy and compassion for one another no matter what stage we’re in. I don’t know about you, but it’s a reminder to not just be compassionate to others, but to myself. When push comes to shove, we often neglect the most important person-ourselves. We forget how much we’ve gone through and how far we’ve come. Grieving over our loved ones, dealing with a broken heart, f... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3876716 Tue, 17 Aug 2010 14:47:55 +0100 3876716 http://www.medworm.com/index.php?rid=3858164&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1242 This is the text of what I said at the funeral of my partner, Howard Leslie, who was buried yesterday.  The world is less, and heaven is so much the better for his departure. It is my honor to speak a little humor into this very sad day.  Considering the situation, it’s a tough crowd!  You are all broken-hearted.  You are all so hurt by our loss.  Howard would want you to do one thing for him right now: He would want you to lighten up, and turn and thump the head of someone sitting next to you!  This is a Christian funeral, people! This is not a goodbye, but a bon voyage!  This is not an end, but a ’see ya later!’ What would that big goofball want me to say? First, he’d want to know if there was coffee here. Not the kind that has been brewing in the same pot for ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3858164 Wed, 11 Aug 2010 16:14:21 +0100 3858164 http://www.medworm.com/index.php?rid=3845110&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1239 Last night, my friend died. Dr.  Howard Leslie was 49-years-old and lost a long battle with melanoma.  We had been partners in practice for 17 years.  It’s hard for me to imagine that he will not be back in the ER, joking and laughing, eating pretzels, practicing medicine with talent and compassion and fuming at injustice, drug seekers and all who wasted his time without actually wanting his help. A practice is like that; it leaves us connected, feeling that all is well as long as the others can share the load with you.  Well, a proper practice, anyway.  It’s a family, in which good things and bad things occur.  Your brothers and sisters sometimes bug you and you bug them; but you see them for the amazing people they are.  And woe to anyone who messes with ‘the fir... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3845110 Sun, 08 Aug 2010 21:47:24 +0100 3845110 http://www.medworm.com/index.php?rid=3827078&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1237 Here’s my column in the August edition of EM News.  A person who seems powerless may hold hostage an entire emergency room! http://journals.lww.com/em-news/Fulltext/2010/08000/Second_Opinion__Magic_Words___I_Have_Chest_Pain_.6.aspx Propped in her bed, frail and weak, the little grandma sighed. Her complaints were legion: weakness, poor appetite, poor sleep, joint pain, cough, dry mouth. Her daughter, eyes rolling, was trying to balance three reasonable emotions. She desperately wanted to go home and rest after spending the day in the ER. She truly wanted to avoid her mother’s admission to the hospital, and she was, graciously, sympathetic to the physician who brought the bad news. ‘Mrs. Adkins, I know you feel poorly, and I’m sorry. But I have to say, I can&#8217... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3827078 Fri, 06 Aug 2010 03:27:13 +0100 3827078 http://www.medworm.com/index.php?rid=3816415&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1235 This is my column in today’s Atlanta Journal Constitution. http://www.ajc.com/opinion/er-care-now-is-583584.html Secretary of Labor Hilda Solis recently produced an interesting public service announcement. In it, she stated that every worker deserves to be paid fairly for his or her labor (whether the worker is documented or not), and offered both a website and telephone hot-line which workers could use to report unfair payment by employers. (Incidentally, here’s the link: www.dol.gov/wecanhelp.) In the video, she stated succinctly, ‘You work hard, and you deserve to be paid fairly.’ Those of us who practice medicine agree completely. So we might reasonably ask if this announcement also applies to physicians who are under-compensated for their work. This routinely... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3816415 Tue, 03 Aug 2010 12:04:42 +0100 3816415 http://www.medworm.com/index.php?rid=3812983&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1231 Emergency rooms are overwhelmed, in South Carolina and around the nation, with mental health emergencies.  It seems that every day I’m asking someone about their suicidal thoughts, exploring their mental health history, trying to discern if their behavior is due to drugs, alcohol, underlying mental illness or simple acting out. I can’t remember the last shift when our emergency department wasn’t 1) holding a psychiatric commitment or 2) watching the ambulance roll up with  yet another person thinking of suicide or acting on their thoughts. Like many facilities, like many communities, we don’t have a psychiatrist. And thanks to budget cuts, we don’t even have much access to counselors.  Consequently (and also like many hospitals) we find ourselves boarding t... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3812983 Tue, 03 Aug 2010 03:08:22 +0100 3812983 http://www.medworm.com/index.php?rid=3802393&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1225 I would love to buy a camper.  You know, the pop-up kind that you pull behind when you travel, and that keeps you and the kids from sleeping on the wet, rocky ground!  If only I had camper insurance, then a bunch of other folks who had kicked in could help fund my purchase of the camper. I have always wanted a mule.  My great grandfather raised mules.  But I never purchased any mule insurance!  Dang it. And wouldn’t it be wonderful to send my children abroad to school! They would really benefit.  But I didn’t purchase the ‘college education’ insurance.  I guess they’ll be going locally. My wife and I have four children.  Feeding them can be expensive.  Why didn’t I get the ‘feeding my family insurance?’ That way, when others weren&#8... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3802393 Thu, 29 Jul 2010 15:47:23 +0100 3802393 http://www.medworm.com/index.php?rid=3790712&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1216 Here’s my column in yesterday’s Greenville News; online access requires a subscription. Repentance My last column was about the BP oil spill in the Gulf of Mexico. If you didn’t read it, I mentioned the various ways we could have prevented the problem over the years, and the way that individuals can’t just blame governement or oil companies, but must share some of the responsibility for it, since we all use petroleum. Unfortunately, I made a mistake. I alleged that the main reason oil platforms were in deep water was so that coastal views wouldn’t be affected. Turns out, while aesthetics have been discussed, the largest reserves seem to be in deeper water. I’m sorry to have taken such a position for doctrinaire reasons, rather than on fact. I am forced... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3790712 Mon, 26 Jul 2010 19:41:24 +0100 3790712 http://www.medworm.com/index.php?rid=3784265&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1212 I am dumbfounded by the endless line of pilgrims on their way to the holy shrine of disability.  They come to me, relatively well-appearing, and express their intense frustration that their Medicare, Medicaid or Disability have not kicked in, have expired, or have not done enough to ease their sorrowful way in this dark, hard world.  Most of the ones I see are not paralyzed, not broken, not brain-injured or bed-ridden.  They look remarkably like…my partners and me!  But somehow, their back pain, their anxiety, their depression all seem to render them entirely unable to work at all.  Except under the table, that is. I am flabbergasted by the young men and women who are angry that they can’t get Medicaid.  I am surprised by the well-to-do elderly who are bitter that Medicar... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3784265 Fri, 23 Jul 2010 16:41:29 +0100 3784265 http://www.medworm.com/index.php?rid=3761435&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1210 Today I had a university student shadowing in the emergency department.  AF is a bright student, a hard worker who will make a wonderful physician.  She is always curious and insightful when I ask her questions, or show her new things.  Today,  she saw something that was new for her, but perhaps too common for me. I walked into the room of an infirm, frail old gentleman who was gracious and polite, as were his family.  It turns out he came to us with a terminal illness.  I did not know it, but his physician was meeting him.  So, as AF and I walked into the room, the patient’s physician walked in after us, and continued a conversation about hospice that he had apparently begun earlier in the day. Realizing I had nothing to add, and would not be needed, I slipped away with my sh... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3761435 Sat, 17 Jul 2010 02:43:09 +0100 3761435 http://www.medworm.com/index.php?rid=3750067&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1208 I’m now the proud owner of a smart-phone; an Android, to be exact.  How it happened is still a little mysterious to me.  But the saga began when my beloved, antiquated flip phone took a bath in the Atlantic thanks to tiny rogue wave; and the fact that I set the beach bag too close to the incoming tide. After a fair amount of wrangling with Verizon to get an early upgrade, I went a fairly happy month with no phone at all.  Remarkably, my world did not collapse.  The fabric of the universe remained intact.  I did not have to answer phone calls or the rare text from my textellent wife and oldest son. Eventually, I went back to the Verizon store ‘when the time was accomplished.’  Turns out that it would have cost me a bunch of money out the door for any phone; and about... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3750067 Tue, 13 Jul 2010 16:46:27 +0100 3750067 http://www.medworm.com/index.php?rid=3718407&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1198 Here’s the latest battle-cry of the psychiatric patient.  After coming by EMS, or with law-enforcement, after punching out walls and windows, then taking a ‘handful of pills,’ which are actually missing from the recently filled bottle of Oxycontin or Ativan, or after cutting their wrists deeply while screaming, ‘I want to die,’  after holding a gun to their head or intentionally wrecking their car, they state, ‘I didn’t mean it…I was just upset!’ No one seems to understand that words and actions, like ideas, have consequences.  So, in the midst of personal turmoil, in the throes of addiction or the aftermath of relationship disasters, many patients talk about suicide and act out their plan up to a point. I understand that these are o... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3718407 Thu, 01 Jul 2010 21:20:14 +0100 3718407 http://www.medworm.com/index.php?rid=3702940&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1192 Some of my favorite rants and tirades in emergency medicine have to do with things my patients do that are just stupid.  Years ago, I saw someone who was playing with a rattlesnake and suffered a life-altering bite.  Recently, I saw someone whose friend offered to help him with the pain of an injured hand…by injecting cocaine into it.  Once I saw a young man with part of his forearm missing…because he was ‘making firecrackers,’ aka pipe-bombs.  And of course, there was the fellow feeding his dog bacon from his own lips. I was thinking about this the other day, and feeling superior.  I mean, look at me!  I’m a doctor who uses good judgment!  I think ahead, I plan, I never, ever do anything stupid…or do I? I can just imagine Jesus bending over the g... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3702940 Mon, 28 Jun 2010 04:20:30 +0100 3702940 http://www.medworm.com/index.php?rid=3687107&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1183 As anyone in hospital medicine knows, the EMTALA law (Emergency Medical Treatment and Active Labor Act) is an enormous unfunded mandate for emergency physicians, hospitals and anyone who takes call in a hospital which receives Medicare funds.  Basically, to review, the law has been in place since the eighties, and it says that no one can be asked for payment as a requirement for emergency care.  They can be billed later, but not compelled to pay. It was initially a good idea, designed to protect the poor.  Except for one teensy, weensy problem.  The government put this burden in our laps without providing any funds to pay for the ‘free care’ they so graciously granted America.  Nevertheless, physicians and hospitals who treat non-paying patients are not in any way protecte... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3687107 Tue, 22 Jun 2010 22:03:30 +0100 3687107 http://www.medworm.com/index.php?rid=3687363&cid=t_132549_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Fspouses-of-alcoholics%2F Alcoholic Partner’s Criticism Linked to Relapse – ‘But not All’ A new study published in Behavior Therapy apparently confirms that Ala-anon’s purpose of offering "understanding and encouragement" to those with drinking problems is best approach family members can take in dealing with the situation. The study, conducted by William Fals-Stewart of the State University of New York at Buffalo, found that men recovering from substance abuse are less successful if they believe their spouse or partner is critical of them, rather than supportive. The study found that of 106 married men studied, those who reported greater criticism from their partners were more likely to have relapsed, regardless of the severity of their drug problem, age or race. Al-Anon is a support group... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3687363 Tue, 22 Jun 2010 16:55:00 +0100 3687363 http://www.medworm.com/index.php?rid=3683627&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1181 Every day in the emergency department I am confronted by pain.  In fact, the treatment of pain is one of the most important skills emergency physicians, indeed all physicians, possess.  For instance, I recently cared for a child with sickle cell disease who was having a pain crisis which involved severe leg pain.  His life is one of frequent, intense pain.  I gently, and repeatedly, treated his pain with morphine until he had relief.  I see hip fractures; all broken bones hurt.  I am thrilled to alleviate that discomfort.  Pain is one of the things I can fix, if only temporarily.  It makes me happy to see the relaxed face of a man or woman with a kidney stone or migraine, who suddenly smiles and says ‘thanks!’ But pain is also the source of so much subterfuge.  Emergen... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3683627 Mon, 21 Jun 2010 16:22:26 +0100 3683627 http://www.medworm.com/index.php?rid=3665980&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1173 This is my column today at KevinMD.  I hope you find it relevant.  It’s shorter than the average medical chart, which is a plus! http://www.kevinmd.com/blog/2010/06/medical-chart-improve-patient-care.html (Source: edwinleap.com) edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3665980 Wed, 16 Jun 2010 03:04:10 +0100 3665980 http://www.medworm.com/index.php?rid=3658960&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1157 http://latimesblogs.latimes.com/booster_shots/2010/04/medication-errors-nurses.html In a recently published study on nursing performance and interruption, it was suggested that interruptions make it difficult for nurses to properly administer medications.  Self-evident truth raises it’s head in the guise of science once again!  Who knew that interruptions make it hard to do our jobs?  Well, everyone. Any practicing physician could have told you that; without a research budget.  Dictating?  Interrupted to sign a prescription.  Talking to a patient?  Interrupted to take a phone call.  Talking on the phone?  Interrupted by a patient with a question who walks past everyone to go to the doctor discussing a transfer.  Thinking about a complex, critically ill patient at the bedsid... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3658960 Mon, 14 Jun 2010 14:56:09 +0100 3658960 http://www.medworm.com/index.php?rid=3641030&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1159 Once every room is full, once the hallways are stocked with beds on which patients lie like so many cords of wood, once EMS continues to bring fresh faces, fresh injuries, fresh drama, the ER grinds to a painful, screeching halt. At that point, a helplessness descends on the nursing and physician staff.   Wait times creep from two hours to four, four hours to eight, eight hours to ten.  Only those who are obviously the sickest come back for care.  Remarkably, on some of the busiest shifts ever, I discover that I have seen the fewest patients.  If the pace were like normal, I could burn through ER visits like crazy; so could my partners.  But when the numbers waiting climb, when the patients being admitted and held grow to legions, then speed is dead. These are the dangerous times.  ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3641030 Tue, 08 Jun 2010 00:52:15 +0100 3641030 http://www.medworm.com/index.php?rid=3629648&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1150 (and medicine as a whole).  My column in May’s Emergency Medicine News.  The text follows the link. http://journals.lww.com/em-news/Fulltext/2010/06000/Second_Opinion__Homeschooling_Lessons_for.10.aspx I just finished looking over the ABEM Requirements for Assessment of Practice Performance. My mind reels as I consider how many meetings were required to come up with the practice performance requirements put forth by our esteemed Board. Looking over the explanations and descriptions of required activities, allowed activities, schedules, oversight processes and all the rest, my mind returned to the convention I just attended with my wife and children. It was no medical meeting; rather, it was a convention in Cincinnati for home-schoolers. We home-school our four children (ages 15, ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3629648 Fri, 04 Jun 2010 02:14:21 +0100 3629648 http://www.medworm.com/index.php?rid=3607508&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1144 Here on this balcony, in Hilton Head, South Carolina, the wind is cool, the air typically thick with humidity and my wife is reading a novel by my side.  Inside the rental, our children are winding down after days of sun, sand and sea.  Their bodies scrubbed pink by salt water and ocean breezes, their faces glowing with sun; my daughter’s lovely blond hair more blond than usual. I am on leave, in a sense.  I am not, however, in the armed forces.  Furthermore, I am not at a conference or working at all (except for a little writing, which is as much breath as work).  I am, in fact, celebrating my 20th wedding anniversary on a trip suggested and planned by my love.  I have accomplished little that the world would view as substantial this week.  I viewed it as a kind of sabbath. ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3607508 Thu, 27 May 2010 23:18:39 +0100 3607508 http://www.medworm.com/index.php?rid=3599431&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1142 To those of you who haven’t heard, an icon of emergency medicine has passed away.  Carol Rivers, MD, died last week following a cardiac procedure.  Carol was an outstanding clinician and educator, and one of the founders of modern emergency medicine as we today are fortunate to know it.  Carol was perhaps best known for her board-preparation guides, which helped many a terrified physician to navigate her or his emergency medicine board exams.  I know her expertise helped me when I took my first ABEM exam. A few years ago, I was blessed with the opportunity to work with Carol on an audio CD called ‘Let’s Talk Turkey,’ in which she and I sat down and recorded two CD’s of discussion about the state of the specialty.  It was a fantastic experience, one that ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3599431 Wed, 26 May 2010 14:02:07 +0100 3599431 http://www.medworm.com/index.php?rid=3569816&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1125 Do you ever leave the hospital wondering if you have the strength to go back?  Do you ever have patients like the ones I call ’soul-suckers?’  These folks are black-holes of need.  Some of them are genuinely sick, but their need (and neediness) is immense.  After you finish the entire chest-pain evaluation, and are ready to send them off to see their family doctor, they look up with tired, pitiful eyes and say ‘what about all the blood in my vomit?’  ‘What about the way I pass out after my headaches?’  Or it may be, ‘by the way, I can’t see my doctor anymore and I don’t have any way home and I haven’t eaten in three days.  Can’t you admit me?’  This usually occurs as you’re about to leave work to see your... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3569816 Mon, 17 May 2010 02:30:08 +0100 3569816 http://www.medworm.com/index.php?rid=3552251&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1117 Is there anything more wonderful than date-night with the one you love?  Jan and I went out last night.  It was a cold, rainy May evening, and we drove down the dark highway in my truck.  The bench seat is wonderful, because she can sit right next to me, where she has been for nearly 26 years now. We were in jackets, and asked to sit next to the fire at the Copper River Restaurant.  Exhausted from a crazy weekend, we exhaled and ordered chips and cheese-dip, then dined on soup.  When we finished, we sat a while longer, our drinks refilled by our attentive waiter.  And we reflected, planned, laughed and told stories.  We discussed the year past and the year to come.  We basked in one another as we basked in the warmth. If you do not take date-nights, you are making a mistake.  Marr... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3552251 Tue, 11 May 2010 15:31:33 +0100 3552251 http://www.medworm.com/index.php?rid=3546853&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1115 As we try to apply various economic and social formulas to the cost of medical care, we inevitably come down to the public perception that much of the expense lies in doctor’s fees.  Although that’ really only a small part of the equation, it’s the doctor everyone sees.  Patients rarely meet pharmaceutical executives, insurance company board members, their representatives in Washington or (most elusive of all creatures) those who create the rules and policies for government programs like Medicare and Medicaid, and in so doing set the tone for the nation in terms of the cost of health-care. As I signed off my verbal orders last night, and signed forms for this and forms for that, it occurred to me that one of the reasons physicians are paid more than some other professio... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3546853 Sat, 08 May 2010 16:53:41 +0100 3546853 http://www.medworm.com/index.php?rid=3538102&cid=t_132549_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1109 Why you should keep going back to the emergency department http://journals.lww.com/em-news/Fulltext/2010/05000/Second_Opinion__Why_You_Should_Keep_Going_Back_to.7.aspx There is discontent in the house of medicine. So many physicians struggle. They seem to wade through uncertainty every day; uncertain about diagnoses, about pain, about disposition. We find ourselves uncertain about our jobs, our futures, our finances. The consultants we call are uncertain about their practices; whether they can remain viable in the coming years as medicine evolves into something we yet may find unrecognizable. Some days, as I enter my 17th year of practice, I don’t know if I can bear to walk around our little department for ten or twenty more years, like some gerbil on an exercise wheel. I am uncertai... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3538102 Thu, 06 May 2010 14:32:50 +0100 3538102 http://www.medworm.com/index.php?rid=3524432&cid=t_132549_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2010%2F05%2Ftired-of-singing-sad-songs.html Rosy's ballet slipper sparkling in the sun.The pavement is soaking wet, the snow hasn’t fallen yetI whisper your name and I can see my breathI’m tired of singing sad songsThe world’s fallen fast asleep and I’m walking down the streetI whisper your name without the heavinessAnd I’m tired of singing sad songsWhen the flowers bloom darling we will too After a hard cold winterAnd the birds fly home with a lighter load They’re singing a hymn of summerThe willow has lost her leaves naked she does not weepShe whispers “it’s finally time to breathe”And she’s tired of singing sad songsAll I have are memories and really that’s fine with meI whisper your name, smile and believeThat it’s time to sing a new songI found words of encouragement from my new discovery, Sara Beth G... Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=3524432 Sat, 01 May 2010 17:36:00 +0100 3524432 http://www.medworm.com/index.php?rid=3383043&cid=t_132549_136_f&fid=39016&url=http%3A%2F%2Fturquoisegates.blogspot.com%2F2010%2F03%2Femptiness-unplanned.html We cried, “How long, O Lord, how long will we be made to wait, and swallow jagged shards of that unchristened chalice of whose warm wine we never took a taste and all we drank was emptiness unplanned?”And he replied, “Until you learn the song that only sorrow sings, of how my soul regards your ev’ry wound, and malice has no place in my design, but all is paced to come with double blessings in my hand.”A man who writes poetry and proclaims God, priceless indeed. Praying that someday - someday soon - I will see Him come with double blessings in hand. Thanks to John Piper for encouraging me to dream today. (Source: Turquoise Gates) Turquoise Gates blogs http://www.medworm.com/rss/comments.php?id=3383043 Fri, 19 Mar 2010 06:31:00 +0100 3383043 http://www.medworm.com/index.php?rid=3276093&cid=t_132549_151_f&fid=35818&url=http%3A%2F%2Frecoveryissexy.com%2Fpartners-of-alcoholics%2F Partner’s Criticism Linked to Alcoholic Relapse A new study published in Behavior Therapy apparently confirms that Al-Anon’s purpose of offering “understanding and encouragement” to those with drinking problems is best approach family members can take in dealing with the situation. The study, conducted by William Fals-Stewart of the State University of New York at Buffalo, found that men recovering from substance abuse are less successful if they believe their spouse or partner is critical of them, rather than supportive. The study found that of 106 married men studied, those who reported greater criticism from their partners were more likely to have relapsed, regardless of the severity of their drug problem, age or race. Al-Anon is a support groups for those who are affect... Recovery Is Sexy.com blogs http://www.medworm.com/rss/comments.php?id=3276093 Mon, 15 Feb 2010 01:42:00 +0100 3276093 http://www.medworm.com/index.php?rid=3092739&cid=t_132549_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F12%2F15%2Fpsych-central-mindapps-offer-ecbt-iphone-app%2F A few months ago, MindApps released an iPhone application called “eCBT Mood.” It allows a user to apply tried and true cognitive-behavioral techniques in their everyday life, and track their progress with those techniques over time with a simple graph. I liked it because it explained CBT stuff in a direct, easy-to-understand manner, and most importantly, was “actionable.” It walks you through specific steps of an automatic thought, for instance, and gives you encouragement to try and change it as it’s happening. The application’s core is an “eCBT toolbox” that allows you to learn more about your thoughts and feelings, identify your automatic thoughts, keep a feeling and thoughts log, challenge automatic thoughts, and identify and challenge co... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3092739 Tue, 15 Dec 2009 18:36:00 +0100 3092739 http://www.medworm.com/index.php?rid=2724828&cid=t_132549_87_f&fid=34935&url=http%3A%2F%2Fmedicine.com.my%2Fwp%2F%3Fp%3D7733 I came across a video of Nick Vujicic in Facebook. It’s a truly amazing story of how one man grew up with so much disability and hardship yet found the motivation and courage to be such an inspiration to others. Links: The Official Nick Vujicic Website DailyMail: Life without limb-its: The astonishing story of the man born without arms or legs from the Malaysian Medical Resources Life without limbs: the inspiring story of Nick Vujicic (Source: Malaysian Medical Resources) Malaysian Medical Resources blogs http://www.medworm.com/rss/comments.php?id=2724828 Fri, 21 Aug 2009 23:00:00 +0100 2724828 http://www.medworm.com/index.php?rid=1693619&cid=t_132549_127_f&fid=34828&url=http%3A%2F%2Fdrclouthier.blogspot.com%2F2008%2F08%2Fnever-give-up.html I am a sucker for athletics, Olympics and the triumph of the human spirit. This is not a promo for visa but a post to encourage anyone who reads it. No matter what your life challenge right now is sport is always a metaphor. Watch the short commercial and see how it applies to what you may be dealing with in your life. Whether it be a difficult health trial or some other challenge in your life, the goal is to finish the challenge with your head held high knowing you have done your best. Enjoy (Source: Dr. Steve Clouthier) Dr. Steve Clouthier blogs http://www.medworm.com/rss/comments.php?id=1693619 Sat, 09 Aug 2008 19:27:00 +0100 1693619 http://www.medworm.com/index.php?rid=1501272&cid=t_132549_127_f&fid=34828&url=http%3A%2F%2Fdrclouthier.blogspot.com%2F2008%2F06%2Fnever-quitting-on-anything.html I know this is not quite health related and I have not posted in a while but this really caught my attention. I am not even a J.K. Rowling fan although I am reading the Harry Potter series as a bedtime story these days. I just thought her two points in this link about failure and imagination would be beneficial to anyone whether going through a health challenge or a severe life trial of some other sort. I hope you will find this encouraging and inspirational as I did. (Source: Dr. Steve Clouthier) Dr. Steve Clouthier blogs http://www.medworm.com/rss/comments.php?id=1501272 Sun, 08 Jun 2008 15:06:00 +0100 1501272 http://www.medworm.com/index.php?rid=1017794&cid=t_132549_109_f&fid=35677&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FBrainBasedBusiness%2F%7E3%2F182233460%2F10_steps_to_serotonin_support.html You've likely heard that encouragement spikes  serotonin chemicals in your brain. But have you found and unleashed that jolt of adrenalin support … when you most need it? Lunckily, some people seem to pack serotonin to spare. Have you seen it?Check out leaders boosting business support out there today … and you’ll likely find somebody who’s got your back too: 1. BurstBlog encourages you to shrink those wordy blogs - to prevent the extra work a brain needs to do … since computer screen refreshes 72 times per second.2. Don’t Mess with Taxes tossed out the idea of staying thankful as a way of revitalizing a difficult day. Check out the moving story of a wounded friend’s support.3. WorkinProperty buoys up aesthetic jewel... BrainBasedBusiness blogs http://www.medworm.com/rss/comments.php?id=1017794 Fri, 09 Nov 2007 15:16:18 +0100 1017794 http://www.medworm.com/index.php?rid=740589&cid=t_132549_109_f&fid=35677&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FBrainBasedBusiness%2F%7E3%2F134747014%2Fcritique.html Since the flip side of critique is to celebrate, it only makes sense to cheer on what works and fix the rest. Do we though? Think about polar opposite effects of these two reactions though …  where one person suggests alternatives that would improve productivity, and another attacks flaws in fellow workers. Research shows people leave jobs most often because critique is too high and celebration too low. Support offers blueprints for improvements, whereas critiques tend to drag down and obliterate any hope for change. People do better when co-workers offer ideas and submit insights – and yet critiques push people into downsizing and desperation. Have you noticed low morale lately or listened to words spoken at mainstream departments? People seem down an... BrainBasedBusiness blogs http://www.medworm.com/rss/comments.php?id=740589 Wed, 18 Jul 2007 01:29:58 +0100 740589