What’s on your mind?

HPI: A 15 year old female with a history of ADHD and anxiety was brought into the emergency department by her parents with concern for a change in mental status. The patient had been seen at an outside facility the day prior to presentation for a separate diagnostic workup

She had complained of dizziness that day, and some subtle shaking of her left upper extremity.  Mom and patient were not initially concerned since the patient had been known to have shaking of her legs at baseline. After returning home from her appointment, the patient fell asleep on the couch and did not awaken for the remainder of the evening. On the morning of presentation, mom reports that she was still unable to awaken the patient. The patient was very weak and had difficulty bearing her own weight.  Her speech was noted to be slurred and largely unintelligible. read more

Surround Yourself with Artists.

3 year old Jimmy was excited when he saw his Daddy’s truck coming up the driveway.  The subtle bump as the giant 4×4 ran over Jimmy’s abdomen was almost missed, but Jimmy’s cry was heard by dad in the cab and mom in the house.  He was awake and alert, boarded and collared as our trauma team descended.  The large tire tread mark over his abdomen was the only obvious injury as we pounced upon him masked and gloved, with hands palpating, scissors tearing and IVs plunging.  As I peered down all forehead and nose to his view he looked back with terror.  Calmly, quietly I did my best to explain in terms a 3 year old would understand the action unfolding.  He was being incredibly brave as I assessed him.  As I tried to illicit any other injuries I asked, “Jimmy what hurts?”  He looked straight up into my eyes and responded, “Being run over by daddy’s truck.” read more

The Armchair ED.

armchair physician

It’s a busy day in the ED.  Thirty deep in the waiting room.  Patients are threatening to leave.  Staffing is short.  Your colleagues are dying for help and you are the one who gets the call to pitch in and lend a hand.  With a heavy sigh, you flop on the sofa, flip open your lap top, and start seeing patients.

Future fantasy?  It is not as farfetched as you might think.  Although the medical industry is often maligned as being a slow moving monolith resistant to adaptation, there are a slew of groups, both academic and commercial, looking into bringing telemedicine to the mainstream. read more

Teachable Moments to Prevent Medication Errors

When we consider education, in the medical arena, we often neglect to consider one of the most vital and important beneficiaries of the teaching endeavor: patients and their families. We have previously discussed this in past a Newsletter (We All Teach – February 2013).

Each patient encounter is filled with a multitude of “teachable moments.” Most of us are eager to take the opportunity to advocate of the use of helmets when we are evaluating the patient who fell while skateboarding and only suffered a forearm fracture. We are quick to express the importance of ensuring dangerous substances are adequately locked away from children while we consol the family who found their infant sitting in spilled bleach. Injury prevention comes naturally to many of us who see the consequences of those injuries, but let us not forget one area that we should all consider a teachable moment: medication administration. Medication Errors are a significant problem that a little preemptive education can help avoid. read more

Secretary’s Second Thoughts: “Good Job”

Good Job

Like many of us, I had a shift the other day that I was just happy to survive without causing any harm to anyone, including myself. At the end of the shift, I looked to my resident, who was able to weather the storm admirably, and I said, “Good job today!” I certainly meant what I said, but, upon second thought, was what I said useful? Was that “feedback” going to help reinforce the positive aspects of what my resident had done that shift? Was my resident able to pick up on the nuance in how I said “good job” to glean from it that the medical decision making was superior and that the patients all had been kept updated regularly? Was my resident able to extract from the “good job” phrase that, while the care of patients was fantastic, the flow could have been improved if the expected course of several patients had been anticipated earlier and more timely admissions made? I would like to think that all of that was conveyed and understood in my efficient and intuitive announcement of “good job.” Unfortunately, I know that it was not. I would also like to say that this is an aberration, and that I normally give well formatted feedback, but it is not. read more