Physician wellness: Avoid the midseason burn

Jonathan Eisenberg, MD

It’s winter. The waiting room has had to bring in extra chairs to handle the overflow, and you are likely working your way through your 3rd or 4th URI of the season. The new staffing model for extra help during the busy season worked the first day but has since devolved into an extra doc following up on respiratory panels from last week. People are wearing their emotions as the next patient with a cough/congestion chief complaint gets checked in.

Physician wellness and its counterpart, burnout, are two of the buzzwords that have captured the medical zeitgeist of the past decade. Although they may be a little overused, their importance cannot be overstated—especially in these overworked, sun setting at 2pm, cold days. It has become so important that there is now a physician wellness fellowship at Stanford. Multiple research papers and physician groups have identified the issues that seem to affect us all: EMRs, documentation, patient loads, insurance nightmares, emotional exhaustion, and depersonalization. Some ways to combat burnout and promote wellness are obvious but may not feasible—cutting patient loads, taking a walk during lunch, or outsourcing your more nominal daily activities. But we are emergency medicine physicians, we do not have a say in patient loads, and I feel lucky when I can eat a sandwich at my computer on wheels in between patients (don’t take away our food in the ED…). read more

Top Five 2019 Peds Published Articles

Noah Kondamudi, MD, MBA, FAAP, FACEP, CPE

The New Year of 2020 has commenced and with it will come new challenges, new opportunities and an abundance of new information. The sheer volume of new literature published and presented in 2019 will virtually make it impossible to keep up for most practicing PEM physicians. This is an attempt to wade through the published literature in order to identify the most impactful articles published in 2019. Compiled here are arguably the top five manuscripts that have potential impact on our day-to-day practice. Surely, there may be other articles that readers find to be more relevant and more impactful to the field, and these should be discussed on our list serve and the website. Here is the list: read more

Keeping Toys Safe is a Collaborative Year-Round Effort

From a simple idea to a product on store shelves, making toys safe for children to play with is a top priority by toymakers and considered during every stage of development and production. To ensure that toys are safe, the U.S. toy industry follows a mandatory set of safety requirements within ASTM F963 – Standard Consumer Safety Specification for Toy Safety, created under the auspices of ASTM International. The industry works year-round with pediatricians and other medical professionals, government, consumer groups, and child development experts in the continual review and revision of ASTM F963, which was most recently updated in 2017. read more

Is it time to rethink fasting times in the emergency department?

Chumpitazi, CE, Camp, EA, Bhamidipati, DR, et al. “Shortened Preprocedural Fasting in the Pediatric Emergency Department.” The American Journal of Emergency Medicine, vol. 36, no. 9, 2018, pp. 1577–1580.

Carmen D. Sulton, MD

The relationship between pre-procedural fasting times and aspiration and/or pulmonary complications are often a topic in anesthesia and sedation literature. In particular, fasting or nil per os (NPO) guidelines for urgent procedures outside of the operating room continue to be vague.  Prolonged fasting times can often be difficult for both emergency providers and families to manage. The American Society of Anesthesiologists (ASA) guidelines focus on 2 hours of fasting for clear liquids and up to 8 hours for full fatty meals. The American College of Emergency Physicians (ACEP) states that procedures in the emergency department (ED) setting should not be delayed based on fasting times alone. Many studies looking specifically at fasting times and adverse events often are under-powered, or may not focus specifically on patients in the ED setting.  read more