Learning is critical to developing and maintaining competence. Learning is slow at the beginning, accelerates rapidly as we gain skills and knowledge, and then slows again as we achieve competence and approach expertise. Rapid periods of expansion of ability and understanding alternate with stages of relative inertia. We may at times focus on routinization, the repetitive effort by which we standardize aspects of our practice, producing a steady practice state that is efficient and systematic. At other times, however, patients and systems demand a more dynamic approach to learning.
“I was able to tell him that I am naming my son after him,” she confessed. I found myself more emotional than anticipated by this stranger’s news. I met Sarah (name has been changed) a week prior to this phone call, because, as a doctor in the emergency department, I had treated her in our “COVID tent.” Like the majority of patients battling COVID-19, she was medically stable and safely discharged home to endure the path toward physical recovery.
There is widespread awareness of one component of today’s opioid crisis in America – the overuse of opioid medications. With overdose deaths reaching epidemic levels, some U.S. states have issued emergency declarations to bring legal authorities to bear for this unprecedented situation.
Volume 17, Issue 4, July 2016
Dr. Daniel Dworkis, MD, PhD, et al.
Patients do not start to exist when they arrive at the door of our emergency departments (ED), nor do they stop existing when they leave. Instead, before they fall ill or become injured they live and exist somewhere and when they are discharged from our care they will likely return to that same somewhere. As emergency providers (EPs), our attention must be focused on the patients in front of us, but fundamentally the details of this “somewhere” directly affect our ability to provide safe and effective emergency care. Specifically, both patient-specific factors like homelessness, immigration status, living situation, or insurance coverage, and structural factors arising from broader community and societal forces like food deserts, community violence, and poor housing quality can strongly impact both emergency presentations and our ability to safely and effectively discharge patients. Here, we argue that our duty as EPs extends beyond the four walls of our EDs into life in our communities, and that understanding and addressing the unique strengths and needs of the communities we serve is a crucial component of our ability to provide effective emergency care.
Volume 17, Issue 4, July 2016
Erik S. Anderson, MD, et al.
Dialogue and policy surrounding healthcare reform have drawn increasing interest to the social factors, accountable for nearly one-third of annual deaths in the United States, that affect the health of populations. The Affordable Care Act (ACA) includes provisions for health systems to address social determinants of health, but how this is to be accomplished remains uncertain. If we are to make progress as a health system in addressing social determinants of health, we must open a dialogue and practice that reaches patients at the front lines of the medical system and population health – including in the emergency department (ED). The fact that emergency physicians care for patients who are complicated both medically and socially is no surprise, but the idea that we have an important role to play in the social determinants of health of our patients is, while controversial, gaining increasing attention among emergency physicians across the country. This interest comes largely from necessity, as we face a daunting task of providing care to the large volume of vulnerable patients who seek refuge in our EDs.
Volume 17, Issue 1, January 2016.
Marian E. Betz, MD, MPH, et al.
December 2015 saw another Congressional budget
standoff and threatened government shutdown. This omnibus
bill was particularly important for public health, because – for
the first time in years – it contained language that would have
reversed a 19-year-old prohibition on Centers for Disease
Control and Prevention (CDC) funding for research on firearm
injury. Unfortunately, 2016’s final Omnibus Appropriations
bill did not reverse this prohibition. And so another year
begins with the United States – and the world – debating
how to solve the problem of firearm violence in this country,
without the benefit of objective public health research.
Volume 15, Issue 7, November 2014
Kristi L. Koenig, MD et al.
Ebola Virus Disease (EVD) has become a public health emergency of international concern. The World Health Organization and Centers for Disease Control and Prevention have developed guidance to educate and inform healthcare workers and travelers worldwide.
Volume 15, Issue 6, September 2014
Lori Ludeman, MD
Two months into my intern year I experienced something that I thought only happened on television. It was 3 a.m. on a relatively uneventful night shift. Being one of the newest residents working that evening I expected to get the less desirable cases, and this one felt no different. A new patient showed up on the grease board: a 22-year-old female with a chief complaint of constipation.
Measuring workplace performance is important to emergency department management. If an unreliable model is used, the results will be inaccurate. Use of inaccurate results to make decisions, such as how to distribute the incentive pay, will lead to rewarding the wrong people and will potentially demoralize top performers. This article demonstrates a statistical model to reliably measure the work accomplished, which can then be used as a performance measurement.
The continual devaluation of emergency medical services by insurance payers will result in inadequate distribution of resources to emergency care, resulting in further emergency department closures, increases in emergency department crowding, and the demise of acute care services provided to families and communities.
A 56-year-old homeless male presented to the emergency department with a bloody nose. When asked if he took medications, he replied in the affirmative. When asked which medications he took on a regular basis he produced the following photograph
Child abuse experts use diagnostic findings of subdural hematoma and retinal hemorrhages as near-pathognomonic findings to diagnose shaken baby syndrome. This article reviews the origin of this link and casts serious doubt on the specificity of the pathophysiologic connection.
As recent events highlight, a global requirement exists for evidence-based training in the emerging field of Disaster Medicine. The following is an example of an International Disaster Medical Sciences Fellowship created to fill this need. We provide here a program description, including educational goals and objectives and a model core curriculum based on current evidence-based literature. In addition, we describe the administrative process to establish the fellowship. Information about this innovative educational program is valuable to international Disaster Medicine scholars, as well as U.S. institutions seeking to establish formal training in Disaster Medical Sciences.
Author Affiliation Peter J. Bloomfied, MD, MPH Olive View-UCLA Medical Center, Department of Emergency Medicine, Sylmar, CA; Brotman Medical Center, Department of Emergency Medicine, Culver City, CA Adam B. Landman, MD, MS, MIS Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, Department of Emergency Medicine, New Haven, CT; US Department […]
Author Affiliation William K. Mallon, MD Immediate Past-President, California Chapter of the American College of Emergency Physicians Stuart P. Swadron, MD Immediate Past-President, California Chapter of the American Academy of Emergency Medicine When you look at the Western Journal of Emergency Medicine’s (WestJEM) cover and masthead this month you will see something new: two logos […]
Internal medicine physicians were once known as the “physician’s physician.” These clinicians were consultants or specialists to the general practitioners of society.
Frequent users of the emergency department (ED), recently defined as having four or more visits per year, are a diverse group of patients that provide a challenge to emergency physicians (EPs).
