Feb

17

Circus of Chief Complaints (Your Tax Dollars at Work): Part 2

February 17, 2008 | 28 Comments

(In reponse to some nervous emails, yes, every patient mentioned had a complete history, review of systems, and physical exam. I’m just distilling the salient elements of the conversation. Okay? -PB)
Actual Patient Interaction Number Six:
“So Mr. Smith, what brings you to the Emergency Department, a place where we handle medical emergencies, at […]

Feb

12

Circus of Chief Complaints (Your Tax Dollars at Work): Part 1

February 12, 2008 | 32 Comments

Actual Patient Interaction Number One:
“So Mrs. Smith, how’s your pain?”
“Oh doctor, it be paining me real bad. Can I get some Dilaudid.”
“How about we start with some Nubain?”
“What’s that?”
“It’s a synthetic narcotic, kind of like Demerol.”
“Is it any good?”
“Sure, it works great and doesn’t give people the rush they get from other narcotics.”
“Oh, I’m […]

Feb

8

The Non-Crisis in America’s Emergency Departments: The Death of Triage

February 8, 2008 | 18 Comments

Staying Power
I suppose the only good thing about my patient’s twelve-hour wait in the Emergency Department waiting room before he even made it into a room, and his subsequent two-hour wait before he finally saw me, was that the results of the basic lab work ordered in triage where immediately available and, as his chest […]

Feb

1

A Real Question From A Real Reader: Panda, Can I Hack It?

February 1, 2008 | 21 Comments

(Another real question from a real reader, really sent to my real email address. -PB)
Ian writes: “You’ve described what Emergency Medicine is like but what would you say are the ideal qualities of Emergency Medicine doctors? (I seem to handle stress and emotions very well and can easily remain calm in pressing moments)”
Let me back […]

Jan

29

Chicken Soup For the Emergency Medicine Resident’s Soul: Inspiring Stories From the Emergency Room

January 29, 2008 | 22 Comments

Field of Dreams
There is a lot of Medicaid money floating around out there, particulary in the pediatric population where a large portion of the patients are covered by the Children’s Health insurance Program (CHIP).  To legally acquire as much of this bonanza as possible, my hospital built a dedicated Pediatric Emergency Department which opened two […]

Jan

24

What I Do, Part Two

January 24, 2008 | 7 Comments

(This is an another article directed more to people who are interested in a medical career than to those already involved.  Feel free to read along but I again offer my usual warning that there is nothing profound or exciting to follow and I cannot be held responsible for your boredom. I’m going to try […]

Jan

11

What I Do

January 11, 2008 | 13 Comments

(With a hat-tip to the Happy Hospitalist.  Nothing new or profound here so my regular readers may, if they desire, ignores this article completely or read on and forgive the basic level of information presented. -PB) 
A young reader writes, “Dear Dr. Bear, I am a senior in high school and am thinking about being a doctor.  What does your job involve?”
I […]

Jan

2

My Shortest Post Ever in Which, After Letting On That We See a Lot of Minor Complaints in Emergency Medicine it is Explained by Another Writer What the Specialty of Emergency Medicine is All About

January 2, 2008 | 9 Comments

Read it and weep. 

Dec

18

Pandorama Randomorama

December 18, 2007 | 26 Comments

Sweet, Sweet Chronic Back Pain
An extremely busy shift last night. Not necessarily by volume (because I actually saw relatively few patients) but certainly by acuity. Almost everyone was legitimately sick and required real, honest-to-gosh admissions for bona fide medical complaints. And three of them were admitted to the ICU, two of them […]

Sep

28

Emergency Medicine Residency (Part 2: Event Horizon)

September 28, 2007 | 5 Comments

(Once again, a caveat: I am a resident in a medium-sized Emergency Medicine program in an academic setting. Not as academic as Duke or USC but we have most of the players. I have never worked in private practice in Emergency Medicine so while I welcome the comments of those who have, I […]

Sep

22

Emergency Medicine Residency (Part 1.75 A Parable About Trauma and Perception)

September 22, 2007 | 18 Comments

Perspective
Consider two separate rooms in the same Emergency Department. In one lies a young man who has been shot in the chest and arrived in full cardiac arrest with the paramedics frantically giving CPR. Red frothy bubbles come out of the gaping hole over his heart whenever the bag attached to his endotracheal tube […]

Sep

21

Emergency Medicine Residency (Part 1.5: Answering an Important Reader Question)

September 21, 2007 | 4 Comments

Whenever you get a major trauma, do you get your fair share of procedures (chest tubes, central lines, etc..) or do the surgical residents tend to take them?
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At our program, because it is a Level I trauma center, trauma surgery is in charge of most of the traumas. The EM residents manage the airway […]

Sep

20

Emergency Medicine Residency (Part 1)

September 20, 2007 | 10 Comments

(The following article is directed primarily at those contemplating matching into Emergency Medicine. Those of you who are not may read it but I make no apologies for targeting a particular group of readers. Emergency Medicine has become a very popular specialty lately so I’m sure there is some interest out there. Most of my […]

Jun

9

Ask Yer’ Uncle Panda….

June 9, 2007 | 35 Comments

Say Uncle Panda, I notice you haven’t written about chiropractors. What do you think about them and chiropractic in general?
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Chiropractors serve a useful role in society, particularly when it comes to taking some of the pressure off of used car salesmen who would otherwise have the market cornered on chicanery. Nobody likes to […]

May

31

What ED Crisis? (And Other Random Thoughts)

May 31, 2007 | 36 Comments

Shake that Money Maker
They say there is a crisis in the Emergency Rooms and while I certainly see a little of its effects at my own program, the crisis is not universal. Some Emergency Departments compete for patients, at least this is my understanding from the numerous billboards I saw the other day as I […]

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