Ebola: Is ‘Don’t Panic’ the Right Message?

Ebola:  Is 'Don't Panic' the Right Message?

If you do a search on Ebola on the net, there are tons of articles, blogs, and editorials from outlets like CNN and the LA Times to Al Jazeera and even scientific publications like Microbeworld, encouraging us all not to panic about the Ebola epidemic – but is ‘Don’t Panic’ the right message? I am certainly no expert on Ebola, and I do get the need for the government and health organizations to counter the … Continue reading

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Safe Pain Med Prescribing in the Emergency Department

Pain Med Prescriptions in the ED

Recently, the California Chapter of the American College of Emergency Physicians has endorsed and is promoting the efforts of Dr. Roneet Lev and in San Diego and Dr. Maureen McCullough in Los Angeles and others to implement Safe Pain Medication Prescribing policies and tools throughout California’s EDs. The model for this effort came out of Washington State ACEP’s response to a challenge to reduce the cost of Medicaid ED visits, and prior work done by … Continue reading

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Why Do Physicians Over-test and Over-treat?

Over-testing....why not?

What prompts physicians to over-test and over-treat patients?  This is a very big and important question, and I find it sometimes helps to make a list when I am trying to get my arms around this kind of multifactorial issue. This list isn’t an attempt to be complete or even statistically valid or evidence based, but it does reflect some of the thoughts and studies that have been published on this question. In no particular … Continue reading

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Inaction on ED Closures Kills 8,000 Californians in 12 Years

Impact of Hospital and ED closures

According to a study just published in Health Affairs by Liu, Srebotnjak and Hsia; inpatient mortality rates were 5% higher for patients who were admitted to hospitals in areas that were affected by the closure of nearby emergency departments. This means that of the 4 million patients who were admitted to impacted hospitals (some 25% of all inpatient admissions) from 1999 to 2010, about 8,000 died who would have otherwise survived their hospital stay. By … Continue reading

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Using, and Misusing, Consultants in the ED

Consultants in the ED

I must admit than over the course of my emergency medicine career, I have misused the services of a lot of consultants in the ED. Initially, this misuse was primarily due to my limited knowledge and experience (exacerbated by the fact that I did not do an EM residency). Much of what I learned in those first few years of practice was from the specialists I consulted, augmented by attending innumerable continuing education courses, many … Continue reading

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