Archives for October 18, 2006

Medpage Today covers ACEP meeting

CME and CE from MedPage TodayAnd covers it welll!

My favorite of these?  No reason to continue banning cell phones in hospitals. 

ER docs: Problem is admitted "boarders." Leavitt: That’s local.

Looks like I missed it by skipping the ACEP Fall meeting:

NEW ORLEANS – U.S. Health Secretary Michael Leavitt and emergency room doctors disagree about why the nation’s emergency rooms are overcrowded.

Many ER doctors say inpatient overcrowding – patients admitted after emergency treatment but parked in their department until rooms open up – is the major cause, and a national priority.

But Leavitt, who spoke at the American College of Emergency Physicians meeting Monday, said he believes the overcrowding is, rather, a matter of local hospital capacity and patients using the ER instead of a doctor’s office. “Emergency rooms ought to be kept for emergencies,” he said.

Inpatient overcrowding, he said, is a problem to be dealt with at the local level.

But doctors say the problem is that ER patients can’t be sent elsewhere in hospitals, causing an ER stackup that leads to inefficiencies and delays in treatment.

But Leavitt said the problem appeared spotty. “There are areas of the country with insufficient capacity. But in some areas they’re overbuilt,” Leavitt said.

This position met with disagreement:

Dr. Ramon W. Johnson, a ACEP board member from Mission Viejo, Calif., said Leavitt “dodged the question. He tried to make it seem a local issue. It clearly is a national problem.”

Dr. Todd B. Taylor, ACEP’s equivalent of speaker of the House, added, “Anybody who believes that inpatient crowding is not the problem with emergency departments just is not looking at the information.”

All emphasis added.

Yes, ER’s should be kept for emergencies.  This has been flogged to death here, but: as long as the individual patient decides what’s an emergency and what isn’t (until the end of an apparently undefinable Medical Screening Examination), the ED’s will be crammed to capacity.  More primary care offices (9-4:15 M-F, 1/2 day W or Th) aren’t going to do a heck of a lot to empty the ED.


Oh, and I want the data on those ‘overbuilt’ areas.

I Have a Work Persona?

My wife came to work recently, and observed me ‘at work’.  We had a nice, brief conversation, and I went back to medicine in the ER.

That night, we had the following enlightening exchange:

Wife: “When I saw you first, you were on the telephone; I listened, and you were pissed.  Then, when we talked you were your normal self, and then when you turned around you were pissed again.”
Me: ?really?
Wife: “Yes, it was remarkable.”

Persona, per the Encyclopedia Britannica:

 in psychology, the personality that an individual projects to others, as differentiated from the authentic self. The term, coined by Swiss psychiatrist Carl Jung, is derived from the Latin persona, referring to the masks worn by Etruscan mimes.

For the record, so far as I know this is the first time Carl Jung has entered my life.

And, one of my private concerns seems to have come true.  I’ve often heard of docs who were ‘different at work, but not in real life’, and hoped it wouldn’t be me.  Alas, I have a public and private personality, and they’re different.  (For the record, my wife’s  definition of pissed (I asked) is me using my stern voice: no shouting, just the ‘I’m not tolerating any crap right now’ voice).


Since then I’ve been more aware of my ‘at-work’ persona, and I have to admit it’s not the real me.  The real me would laugh and joke with most of the people I meet, be they patients, staff or housekeepers.  Having paid more critical attention since the enlightenment, I actually only laugh and joke with the housekeepers and the secretaries.  The patients get the friendly but all-business me, not quite Joe Friday (just the facts, ma’am), but not a long way off either; the nurses get the mildly pleasant but mostly-business me. 

There wasn’t a conscious ‘I”ll be a different guy’ moment, and I think this began in residency, but it’s real.  Now whether, and what, to do about it.  I’m not sure it’s bad for me or my patients, but it’s not a happy realization, either.