A recent article in the NY Times pointed to the belief that “the move to
electronic health records may be contributing to billions of dollars in
higher costs for Medicare, private insurers and patients by making it
easier for hospitals and physicians to bill more for their services,
whether or not they provide additional care”.
A walk down memory lane reminds us that we have yet to see a stroke
study of sufficient size to end the tPA debate. And even when we had
such data, it was largely ignored. Let’s study our history to avoid
Lincoln County Hospital 1982. A mother bursts into the ED waiting room
where I happen to be, sees my white coat and hands me a non-breathing
infant. The look on her face stuns me and in less than an instant her
panic, fears and raw emotions become my own. All the preparation,
planning, memorization and practice in the world cannot fully prepare
you for that moment.
Although the technology is fascinating, caution must be exercised when
applying coronary computed tomography angiography (CCTA) to emergency
department chest pain patients. The only way this diagnostic modality
will help us, and our patients, is if it guides us with risk
stratification, showing a clear path to discharge for patients we
currently don’t know what to do with.
Should antibiotics be used in conjunction with incision and drainage of a
simple abscess? Recent studies suggest not, yet they leave room for
physician discretion at the bedside.
The College’s new policy lacks a comprehensive perspective and too readily discourages the use of opioids. The dearth of valid evidence should lead EPs to a balanced approach on pain, rather than a restrictive one.
Last month, Dr. Kevin Klauer suggested that emergency physicians “unbundle the sepsis bundle.”
This month, Dr. Emanuel Rivers offers his rebuttal, explaining why EGDT greatly improves sepsis outcomes.
Two years ago I called into question the use of the sepsis bundle of
therapies defined by the “Surviving Sepsis” campaign (EPM, March 2010)
Although aggressively managing sepsis is a good thing, and the mere
focus on the rapid identification and application of appropriate
management strategies for sepsis is essential to good patient outcomes,
it appears that EGDT and the research it was based on may have promised
more than it could deliver.
Despite popular belief and common practice, due process for EPs is a
right, not merely a privilege. Dr. Larry Weiss offers a counterpoint to
“Due Process in Due Time,” from EPM’s February issue.
You rarely hear of problems with the old standby, TMP-SMZ, but there is a
growing body of literature suggesting that physicians need to be wary
of the drug’s potentially serious side effects.