I believe that the answer to defensive medicine and the damage it has done to our health care system lies in our own hands. We are the ones who establish the ‘standard of care,’ beneath which is negligence. 

 “Hey Doc, where’d you get that costume?” Andrew asked after he instinctively jumped to his feet upon my entering the kitchen. As a midshipman at the Naval Academy he is trained to be respectful, but I guess the ‘costume’ sort of took him by surprise. He and a friend from the academy had just arrived for a visit to our house for the weekend.

This month Night Shift changes gears, publishing a post from one of our favorite medical blogs,

I walked into Room 17 to see a sixty-ish woman who, by the nurse’s triage note, had come to our ER for shortness of breath. A smoker, with a history of chronic obstructive pulmonary disease (COPD). The nurse’s note reflected her suspicions that this patient may have pneumonia.

alt“What the heck are you reading at this hour?” my wife moaned after being awakened by my bedside lamp. She took a moment to clear her eyes and leaned over to read the title on the screen of my computer. “Diagnostic and Statistical Manual of Mental Disorders. You’ve got to be kidding me. It’s 2 o’clock in the morning. You’re the one with the mental disorder.”

Problem: If EPs wait for big organizations to act, they will miss their real need.
As soon as I saw the scale of disaster in Haiti I knew I wanted to respond. But because I was on the West Coast, I was unprepared to respond to the Navy’s call to join the USNS Comfort. I then wasted a week looking for another group, finally joining Team Rubicon, an NGO that had only been formed the week prior by people like me who just wanted to do something.

Take Home:
If you want to be able to respond in the first wave of relief, have a relationship with a team of like-minded individuals or an organization that is ready to respond on a moment’s notice.
“Ma-a-ark,” I heard the distinctive warbly voice upon answering the phone. It was my mother-in-law, Peggy, better known as Mom Mom. When she called my name like that it always reminded me of a beloved hen that my brother had as a pet when we were children. “My stomach still hurts. I’m not feeling any better?”
 “You know what?” I said philosophically as I put my feet up on the table and took a sip of coffee from a Styrofoam cup, “I like lawyers.”

 “I do too,” said my partner without hesitation. “If they are cooked properly.”
I sat in the huge rotunda of the US Naval Academy Chapel and looked up at the soaring height of the dome and the giant stained glass depiction of Christ walking on the water. As the Naval Academy choir braced and sang the Navy Hymn, Eternal Father, to end the Sunday service, I witnessed a time-honored tradition. Two midshipmen flag bearers slowly removed from their stands the flags of the United States and the Naval Academy. They then dipped the flags, one by one, in symbolic thanks to God, the One “who bids the mighty ocean deep, its own appointed limits keep.” Then, as they marched crisply past our pew, tossing the flags behind their head to fly free, my mind went back to the fluttering of the flag I hung outside our Shock Trauma Platoon in Iraq, just one year ago.
 Olfactus amissio. Anosmia. For some it is a medical condition. But for emergency physicians, it is a talent, cultivated through years of practice. Who else can walk into the room of a patient who hasn’t bathed in a month and say pleasantly, “Hello, I’m Doctor ___, how can I help you.”
“So, what do you think about health care reform?” asked Geoff. My wife’s family had gathered to celebrate my mother-in-law’s 80th birthday. I always looked forward to the food and the stimulating conversation, particularly with Geoff, my ‘liberal’ brother-in-law from New Hampshire. Being well read, Geoff loved a good debate on a variety of topics. But this topic had the potential to be long winded and personal. All I wanted was some of Mom-Mom’s brisket with her famous homemade barbecue sauce. I just stared at my plate, piled high with delicious food, knowing that the talk would be heating up as my food got cold.

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