To think that ethnic prejudices are the only prejudices we carry around is a huge mistake; we have all kinds of forces that push the way we believe and act every single day. The key to being an emergency physician is understanding your own prejudices and controlling them.

This year, on the exhibit floor, there were at least four booths advertising scribe systems. I don’t understand why there weren’t 14. As there is going to be more pressure on medicine to produce more patient care for less money, the scribe is the obvious way to go.

The principle issue in this country today, with regard to medicine, is not any particular form of research. It is not any particular operation. It is what are we going to supply to elderly people where there are limited resources and a shrinking base of people to pay the bills. This is more than symbolic. It is a day-to-day problem which no one seems able to deal with in any realistic way. And no one sees this dilemma like emergency physicians.

 Suffering is optional. Unfortunately for some of our patients, it’s at our option and not theirs. As I look back and am confronted by some of the most difficult patients that I ever cared for, it was the suffering that was the problem.

As I sit, penning the cases to be discussed for the Mills Lecture which will be given at the ACEP Scientific Assembly in Las Vegas, I am struck by a thought: the largest, most-needed element of health care reform was never discussed in the recent debate. This is the dilemma of what we do as death approaches.

altAs summer progresses, hardly a day goes by that doesn’t challenge America’s hegemony, from the Gulf of Mexico turning into an oil slick to the Iranians amassing nuclear weapons. In the midst of the chaos, we have to live with a health care reform bill which has nothing to do with health care and virtually nothing to do with reform.

The choice is simple: process or product. Do we support the simple checking of boxes or are we concerned with producing something real? We have seen what happens to countries that feel that the process is more important than their products: they lose. In America, there’s hardly a better example of this mindless checking of boxes – without a whit of care for outcome – as continuing medical education.

I have no interest this month in sounding like a malignant Luddite. I am not against all change; some change may actually be good.  But, we cannot confuse change with progress. The two have nothing to do with each other.

Depositions are not casual conversations or informal get-togethers providing you with an opportunity to prove your innocence. They are well-choreographed, deep-sea fishing expeditions designed to find the tools the plaintiff attorney needs in court to hang you on your own words. Be wise.  Be careful.  There are only two things you can never take back in this world, a bullet and your testimony in a deposition.

This month Oh Henry changes gears and follows Dr. Henry on the last shift of his iconic 42-year career.

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