When emergency physician Harvey Castro asked a nurse to start a dopamine dose for a hypotensive patient one day, he watched the nurse leave the room, find the book that could guide her to the titratable dose, look in the index and then flip through until she found what she needed. Castro wondered, Isn’t there a more efficient way?

In 2009, Emergency Physicians Monthly polled 5,000 readers online to determine if and when EPs altered the tests they ordered out of fear of litigation. The poll, which garnered 385 responses, may not have been scientifically valid, but it confirmed what most of us know intuitively – that there is a significant cost to defensive medicine. Now, the Pennsylvania College of Orthopedic Surgeons has added fuel to the fire, publishing a study that confirms the very same thing.

One night on a lonely stretch of Mexican highway, Dr. Haywood Hall stumbled on a car accident and a man who was unconscious. For 30 minutes Hall, a vacationing emergency physician, waited for the ambulance to arrive. When it did come, it was with shoddy equipment, expired Valium and an undertrained staff. Although Dr. Hall didn’t have a license to practice medicine in Mexico, he got police permission to help.

Daryl Wilson was a medical student on rotation in the emergency department when a man with severe chest pain was rushed in along with his family. Wilson was briefing them on the father’s condition when the teenage son suddenly stopped him short: “You’re Daryl. You’re the singer for the BollWeevils!”