Archive for the ‘Random Thoughts’ Category

14 Ways To Know Whether You Are Failing As A Hospital Administrator

Sunday, July 5th, 2015


I’ve been an administrator.

I’ve seen hospitals in which a strong leadership team has improved the hospital’s market share and I’ve seen hospitals that have closed and that are struggling to stay open due to a failed administrative team. Here are some common traits I’ve seen in the failures:

1. You don’t know the names of the people who work in your corporation. You aren’t fooling anyone when you walk the halls without addressing people by their names. All this shows is that you don’t care to take the time to know them. If you don’t take the time to get to know them, why should they care about your corporation?

2. You spend a lot of time and effort seeking feedback about your employees’ performance, but you spend little or no time seeking feedback about your own performance. All this shows is that you are a hypocrite. People hate hypocrites.

3. Your hospital has a high employee turnover rate. This isn’t an issue with employees, it is a clear and unequivocal issue with management. People don’t leave their jobs, they leave their bosses. If your hospital has a high turnover in one department and you aren’t seriously evaluating that department manager’s work, you have no business running a hospital.

4. Your “help wanted” listings go unfilled. In an economy with high unemployment, the fact that people would choose to stay unemployed rather than work for you and your organization is a good reflection of the public opinion about the business you are running.

5. Your employees leave the room when you walk in or they try to avoid you in the hallways. When no one wants to be around you in your workplace, it isn’t a sign of respect, it’s a sign of disgust. Keep that in mind the next time you see someone duck into a stairwell when they see you walking down the hall.

6. You don’t show up at holiday parties for your employees. If you feel uncomfortable mingling with your employees at a party, you shouldn’t be trying to lead them. The good thing is that if you feel uncomfortable attending an employee party, your employees probably won’t want you there, anyway.

7. You don’t participate in charity events for employees or employee family members. Your failure to support your employees in their times of need will only drive everyone to dislike you even more.

8. You don’t support employees who have been injured. Or worse yet, you try to terminate employees who have been injured. News of these types of actions spreads quickly through the hospital. Again, if you don’t have their backs, what makes you think that they’ll have yours?

9. You care more about your bottom line than you care about your patients’ or your employees’ bottom lines. When you create policies to increase your bonuses, you employees will know and they will resent you for it. They may even make passive aggressive attempts to keep you from reaching your goals.

10. You spend more time criticizing your employees than you do complimenting your employees. Worse yet – you don’t compliment your employees at all.

11. You display favoritism. If you allow anyone to drop your name or to use their relationship with you to gain an advantage at work, your employees will quickly grow to resent you and your clique.

12. You discourage constructive criticism of your organization from within. If you think everything is going just fine in your facility, you’re out of touch and you’re wrong.

13. You don’t act on employee concerns. Your failure to follow up on an employee concern not only shows that you’re unreliable, but it also may serve as a basis for legal action if something related to that concern goes wrong.

14. You don’t visit the departments in your hospital on a regular basis. If it’s been more than a week since you’ve visited any department in your hospital, you have lost a great opportunity to compliment your employees on the job that they are doing. You have also lost the ability to uncover and address small problems before they become big problems.

How Can You Be Sure?

Monday, January 12th, 2015

“How can you be sure?”

That question stopped our discussion for a second.

During some down time, several nurses and I were talking about childhood coughs. Her 6 month old child had just started daycare 2 weeks ago and has been coughing ever since. The child was put on amoxicillin and then Zithromax by her pediatrician but … [GASP] … her cough wasn’t getting any better. The nurse thought her child had pneumonia.
“What should she be taking now?”
I was in a particularly snarky mood, so, with a smirk, I said “probably vancomycin … maybe add gentamycin just for the gram negative coverage, too.”
“I’m being serious. She’s not getting better with antibiotics.”
“BINGO! That’s because she has a virus infection and antibiotics don’t kill viruses any more than RAID kills dandelions.”
“But a virus infection isn’t going to last for two weeks.”
“Neither is bacterial pneumonia. The fact that she isn’t getting better with antibiotics should tell you that she has a chest cold. It’s a virus.”
“How can you be sure?”


There’s just no good response to that question. The truth is that we can’t be “sure” that there isn’t a bacterial infection present. We can’t be “sure” she didn’t aspirate a foreign body. We can’t be “sure” that she doesn’t have tracheomalacia. There is just no way that we can ever give a Flo’s Progressive Insurance 100% guarantee that a given set of symptoms is being caused by a given disease process and nothing else. The problem is that often patients expect this kind of diagnostic accuracy and get upset when there’s a misdiagnosis. Unfortunately, medicine is an inexact science at best. One of the things that I always found ironic is that many patients and even some medical experts expect doctors to “prove” their diagnoses do exist or to “rule out” other diagnoses by showing that those diagnoses couldn’t possibly exist. However, in court, when a doctor is accused of wrongdoing, an expert is required to testify to “a reasonable degree of medical certainty” which in most cases means that something is “more likely than not.” In other words, court testimony demands only 50.001% certainty while clinical practice often demands a much higher level of certainty.

Our discussion transitioned from snark to reality.
“Most of the time you can’t be ‘sure’ of a medical diagnosis – especially a diagnosis with a symptom as vague as a cough.”
“Well patients want certainty. If I bring my child to the doctor, I want to KNOW what’s wrong, not get some wastebasket diagnosis like a viral infection when my baby could have pneumonia.”

I nodded my head. Then I went to the cafeteria to get some lunch and I mulled that last statement while walking down the hall. How could I explain the concepts of pre-test probability and futility without getting too far into the weeds? The runny cottage cheese at the salad bar gave me an idea.

I got back to the ED and asked the nurse
“Have you ever given your child poisoned food?”
“Of course not.”
“But how can you be sure? How do you know that the formula doesn’t have contaminants in it – like that Chinese infant formula contamination back in 2008?”
“That’s completely different from diagnosing pneumonia.”
“True, but it’s the same concept. We assume that a healthy-appearing child with a runny nose and cough in the middle of winter has a head cold the same way we assume that the food we eat is not contaminated. If there are signs of complications with a coughing child, we may do further testing to see if there are other problems. If there are signs of food spoilage, we may choose not to eat the food.”
“Not the same thing.”
“Hear me out. We naturally eat food without examining it much because the likelihood of it being poisoned is quite small. However, if we wanted to be “sure” that the food wasn’t contaminated or poisoned, then we could do a bunch of microbiological testing before we eat every bite to make “sure” that the food wasn’t poisoned. But because the likelihood of poisoning is so small, all of the expenses of the extra testing probably would be a waste of money.”
“Not the same.”
“Even worse, if we do a bunch of testing on a well-appearing child with a runny nose and cough, there may be some complications from the testing or complications/side effects from the treatment for a disease that may not be present. People can get resistant infections or bad diarrhea from antibiotics for a “pneumonia” that was over-read on a chest x-ray.”
“I’ll say. My daughter has had diarrhea for a week.”
“Exactly my point. She’d probably be doing better with nasal saline, suction, and perhaps some … OTC cough medications” – a cringeworthy concept for most pediatricians.

I was convinced I had prevailed in our little discussion until she asked “Can children take Levaquin?”
“Only for bacterial infections.”
“But …”
“No. Just no.”

Michael Kirsch, MD Redux

Monday, June 9th, 2014

For the past 30 minutes, my cell phone has buzzed repeatedly, urging me not to climb out of this rabbit hole. “Come back,” it beckons, “we’re not finished yet.”

When KevinMD deleted my first comment about Dr. Kirsch, I decided to keep further comments on my own blogs so they don’t mysteriously disappear again. Now I’ve learned that I’ve been demoted: Instead of my comments on KevinMD posting immediately, I must receive prior approval before my comments can be viewed by anyone else on Kevin’s blog. All because I pull aside the curtain so people could see the real “insider.”

KevinMD Moderation

Next will be the stocks. Then an outright ban on my creative postings.

So, as with the previous post, I’ve copied Dr. Kirsch’s comments here and will comment below.

[phone buzzes yet again]  OK, I’m typing as fast as I can …

Dr. Kirsch writes:

I have read the comments to my post on this blog and elsewhere. Regrettably, some have resorted to vituperative language and demonization, rather than to engage in civil discourse and debate. If I have made factual errors regarding the reimbursement of ED physicians, then I am prepared to stand down from these comments. The fact that one commenter above who was particularly critical of me wrote, “the hospital loves it when I order tests”, suggests that there do exist economic incentives. I am not prepared to retreat, however, from my belief that over-diagnosis and over-treatment are embedded in American medical culture. This is an undeniable fact. If some commenters wish to opine that their specialty is somehow not part of this reality, then they are free to do so. I think they have a tough case, but they are free to make it. Regarding my own specialty, I have written more than once under my own name, and expressed elsewhere, that my specialty and me personally are part of the problem. A fair minded reader of my own blog would already know this.

To write and circulate throughout the internet that I am an ‘ER basher’ may have some red meat appeal, but it is false and defamatory. I write in my post that “If I were an ER physician I would behave similarly facing the same pressures that they do”. I continue for several sentences offering a sympathetic view of emergency medicine physicians. Not quite my definition of a ‘basher’.
Regarding my NY colleague’s assertion that gastroenterologists are not qualified to evaluate acute abdominal pain, I believe that the other physician readers will agree that this claim has no basis. In my experience, we are the specialists who are first responders to acute abdominal pain.

Responding to the claim that emergency room physicians do not admit patients, this needs some context. While ED doctors may not sign the admission order, they have often advised patients and later the admitting doctors that the patient needs admission. How many times have emergency physicians called primary care physicians or consultants telling us, “this guy needs to come in”? This is a proper exercise of their role, in my view. It is somewhat disingenuous to claim that “Emergency physicians don’t admit patients”, which may be only technically true.
Finally, personal attacks only demean the attacker and provide little opportunity for a dialogue that could offer all participants the chance for a civil airing of divergent views. We can do better than this and we should.

Dr. Whitecoat responds:

My father was a lawyer. One of the points he always used to make about his opponents is that when they complained that he was being mean, or uncivil, or offensive, or otherwise just plain hurt the opponent’s feelings, it really meant that the opponent had no counterargument to his position and was simply trying to gain sympathy with the judge or jury. He never used the word “vituperative,” though. That may have been because I was in third grade when he told me these things, but that’s another story.

So Dr. Kirsch has labeled people responding to his initial post (and I’m sure I fall in that subset of people) as being vituperative, demonizing, uncivil, and engaging in personal attacks. Yes, I was being vituperative in one sense of the definition. According to Merriam-Webster’s dictionary, vituperative means “uttering or given to censure :  containing or characterized by verbal abuse.” If you don’t want to be censured, then don’t make vituperative-worthy statements. And if you’re “offended” or consider it “abusive” that I repeatedly mention that you’re an “insider” with “insider’s knowledge” as I eviscerate all of your misstatements, then, after drying the tears from your eyes with the Kleenex for extra sensitive skin, perhaps in the future you’ll consider researching and providing evidence for your assertions rather than making inaccurate statements of fact to policymakers – many of whom lack the knowledge and insight to see through your self-aggrandizement.

[my phone buzzes yet again] I’m WORKING here. Have patience.

I also get accused of the tort of defamation for calling Dr. Kirsch an “ER basher”. First of all, it is an emergency DEPARTMENT.

[another buzz from the phone]

As I was saying, it is an emergency DEPARTMENT, not an “ER.” Since you seem to be stuck on the title of the cancelled TV show from last decade, let me explain. Back in the early days, there was a “room” in the hospital where all the consultants used to take their patients when they had emergencies. The emergency “room”. These days, hospitals have whole departments with lots of separate “rooms” where lots of emergency physicians treat really sick patients. See the difference? It would be like me calling an endoscopy suite an endoscopy closet.

Back on point. Let’s look up the definition of “bash” at Merriam-Webster’s site. To be a “basher”, one must either “strike with a crushing or smashing blow” or “hurl harsh verbal abuse at.” Now asserting

[phone buzzes again. I am now putting it on “airplane mode”]

Asserting that emergency physicians perform “unnecessary” medical care, while as an “insider” knowing that billing for unnecessary medical care is by definition health care FRAUD seems pretty harsh to me. Asserting that we are somehow incompetent in our trade because “there is a significant percentage of ER patients who should be sent home and are sent upstairs instead” seems pretty harsh to me. And to assert that our morals are so low that we would conspire with hospitals that “encourage” us to inappropriately admit patients to make more money sounds more defamatory than your hurt feelings after I labeled you as an “emergency department basher.”

Remember this little post over at ACP Hospitalist and how I called you out on it back then, too? Same tune, different day. You try to make yourself appear as a better clinician, a smarter physician, and as a more cost-efficient steward of resources by second guessing the emergency physicians after you have completed your negative workup. What you either think no one will pick up on or what you’re too dense to realize, though, is that by the time you have come to your conclusion that the patient never should have been admitted, you also have much more information upon which to base your “insider” opinion. Hindsight is always 20/20.

So to end the comments about butt hurt and defamation, recall that truth is an absolute bar to defamation. You don’t like the label, then stop acting the part. And for Pete’s sake stop whining about it. You’re a grown man.

So let’s get to some of your other comments.

“I am not prepared to retreat, however, from my belief that over-diagnosis and over-treatment are embedded in American medical culture. This is an undeniable fact.”

First, this isn’t what you said in your post. You bash the emergency department because “They are in a culture of overtreatment and overtesting.” Now you’re trying to walk it back to say you really meant that “all of us are to blame.” Oh, and for the added emphasis, your statement is “undeniable,” too. I asked you before and you didn’t respond. Give me a list of testing that should never be performed and of some treatments that should never be offered. You’re the “insider,” share some of that information with us “outsiders.” You know why you won’t do it? Because your statement isn’t “undeniable.” In fact, when you try to prospectively examine emergency department evaluation and treatment, it’s highly deniable. There are low yield tests and high yield tests. Whether those tests are ordered depends on a physician’s medical judgment. And you certainly aren’t the yardstick by which an emergency physician’s judgment should be measured.

“I continue for several sentences offering a sympathetic view of emergency medicine physicians.”

Is that kind of like a husband who beats his wife telling her that he really loves her before he winds up for another punch? Just because you feign sympathy doesn’t mean that you get a free pass to backstab emergency medicine throughout the rest of your post. Nice try, though.

“In my experience, [gastroenterologists] are the specialists who are first responders to acute abdominal pain.”

This statement exemplifies what is wrong with you, your insights, and your “inside information.”
YOU HAVE NO EMERGENCY DEPARTMENT “EXPERIENCE.” You’re making yourself the laughing stock of the medical community when you make statements like this. Many emergency physicians have already responded that they rarely if ever call a gastroenterologist for evaluation of abdominal pain. I can add my own experiences to that list. I can’t remember ever calling a gastroenterologist to evaluate a patient with undifferentiated abdominal pain. I’m betting that if someone interviewed the emergency physicians in your hospital’s “ER,” they would say the same thing. But you babble on in your blissful ignorance holding your asserted truths to be self-evident, “inarguable,” and “undeniable.” Enough already.

Finally, your whole argument about whether or not emergency physicians truly “admit” patients is a non-argument. You agree that it is “technically true,” but then you seem to state that it really isn’t true because we advise another doctor that “this guy needs to come in”? What is your point? Another physician is still admitting the patient. Are you going to change your criticisms to attack the true admitting physicians who “unnecessarily” waste all of our precious health care dollars?

I’ll end this response with a Twitter picture that just happened to pop up on my Twitter feed a day or two ago. With hat-tips to @CardioNP for re-tweeting it and to @pkedrosky for initially tweeting it.

I’ve spent a couple of hours responding to something that shouldn’t have even needed a response. Hopefully this ends both this debate and any of Dr. Kirsch’s future uninformed posts about “emergency rooms”.



Income Comparisons – Teacher vs. Physician

Tuesday, April 15th, 2014

Who makes more money over the course of their career – a high school teacher or a doctor?

Doctors are obviously paid more.
However, when you also consider that doctors work 1.5 times more each week than other Americans, that doctors spend an average of 42,000 to 50,000 hours (20-24 years of full time work equivalents) just to become a doctor, and that doctors pay almost $700,000 for their educational debts, the net hourly wage of doctors versus high school teachers shows that, on average, teachers earn about 3 cents per hour more than doctors over the course of their careers.

And these calculations don’t even consider the licensing fees, licensing exam fees, DEA fees, malpractice insurance premiums, continuing medical education fees, hospital staff dues, costs of running an office … and also assumes that the doctor doesn’t get hit with a multimillion lawsuit judgment.

[Also see this related post: http://www.er-doctor.com/doctor_income.html]

Teacher Salary vs. Doctor Salary

Happy Doctors’ Day

Sunday, March 30th, 2014


According to the Southern Medical Association,

Doctors’ Day was first observed in 1933 as a way to honor the profession. Initially, it involved mailing cards to physicians and their wives and placing flowers on the graves of deceased physicians.
It wasn’t until 1958 that the US House of Representatives adopted a resolution commemorating Doctors’ Day.
In 1990 several Mississippi legislators drafted a bill to make March 30 National Doctors’ Day.  George Bush signed this bill into law later that year.

A red carnation has traditionally been used as the symbol of Doctors’ Day.

Give your doctor a fist bump today.

Just Checking

Saturday, February 22nd, 2014

CT BB NoseIn one of the hospitals where I work, when we order certain tests in the computer, we have to write the indications for the test on the order sheet. I suppose this isn’t a bad idea in some cases. For example, if an ultrasound might be better than a CT scan to look for the suspected diagnosis, writing the indication may help to provide the most useful test.

The problem that has popped up recently is that the typewritten indications have now turned into a full scale interrogation by the radiology techs. What symptoms is the patient having? For how long? What is the patient’s medical history? What medications?
Apparently this all has to be written on the order form for some patient safety protocols.

I’m even getting regular calls to ask if I “really want the test” and then ask why I am ordering the test – even though the indication for the test is written on the order.
Just double checking, of course.
It isn’t uncommon for two techs to ask me if I really want a test in some cases.

The director of the radiology department approves of all the questioning. After all, it improves patient safety. I’m not sure how repeated questioning improves patient care and I haven’t been persuaded to change or cancel any of the tests I have ordered, but I am now beginning to see how the pre-authorization process would dissuade some doctors from ordering certain tests. Some doctors just get tired of dealing with the hassles involved in ordering the tests.
I’m not one of those doctors, though.

Initially, I planned to just start typing “yes I really want the test” in the order comments. Then, my better judgment got the best of me. A statement like that probably wouldn’t look too good if the charts were sent to outside hospitals or other third parties.

Although the actions of the techs are frustrating, they are just doing the job assigned to them by their boss. Not really fair to give them a hard time.

How would you address the situation? Is it even worth complaining about? Let me know what you think.

Open Mic Weekend

Sunday, February 9th, 2014

theatre curtainIt’s been a year since I last did this and I’ve had a couple of people send me questions about medical issues. Interest has varied in previous Open Mics, so we’ll see how this one turns out.

Like Reddit, you can “Ask Me Anything” in the comments section and I’ll give you the best non-binding informational answer I can give you.  I’ll be back Tuesday to answer questions and any of the other readers who want to chime in are welcome to do so.

The only rules are that there are no personal attacks and that the comments/questions have to be medically-related.

Let the show begin …

The Most Common Thanksgiving ED Complaints

Thursday, November 28th, 2013

TurkeysWhen I first saw this article in Live Science about the strangest holiday ED complaints, I was interested in what other doctors’ perceptions were, but I first sat back and thought about what types of complaints I usually see more often on Thanksgiving than during other times of the year. I’ve given up on trying to time “strange” complaints. They occur so often that I lose track of any temporal aspect to them.

Because Thanksgiving obviously occurs on a Thursday and because many doctors offices usually aren’t open the Friday after Thanksgiving, the holiday often presents patients with difficulty in obtaining medical care. Office schedules are booked in the days leading up to Thanksgiving, few offices are open during the holiday or weekend, and the schedules are again packed the following Monday and Tuesday with patients needing care. So patient volumes in the EDs usually increase, and I typically see more patients with routine problems than I do during “normal” weeks.

Thanksgiving is also one of the times where families get together – many times when they haven’t seen each other since the last holiday season. When busy adults haven’t seen the steady decline in the health of their elderly family members over the prior year, they will sometimes bring in their family members for an evaluation of what they perceive is a sudden change in their family member’s health. Then, instead of spending time enjoying the company of their families during the holidays, many elderly patients are admitted to the hospital to rule out old age.

Thanksgiving is also a time of food and drink intake. The excesses of alcohol often result in reduced inhibitions and oversedation. So there are always the injuries from fights over such things as whose football team is better and who got to eat the turkey neck. Later in the evening, it isn’t uncommon for families to bring in family members whose excessive alcohol intake has made them difficult to arouse.

Getting back to the Live Science article … the strangest complaints for visits to the ED include burns from turkey preparation, lacerations from carving accidents, food contamination, overindulgement in alcohol and food, sports injuries, anxiety, and performance pressures. I wasn’t even close.

Lacerations and stab wounds, sports injuries and hurt feelings, heart attack and heartburn, anxiety and isolation – we’re there to take care of everyone so that hopefully families can reconnect next month to enjoy more of each others company. If you happen to be in the ED today, remember that the person taking care of you or your family member is probably giving up time with their family so that they can be there for you.

Safe and happy holiday wishes to everyone and their families.

And go visit a family member or friend you haven’t seen in a while. Bring a picture and a card. It will be worth a lot more to that person than will a “Doorbuster” you got by standing in line in the freezing cold waiting for a store to open up on Black Friday.

Dragonisms – Voice Misrecognition Contest

Thursday, November 7th, 2013

I like the Dragon NaturallySpeaking program. I like tequila, too. But I try to use both with caution.

Dragon’s speech recognition is good in that it saves a lot of time and costs in transcribing medical records, especially in complicated patients where it would take a long time to type out the patient’s history and the patient’s course.
The problem with Dragon NaturallySpeaking is that it isn’t perfect. Sometimes the difference between a doctor’s dictation of “no murmur present” and the Dragon transcription of “murmur present” can make a big difference in a patient’s workup. Other times, Dragon will misinterpret a dictated phrase for a similar-sounding but inappropriate phrase.
I’ve tweeted about a few of them.
For example, in the patient with GERD who was having repeated exacerbations, I dictated “bland diet” in the discharge instructions. Dragon apparently didn’t like the patient too much because it transcribed “plan to die” onto the chart. It’s fortunate that I didn’t miss that error while I was multitasking. Imagine those discharge instructions showing up in a patient complaint to an administrator.
Another patient was recently looking for a prescription for oral contraceptives. The Catholic hospital in which I work doesn’t allow prescription of contraceptives from the ED, so I have to recommend that patients follow up at Planned Parenthood. Dragon translated my instructions as “Follow up plan paranoid.”
And then there’s the colleague who dictated his findings that “examination of the patient’s breasts with a chaperone showed no lumps, masses ….” Dragon transcribed “semination of patient’s breasts with a chaperone showed no lumps, masses ….”
Dr. Grumpy regularly documents the foibles he has with his Dragon software as well.

Then I thought to myself … Self, you haven’t had a contest in a while.

So we’re having a contest for the best “Dragonisms.” What have you seen or read in a medical record that was misconstrued by voice recognition software? Add it to the comments section. Best Dragonism wins a free copy of Mark Plaster’s critically acclaimed “Night Shift” book (affiliate link). We’ll also try to find some EP Monthly swag for runner up prizes. I think I have an old coffee mug somewhere in my closet. Or perhaps a couple of Amazon gift vouchers.
Contest ends at 12AM on November 15.
Let’s see what shoe grout you’ve got.


It was very tough to pick a winner from all of these great entries. We smiled at almost all of them and laughed out loud at a few. The winner is …
#6 Ashley for the metaphorically true mistranscription about a referring facility transferring a patient because it had no testicles.
Ashley will receive a free copy of Mark Plaster’s new book “Night Shift.”

We also chose a couple of runner up winners who will each receive EP Monthly coffee mugs.
#14 Mati whose discussion about an advance directive turned into a discussion about an advanced rectum
#1 ndenunz whose patient’s warm feet turned into warm other body part

If the winners e-mail me at whitecoat-at-epmonthly-dot-com, I’ll get your swag to you. Thanks to everyone for their comments. Hope that the entries at least brightened your day a little.

ACEP 2013 WhiteCoat Recap

Thursday, October 17th, 2013

ACEP 2013I arrived at ACEP’s 2013 Scientific Assembly a day early to attend the Council Meeting and to meet up with some old friends.

The venue for the gathering was good. Transportation, hotels, dining, and shopping all within easy walking distance from the Convention Center. The Convention Center itself was rather oddly situated. Had to take escalators up four floors to get to lectures. Staff was uniformly pleasant and helpful.

Some of the issues at the Council Meeting that had the most vigorous debate seemed tangentially related to emergency medicine. If I hear one more proposed resolution about marijuana, I’m going to go postal on someone. We’re the American College of Emergency Physicians, not the American College of Emergency Potheads. If the “Joint” Commission wants to smoke marijuana during their days off, that’s their business. Don’t smoke it directly before or during your shifts and stop with all the resolutions about it. If you were in court and submitted the same topic for judicial consideration half as many times as it has been submitted to the ACEP Council, you would have been sanctioned a long time ago.
And a 25 minute debate followed by an emergency physician Council vote on breastfeeding? I’m a breastfeeding advocate and my wife has breastfed all of our kids, but how are breastfeeding rights relevant to emergency medicine? A resolution to follow state laws relating to breastfeeding is a waste of Council time. I’m just hoping that next year someone doesn’t submit a Council resolution asking that ACEP declare Britney Spears more popular than Nicki Minaj. Then again, maybe someone could submit a resolution that the ACEP Council will not consider any other resolutions relating to marijuana for the next 10 years.

ACEP Opening SessionI enjoyed the opening session. Shawn Achor was informative and entertaining. He summarized predictors of success in life including: Optimism, strong social connections/social bonds, perception of stress as a challenge and not a threat.
To create positive change, he had these suggestions:
1. Write down three new things each day for which you are grateful. Don’t have to be major things. The idea is to train your brain to look for positive things in life.
2. Doubling. Sit down for a half hour and write everything you can remember about a positive experience. Doing so helps you relive and “double” the positive experience. This trick improves ones positive outlook the fastest.
3. Exercise. Helps improve our health and shows us that intervention matters. Fifteen minutes of exercise each day is as effective as taking an antidepressant.
4. Meditation. Meditate daily for just a few minutes. We are all into multitasking. Meditating forces us to “singletask.”
5. Perform one conscious act of kindness each day. Doing so increases our social consciousness and improves our social connections. Strong social connections have a significant positive effect on our longevity.Top ACEP 2013 Influencers
His parting words were that “happiness spreads – create a ripple effect.”

Classes first day were informative. Tried to tweet pearls as much as possible. Made the top 10 list for most influential tweets, but left in the dust by @GruntDoc and @mdaware. Shout out to Team Health that provided wi-fi coverage for the meeting. The connectivity was usually quite good, although it sometimes lagged a little during peak times. My tablet kept having problems connecting which made keeping up with @GruntDoc and @mdaware even more difficult. Here are my WhiteCoat tweets from the ACEP 2013 conference.

Enjoyed the secret ED blogger dinner meeting Monday night. Always good to see old friends and catch up on the arguing and poking fun at each other.
10-17-2013 11-57-56 AM
Tuesday involved more lectures and also gave me a chance to visit the exhibits. Lots of interesting gimmicks to draw interest including the Deer Hunter video game, indoor golf, and a Chewbacca/Sasquatch emergency physician spokesperson … or perhaps it was a gruntsperson. Probably the smartest gimmick was fresh-baked cookies. A functioning oven on the exhibit floor was perhaps a little bit of a fire hazard, but the smell of cookies wafting through the air created a natural draw to find out where the smell was coming from.

ACEP 2013 Exhibit GimmicksSeveral neat innovations at the InnovatED. New Stryker wheelchairs are easy to maneuver, comfortable, but run about $2500 each. Also had some Lost in Space freaky robot chasing me around the exhibit. Neat idea, until some ticked off patient knocks it over. Not sure that this would be cost effective in many emergency departments, but if some rural areas could use it to screen suicidal patients and discharge without having to hold them in the ED for days at a time until a psych bed opens up, it may pay for itself over the long run. Monthly lease cost reportedly averages $1500 to $3000+ including IT support. Jason Wagner was also doing some demonstrations with Google Glass. Lot of hiccups in the demonstration. Have to nod your head to activate. People were doing this so often while trying out the glasses that I can see docs developing subconscious tics from using the glasses too much. Also, there can’t be any delay between verbal commands or the software resets itself. Shows some promise after you get past the HIPAA issues but I agree with @theSGEM that Google Glass just doesn’t seem ready for prime time use in emergency medicine.

InnovatED picturesOne complaint I heard from several vendors was the placement of the displays. With the exhibit floor separated by a skybridge, few people seemed to know about the other half of the exhibits. One vendor said that his company would not be back because of the low foot traffic. ACEP might consider providing vendors on the far side of the exhibit floor with some give backs to maintain goodwill with those vendors. Just a suggestion.

Got to see a couple of short “flashmob” type talks while wandering the exhibits. Angela Gardner gave an excellent synopsis of the benefits of tort reform in Texas. Quite knowledgeable on those legal topics, she is. Jason Wagner was back discussing useful apps for emergency physicians. Unfortunately many of the apps he reviewed were exclusively for Macs and iOS. Wandered away mid-lecture since I’m not a Mac fanboy anymore. Would like to have seen suggestions for Windows, Android, and even Linux (which I also use).

ACEP 2013 Lectures
Snagged a copy of Mark Plaster’s new book Night Shift – Stories from the Life of an ER Doc – a collection of his columns over the years. While visiting at the EP Monthly exhibit, Mark told me that many people stopping by the exhibit have just assumed he is “WhiteCoat.” I’m again dispelling that myth. We are not the same person. He’s much shorter and better looking than I am.

Sea-Tac Airport TSA Lines Around AirportThe trip home was a little trying. Both Sea-Tac Airport and the TSA in Seattle fell asleep at the wheel. It isn’t like they don’t have the ability to predict the volume of passengers based upon the number of flights leaving during a given time frame. Yet with a huge passenger surge and lines queuing across the entire airport (literally!), there were only two TSA lines open. But there sure were a lot of supervisors running around with walkie talkies and clipboards, though. Too bad they couldn’t have opened up another screening lane and helped move the passengers through security. I felt bad for the agents doing the screening. They maintained grace under pressure. Oh, and during the surge, the airport also shut down a runway for “inspections”. Don’t know the details of why, but the airport experience was definitely the worst part of the trip.
By the way, if you ever fly into Seattle and don’t want to pay $50 for a cab, there is a train that will take you right into the heart of the city and that costs a whopping $2.75.

Seattle ACEP 2013 Summary:

Pros: Location, Wi-Fi connectivity, courses, impromptu lectures and “genius bar”
Cons: Exhibit layout, cost ($770 is getting to be too expensive)
Overall Grade: A-

Looking forward to next year in Chicago October 27-30. Should be lots of fun.

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