Seeking help for mental health problems: Change the culture for providers

“I don’t need meds,” the young psychology major told me confidently. “Or therapy really. Maybe I’ll just touch base with you every once in a while. I should be able to handle this on my own.” The young woman’s physician had been concerned enough in a recent visit about this patient’s panic attacks and passive […]

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What I learned about childproofing from working in the ER

As a new mother, working in an emergency department made me want to go home and childproof every nook and cranny of our house. On a daily basis at work I care for children, most often toddlers, injured at home in various ways. I learned of all the potential household dangers and how to keep […]

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The human physician will soon become history. Here’s why.

In the age of spiritual machines Ray Kurzweil in 2001 predicted: By 2020, a $1,000 computer will match processing speed of the human brain — 20 billion calculations per second. By 2030, it will simulate the brain power of a small village about 1,000 human minds. By 2048, it will have the brain power of the entire population of the U.S. I predict that within 20 to 30 years the computer will replace the venerable physician. Computers can already be programmed to detect sarcasm and read emotions. They can study your face and body language. […]

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Much of the human spirit lies outside a physician’s power

I first met Marie five years ago. A petite, soft-spoken woman in her thirties, she was the patient of one of the residents whom I supervise at our community hospital. Marie worked in housekeeping for a large corporation; she and her husband, a bus driver, had a six-year-old son. Now she was twenty-six weeks (six […]

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3 things Walter White can teach doctors

Breaking Bad has been rated one of the best TV shows of all time, and for good reason. The improbable story of a regular and shy high school chemistry teacher, faced with a terminal diagnosis, turning into a gangster and drug kingpin certainly makes for good television. A compelling storyline set against the backdrop of […]

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It is time for an honest conversation about money and cancer

There are two, old, particularly nasty rumors, about cash and cancer. The first, which seems to be fading, is that scientists cured the disease long ago, but the pharmaceutical industry suppresses the cure so they can get rich selling worthless therapies. This never made sense to me, since the company or person that cures cancer […]

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When patient-centered care becomes patient-dictated care

“I’d like an MRI for my leg pain. I haven’t had an MRI for many years, and I’m worried.” These were some of the first words I heard from a patient I was seeing for a new patient visit. Based on this patient’s story and physical exam, her pain was most consistent with a muscle […]

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How good of a clinician are you?

In psychology, the Lake Wobegon effect refers to a mythical town where “all the women are strong, all the men are good-looking, and all the children are above average.” In other words, humans have a tendency to overestimate their capabilities, particularly in relation to others. As a physician, I have yet to meet a fellow […]

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4 things on the horizon in childhood cancer

The 20th century saw striking advances in curing childhood cancer, primarily as a result of the discovery that broadly toxic chemotherapy agents could kill malignant cells. As a result, pediatric cancer, once a virtually incurable disease, now enjoys an overall long-term survival rate that tops 80 percent. In the 21st century, attention is turning to newer […]

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Pain tolerance: A story of two patients

One thing I learned early on as a doctor is different people have different tolerances for pain.  At one end of the spectrum, for example, I recall a woman who came to the emergency department with a small splinter in her foot.  She arrived wailing in pain, and we had to take her back to […]

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Innovation in health care: Too much, too little, or just right?

I was recently discussing all the changes going on in healthcare at a summer cookout with a few doctors in private practice.  The topic of accountable care organizations (ACOs) came up, and the group started debating the pros and cons of them.  At one point in the conversation, I brought up Medicare’s Innovation Center (the […]

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LITFL Review 198

Welcome to the 198th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.

The Most Fair Dinkum Ripper Beauts of the Week

A great new #FOAMcc website is born: ICM Case Summaries! This is what it is all about: “Writing ten expanded case summaries is a requirement of the CCT in Intensive Care Medicine training program for doctors in the UK. These summaries are usually the result of hours of work collecting, synthesising and distilling the most up-to-date evidence on specific clinical questions relevant to intensive care practice in the UK. For most of us though, once they are completed they just sit on our hard drives gathering e-dust. Our aim is to release the untapped potential of these resources and create an online repository of ICM expanded case summaries. As ICM Case Summaries grows it will form a continuously expanding and updating free online educational resource for intensive care medicine professional”. This is an excellent initiative that I hope all UK-based trainees and ICU consultants consider contributing to. The collection of posts is growing rapidly… One to watch! [CN]

The Best of #FOAMed Emergency Medicine

• Excellent review of the evidence behind the use of nitrates and NIPPV in decompensated heart failure in the ED from HEFT EM Cast. Includes the disutility of loop diurectics. [AS]
• More great podcasts coming at a quick-fire rate from CORE EM. This time it’s the management of DKA. [SL]
• The All NYC EM Podcast features Pik Mukherji discussing heuristics and diagnostic errors. [AS]
• Rebecca Maxwell from the Severn FOAMed Network delivers a fantastic podcast on Tricyclic Antidepressant Overdose and discusses the role of intralipid. [SL]
• EM Lit of Note discusses new targets for finding patients amenable to catheter-directed therapy in ischemic CVA for reperfusing at-risk (as opposed to infarcted) tissue. [AS]
• An interesting update on The Alteplase Controversy Goes Prime Time, as the concern over stroke thrombolysis gains more momentum. [SL]
• The Bottom Line reviews an excellent RDCT comparing low dose ketamine to morphine for acute pain management in the ED. [AS]
• Mistakes in medicine are inevitable but rarely gets discussed. This fantastic blog from Sweat the Small Stuff talks about medical errors in a open, honest and informative manner. It is essential reading for all. [SL]
• The latest episode of ERCast delves into the difficulty of deciding “is my patient suicidal”? [MG]

The Best of #FOAMcc Critical Care

• Video demonstration of the core micro-skills necessary for expert central line placement from EM Crit. [AS]
• There has been a surge in case-based Q&As over at INTENSIVE, courtesy of Chris Sia: congenital heart disease in an adult is the focus of Cyanosis, Boots and the 5Ts, key finds on AXR in Belly ache and Rigler’s Sign, and the differential diagnosis of different types of lung opacitites on CXR in Why the alveolar opacities?. [CN]
• Deirdre Murphy (aka ‘ECMO Goddess’!) talks to San Diego’s finest podcasters Joe and Zack about Weaning VA ECMO on the EDECMO.org podcast. The discussion provides great insights into the management and weaning of VA ECMO patients in the ICU. I could have done with hearing this a few years ago! [CN]
• Cardio-pulmonary physiology maven Jon-Emile Kenny has made his Critical Care Medicine board exam review notes available on PulmCCM.org. [CN]
• ScanCrit reviews the recent article in Annals of Surgery looking at the utility of FAST in predicting patients who will not benefit from ED thoracotomy after trauma. [AS]

The Best of #FOAMtox Toxicology

• ECMO makes a double mention this week at the Poison Review: ECMO as a bridge to lung transplantation in paraquat poisoning and ECMO in colchicine poisoning [JAR]
• How does obesity affect the poisoned patient? The Poison Review discusses a recent article on the topic. [AS]

The Best of #FOAMped Paediatrics

• New free iBook – Pediatric Emergency Medicine Guidelines. [AS]

The Best of Medical Education and Social Media

• Excellent podcast discussing how we can reconcile novel education (i.e. FOAM) with the traditional models at Injectable Orange featuring Vic Brazil and Damian Roland. [AS]
• If you’ve got a presentation to give soon then this is a must listen! Jonathan Downham talks to Ross Fisher on how to make a fantastic presentation. [SL]

News from the Fast Lane

• There are now over 1,600 entries in the Critical Care Compendium… and counting! [CN]

Reference Sources and Reading List

• Emergency Medicine and Critical Care blog/podcast list
• LITFL Global Blogroll
• FOAMEM RSS feed syndication for global FOAM
• Twitter: #FOAMed – #FOAMcc – #FOAMtox – #FOAMped – #FOAMus – #FOAMim

Brought to you by:

• Anand Swaminathan [AS] (EM Lyceum, iTeachEM)
• Brent Thoma [BT] (BoringEM and Academic Life in EM)
• Chris Connolly [CC]
• Chris Nickson [CN] ( iTeachEM, RAGE, INTENSIVE and SMACC)
• Joe-Anthony Rotella [JAR]
• Kane Guthrie [KG]
• Mat Goebel [MG]
• Segun Olusanya [SO] (JICSCast)
• Simon Laing [SL] (HEFTEMCast)
• Tessa Davis [TRD] (Don’t Forget The Bubbles)
• Marjorie Lazoff [ML]

The post LITFL Review 198 appeared first on LITFL: Life in the Fast Lane Medical Blog.

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Why doctors and digital experts should work together to improve patient health

As a family doctor, I have seen a dramatic shift in the range of people I work alongside every day — all for the better. When I was in training, most family doctors worked only with other family doctors and registered nurses. Today my health care team is rich with a variety of critical skills, […]

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I despise my EHR. But I’m still using it.

Modern electronic health records (EHRs) have become the norm in U.S. health care — nearly 80 percent of office-based physicians use them, up from 40 percent in 2009, according to federal data. But while adoption is up, satisfaction has plummeted. In 2010, about 61 percent of physicians liked their EHRs (were satisfied or very satisfied, according […]

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The story of the pot-smoking neurosurgeon is more complicated than you think

A brief article recently posted the name and picture of a neurosurgery resident accused of smoking marijuana on the job.  Dr. Gunjan Goel, MD is a neurosurgery resident at University of California, San Diego, and the list of her awards and publications alone is almost as long as my entire CV.  The article is brief, […]

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Doctors should beware the attribution sign. Here’s why.

When getting a medical history, patient attribution can be very helpful.  We are even taught in medical school to specifically ask patients what they attribute their symptoms to.  For example: Doctor: “What do you think is causing this pain in the right upper part of your abdomen?” Patient: “It happens every time I eat a […]

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How a head CT changed everything for this patient

From her vantage point, cost had nothing to do with money. On most days, she struggled to her feet when I entered the room, greeted me effusively, and escorted me to her bedside chair, all the while chattering about the inadequacy of our hospital’s slushies, the beauty of the day outside, and the latest update […]

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Are physicians really to blame for the opioid addiction epidemic?

During my training in the 70s, heroin use dominated our substance abuse horizon.  We saw many patients with IV drug-related complications.  We saw heroin overdoses. For the next 30+ years, we rarely heard about heroin.  Over the past 10 years we have seen increasing opiate abuse, but the opiates came from prescriptions.  Over the past […]

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Test your medicine knowledge: 33-year-old woman with atrial fibrillation

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 33-year-old woman is evaluated as an outpatient following an episode of atrial fibrillation. The episode resolved shortly after she arrived at the emergency department. She has a history of tetralogy of Fallot with repair performed at the age of 4 […]

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The human cost of breast cancer screening

Karen Vogt’s breast cancer journey began like many others, with her breasts painfully squeezed into a mammography machine. At age 52, it was far from her first mammogram, but this scan would be the most consequential by far. It revealed microcalcifications, little areas of breast tissue speckled with deposits of calcium that her radiologist worried […]

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