NYT shout out to Emergency docs

[WildcatS11]

http://mobile.nytimes.com/2015/05/03/opinion/sunday/maureen-dowd-stroke-of-fate.html?referrer=

I especially appreciate the emergency department being likened to a run down gas station.

Did this guy think the ED doc saw the dead brain tissue and that was it? I'm sure the radiologist didn't interpret the images. I'm sure neurology wasn't involved for a 40 YEAR OLD WITH A STROKE!

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[goodoldalky]

What a *****ic comment. Sounds like this old codger needs to retire because he has no idea what he's talking about. What he should say is that if you think you're having a stroke, you need to get your ass to the nearest emergency department in an ambulance as fast as you can because that is the ONLY PLACE you can receive the expert evaluation and treatment needed for this condition. What a misleading disservice to NYT readers.

 

[namethatsmell]

The supreme irony here is that a neurologist is calling EP/EDs dangerous when THEY are the blind champions of arguably the most dangerous drug given in medicine. A drug with no solid evidence supporting it in the context of current patient selection and rife with high risks. I'd be surprised if any EM or neuro resident at a stroke center goes through training without caring for a patient who suffers a hemorrhagic conversion after receiving lytics.

I'd love to see another article where our Harvard friend spews his spin on TPA. I can see it now: "We have all this great industry-sponsored data saying TPA may be super-duper for brain problems. The only problem is that our board-certified ED colleagues impartially view the data and want more solid evidence. Unfortunate, they won't go to the drug company dinners to hear the latest research."

I love it when ignorant specialists cast baseless aspersions against our field in an effort to inflate their own egos and sense of worth in the eyes of the patient. The epitome of naïveté and classlessness.

 

[link2swim06]

The supreme irony here is that a neurologist is calling EP/EDs dangerous when THEY are the blind champions of arguably the most dangerous drug given in medicine. A drug with no solid evidence supporting it in the context of current patient selection and rife with high risks. I'd be surprised if any EM or neuro resident at a stroke center goes through training without caring for a patient who suffers a hemorrhagic conversion after receiving lytics.

I'd love to see another article where our Harvard friend spews his spin on TPA. I can see it now: "We have all this great industry-sponsored data saying TPA may be super-duper for brain problems. The only problem is that our board-certified ED colleagues impartially view the data and want more solid evidence. Unfortunate, they won't go to the drug company dinners to hear the latest research."

I love it when ignorant specialists cast baseless aspersions against our field in an effort to inflate their own egos and sense of worth in the eyes of the patient. The epitome of naïveté and classlessness.

Can I like this X 100?

That's what the NYTs should be reporting on...how industry successfully bought off the experts and essentially created a standard of care that repeatedly harms patients.


People can give EM crap all the time...but bottom line is when their family member is direly ill where do you think they will be?

 

[CliveStaples]

I have many questions for Dr. Caplan.

1) Do you understand how a hospital functions? You seem not to understand the purpose of the ED as a point of entry into the hospital system and its purpose is to identify and stabilize life threatening pathologies and that the problem with her care following her initiation presentation lies on her neurologist (because a neurologist was surely involved in her case).

2) Do you not understand that diminishing the reputation of the point of entry into our medical system is simply begging for people to die? Not only is your kind of statement unprofessional ("bashing" colleagues always is) but dangerous.

3) Does your Rolls Royce not receive gas from a gas station? For that matter, do you even know that Rolls Royce sells terrible driving machines that nobody under the age of 70 or with an intelligence above Paris Hilton or Kim Kardashian (actual Rolls Royce owners) would spend that much money to buy? Forget the handcrafted British status symbol - the Brain is an Audi R8. German engineering for life

 

[womp]

the Brain is an Audi R8. German engineering for life

Audis have a reputation for poor reliability.

 

[Birdstrike]

There's a simple solution to all of this. When this arrogant jerk comes to an ED near you, regardless of when, where, why or what for, consult a neurologist and walk away.

 

[CliveStaples]

Audis have a reputation for poor reliability.

The brain, too, will break down over time and with inadequate maintenance.

 

[deleted109597]

So far Joe Lex and David Rosen have responded. Unfortunately, like all internet comments, they're scattered amongst a huge pile of ****.

 

[Xerxes1729]

He's not wrong that a young person with a stroke should have a CT angiogram.

On the other hand, if you read between the lines in the column, that was done.

"He ... looked at her brain and vascular images. They had been misinterpreted by the Maryland doctors, who thought that Tara’s vertebral artery had closed when it had just narrowed, meaning it could open and heal."

So the thing he's criticizing other doctors for not doing - getting vascular imaging - was in fact done. I don't know about you guys, but I don't determine occlusion v. dissection on angiograms, so it sounds like the radiologist or maybe even the neurologist (!!!) at the original hospital is the source of the error.

I like asking specialists who complain about EM what there solution is to what they see as our lack of competence, such as consulting them for every patient with a complaint referable to their specialty. This seems to cause their desire to improve patient care to evaporate.

 

[Old Grunt]

Does anyone have Dr. Caplan's pager number? I want to page him the next time one of the patients in my inner city hospital has a "problem with their brain" between the hours of 1700 - 0900 and I can't get a neurologist to pick up the phone.

I am sure he will be interested in saving a completely uninsured patient from the care of a gas station attendant.

The phone call alone would be worth all the trouble I would get in for making it.

 

[Arcan57]

That's the problem with EM docs. They get all thin skinned when told they're useless and dangerous.

 

[Janders]

One doesn't want to be thin-skinned, whiney, and weak when insulted. One also does not want to roll over and offer no resistance to insults/bullies. In EM, it can be a very delicate balance as this type of thing comes up frequently with specialists, consultants, admitting physicians, etc.

In this case, I think this this rebuttal is well done--
http://www.huffingtonpost.com/david-h-newman-md/quiet-fortitude-in-the-er_b_7209372.html

 

[deleted109597]

Popped on over to the neuro forum to see if any of this had crossed their radar.
Nope.
Guess it didn't pop out of the little bag they carry around.

 

[Birdstrike]

New York Times is unacceptably politically slanted, in my opinion. You shouldn't waste your time reading it, and it's been steadily losing readership and is headed for insolvency. This is the nonsense they routinely produce and such a view point is not remotely surprising to me. It fits their false narrative: "Rich, greedy, overpaid doctors fleece the system with their incompetence rewarded by the evil fee for service payment system," which in their eyes is controversial because it rewards actual work. It's okay for them to get paid for each article they write, each day they show up to work, each "service" they provide, but for us it's evil because we only bilk patients with unnecessary treatments and services (so they say), whereas they are pure and altruistic in their work.

Dr. White Coat takes down Dr Caplan and the author of this article. Read his article, comment and share.

http://drwhitecoat.com/louis-caplan...&utm_campaign=Feed:+drwhitecoat+(DrWhiteCoat)











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Birdstrike on DrWhiteCoat.com

http://drwhitecoat.com/?s=Birdstrike


and KevinMD.com

http://www.kevinmd.com/blog/?s=Birdstrike

 

[LaBusqueda]

Dr. White Coat killed it Splendid job!!

 

[meister]

Guess it didn't pop out of the little bag they carry around.

Hahahahaha

 

[Janders]

an apology.

 

[namethatsmell]

an apology.

Link doesn't seem to be working.

 

[Birdstrike]

Link doesn't seem to be working.

Go to "more," then "web view," then log back in, in web view. Then you can see it. Or look on a desktop.

 

[Janders]

Here is the PDF attached...

 

[Apollyon]

an apology.

"Official Hospital of the Boston Red Sox"?

 

[Janders]

Damned straight.

 

[Janders]

The newborns even get a red sox hat!

 

[WilcoWorld]

I just realized that this ED-bashing author also brought us this piece of investigative journalism.

She can't even follow instructions on how to get high. Good thing she's influencing national discussions on emergency stroke care.

 

[Birdstrike]

I just realized that this ED-bashing author also brought us this piece of investigative journalism.

She can't even follow instructions on how to get high. Good thing she's influencing national discussions on emergency stroke care.

Classic New York Times.

 

[deleted682700]

Emergency room physicians are heroes. As an anesthesiologist, I marvel at how they are able to take care of 40 patients in a 12 hr shift. Diagnose and treat life threatening emergencies. Able to run codes while being interrupted by mid levels for common colds.
My friends in the Emergency room tell me all the stories that doesnot make to the nyt or wash post. So many times they start streptokinase and shock the patient when they have a reperfusion arrhythmia. It's night and day for the patients.
Ordinary Americans are not fools. They know who is on their side. At the end of the day rest does not matter including who pays or who is the admin in charge.