Controversy: “The antibiotic course has had its day”

From the BMJ:

With little evidence that failing to complete a prescribed antibiotic course contributes to antibiotic resistance, it’s time for policy makers, educators, and doctors to drop this message, argue Martin Llewelyn and colleagues

Rural wait times for EMS more than twice that for urban, suburban areas

From Healthcare Dive:

  • Patients in rural America can wait up to 30 minutes for emergency medical services (EMS) after dialing 911 — far longer than the average interval of 7 minutes, according to a new study in JAMA Surgery.
  • The researchers analyzed 1.7 million EMS runs in the U.S. and found average wait times of 6 minutes in urban and suburban zip codes, compared with 13 minutes in rural ones. But one in 10 calls to 911 in rural areas resulted in waits just shy of 30 minutes.
  • The findings point to the need for trained bystanders who can intervene in cases that are time-sensitive like severe allergic reactions, heart attack or severe bleeding, the researchers say.

Doctors view technology as largely problematic

From Reuters:

Technology offers doctors a view inside patients’ hearts, brains and bowels. And technology may speed the diagnosis of diabetic retinopathy, the leading cause of blindness, said panelist Dr. Jessica Mega, who leads the healthcare team at Verily, formerly Google Life.

Nonetheless, 69 percent of the 100 doctors in the audience said increased reliance on technology and electronic health records only served to separate them from their patients.

As evidence of the problem, the panelists cited apps that claim to do things they don’t really do, like accurately measure blood pressure.

But the biggest problem stemming from technology for the doctors, and the bane of many doctors’ existence, is the electronic health record, also known as an EHR.

The overwhelmed emergency physician

From Kevin MD:

I see it time and time again. Overwhelming numbers of patients with increasingly complex medical and social problems, versus inadequate physician coverage at all hours of the day, and especially the night. We’ve all done it. Already fatigued, we have five chest pains yet to see, as well as a trauma on the way into the department. Two more patients have fever but don’t speak English, and we’re waiting to make the translation line work. And there’s a large facial laceration yet to be repaired. And that’s just the first nine patients. It’s not even three hours into the shift. (And the EMR backup is in process.)

Why Low-Acuity Patients Often Complain

From Emergency Medicine News (hat tip: Dr. Menadue):

Patients, just like everyone else, experience cognitive dissonance. Sometimes they feel it in the ED when two ideas conflict. The decision to seek care is not an easy one. When they realize they’ve misjudged their emergency, they experience cognitive dissonance about their acuity, or more specifically, acuity dissonance.

Low-acuity patients still have nonmedical needs, even though their medical needs are easy to meet. But these nonmedical needs are legitimate. Rushing them through their encounter is a disservice to everyone. Inexperienced doctors make the mistake of ignoring acuity dissonance at their peril.


Let’s understand something about the American healthcare system: The problem is not the emergency department nor emergency physicians

From Becker’s:

Our emergency physicians and their departments have been described as the safety net of our healthcare system. They are available 24/7/365 to everyone. They represent the healing edge of our system today, in many ways far more than a safety net. Emergency physicians are positioned within our healthcare system as both master diagnosticians and masters in knowing all of the strategic nuances of care alternatives, follow up sub-specialists and downstream care options within their hospital systems for their patients.

Rural Hospitals Across Tennessee At Risk Of Closing

From News Channel 5:

Decatur County General is hardly alone in the struggle to stay open. Nationwide 81 rural hospitals have closed since 2010. Nine of those closures have happened in Tennessee, county run hospitals from the eastern mountains to the Mississippi River have disappeared. The only state with more rural hospital closures than Tennessee is Texas, where in 2013 an 18-month old died after being rushed to an emergency room that her parents didn’t realize had closed.