Who is the “Bad” Doctor?

During fellowship, I witnessed a very unusual thing:  the questioning of an internist in a courtroom in a malpractice suit. The plaintiff's lawyer was asking multiple questions, most of which were inquisitive about the nature of our work or the meaning of certain medical terms. The physician was being questioned by a lawyer before a jury lacking expert knowledge in both medicine and law. Since then I have been asking myself this question and what it really means to be “good” or “bad” in our profession.Shortly after that experience, I began my work as a pediatric emergency physician. I Read more [...]
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Answer: “Hips Don’t Lie”

  This post is in response to the post “Hips Don’t Lie” To summarize, this was 3-year old boy who presented with inability to bear weight on his right leg.  A hip ultrasound was performed and the following images were obtained: Thank you to everyone who took the quiz! For question #1, 87% of you guessed correctly that "B was the affected side", as evidenced by the large hip effusion measuring > 5mm.  4% of you thought that A was the affected side, 9% thought both were abnormal and none of you thought both were normal. Sonographic criteria for a positive Read more [...]

The drones are coming!

This post continues the July CPR technology theme. Nope- I'm not referring to the fresh crop of interns, 1st year fellows, or other newbies that grace the hospital system each July.  "Sure, I'd be happy to come in an assess that right lower quadrant pain before you order imaging".  I'm actually speaking about those flying quad captors that will deliver us packages, spy on our every move - and one day may help us to make a dent in out-of-hospital survival from cardiac arrest.  Check out this quick vid below to see the concept in action: https://www.youtube.com/watch?v=y-rEI4bezWc Survival Read more [...]
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Hips Don’t Lie

A previously healthy 4-year old boy is brought in by his parents because they noticed that he has been refusing to walk since this afternoon when they came home from work.  He had previously been doing well but parents noticed over the past few days he has been complaining of right leg pain without any limitation in his activity until today. He was in school all day but there was no reported trauma.  Aside from that, the child has not had any fevers, cough, runny nose, vomiting, diarrhea, abdominal pain or rash. He is well appearing and cooperative with your exam, as he is well distracted Read more [...]

MD Cents: Health Savings Accounts: But Wait, There’s More!

Late night infomercials often have the catch line “But wait! There's more!” right when you thought that the deal couldn’t get any better. Similarly many types of retirement accounts also have hidden benefits that make them impossible to turn down. The retirement account I want to focus on today is the health savings account (HSA). How can an HSA be a retirement account you ask? Used right, an HSA can be a cool vehicle to save money for retirement. Here is what some experts think about HSAs: "I think the health savings account is the best savings vehicle going!"-Kirk Kinder CFP  "A Read more [...]

Welcoming the Worst: Breathing Life into your Trauma Resuscitation

Being one of the few pediatric emergency departments to care for pediatric trauma patients up to age 18, St. Louis Children's Hospital sees more than its fair share of action.  While this exposure catapulted my experience, confidence, and clinical skills, hearing the trauma pager beep during my first few months as an attending evoked a Pavlovian response only completely summarized as nail-biting,  diaphoretic anxiety.  While the butterflies still flutter away to this day when that pager goes off, I learned to "welcome the worst" into the ED by taking several fast and easy steps to anticipate Read more [...]

Stayin alive– there is an app for that!

What is your chance survival if you were to drop dead while walking down a busy street in the US? As they say in real estate- location, location, location... Your survival depends on where you live and who is around you.  While cardiopulmonary arrest (CPA) affects individuals of all ages and health status, each minute of without high quality CPR increases the chance of death.  CPA kills half a million people each year and is the third leading cause of death in the US.  Unfortunately, in the US < 3 % of the population receives CPR training each year-- in contrast this number is Read more [...]