MD Cents: Who is Wealthy?

Many people define a wealthy person in many different ways. It depends on whether you define wealthy in terms of emotional, spiritual, relational, or financial issues. As this series deals with finances I took some time to ponder this over the past weeks. I just finished a book titled, "The Millionaire Next Door," by Thomas Stanley and William Danko. It was written in 1996 but has fascinating insights into millionaires' lifestyles. In their book, they define someone as financially wealthy if their net worth is $1 million or more. How do you define your net worth? Net Worth = Assets - Liabilities Net Read more [...]

Promotions and Academic Scholarship, Part V – Preparing for Promotion

For those of you jr. or mid-level faculty who are thinking...what are the next steps for Academia?  Or senior-level faculty who have been doing the same things for a decade or longer?  Or even the spry, recently added faculty looking to promote past Clinical Instructor... all of these folks have academic promotion on their minds.  Because PEM occupies an interesting clinical niche that is not standard throughout the US and Canada and abroad, there some interesting work that you have to do to at least begin thinking about promotion. Most promotion details are housed somewhere deep in the University Read more [...]

Termination of Pediatric Resuscitation – the Elephant in the Room, PART 2

The acuity of the pediatric emergency department at St. Louis Children's Hospital is the highest I have encountered. While this has been an excellent experience for me as a junior faculty member, those instances requiring me to terminate resuscitation in a child have been difficult clinically and emotionally - driving me to analyze the process and sit with the "elephant in the room" previously introduced in the PEMNetwork's Termination of Pediatric Resuscitation PART 1. I cared for Child A that sustained a gun shot wound to the head. The child arrived to my care within 30 min of the Read more [...]

Termination of Pediatric Resuscitation – the Elephant in the Room, Part 1

The picture of the grieving emergency physician who "couldn't save" a patient went viral in common media. However emergency physicians know that their emotions run even higher after we "couldn't save" someone because we are the "final call", the decision maker, the one that says "stop...right now." That responsibility in itself can make what might have been already a futile case feel gut-wrenching - especially when it involves a child. As pediatric emergency medicine physicians, we will all be faced with the decision to terminate a resuscitation following cardiac arrest. Clinically, this Read more [...]

What’s the plan, man? Assessing how trainees develop the plan of care

The Pediatric Milestones are now being used to guide the ongoing evaluation of trainees in all rotations. Certainly the most important Milestones vary from rotation to rotation. In the Pediatric Emergency Department (as in many others) making sure that you develop an effective plan for diagnosis and treatment is critical. This post is all about what we do multiple times a day: Developing a plan of care and carrying it out. Early/novice residents rely on theoretical knowledge that they gained in medical school. Having not seen the condition, especially in the context of the ED they lack the previous Read more [...]

Healthcare- heal thyself!

The other day, I as I scarfed a meal in 3 minutes flat – I thought to myself, why do I feel so guilty about eating? Doctors are never supposed to eat, pee or sleep. It is a sign of weakness. Some sauce dripped onto my shirt and stained like a scarlet letter. An object of scorn, an opportunity for a colleague to jab “hey what’d you get for me?”. I few years back, I wore the red cape of an ER physician, sacrificing self before everything else. Now I need to keep steady glucose levels during a shift or I won't function.  I also don’t bounce back from a night-shift like I used to. Read more [...]

Are We Doing It Right?

A 4-year-old patient was brought in for abdominal pain for the past day. He was brought to the ED a week prior with similar symptoms and was diagnosed with constipation. He has been taking Miralax regularly without improvement in bowel habits. We asked the parents how they use the medication. Their answer: feeding him the powder with a table spoon! Consider another patient I saw, whose father was concerned that she was vomiting blood. When we took a closer look we noticed that she was vomiting the red Gatorade she was trying to drink. In our profession we see many patients within a short Read more [...]

Do you have a guideline for that?

Clinical practice guidelines are an effective way of disseminating knowledge.  The best CPGs represent the culmination of research in a field translating into clinical practice and improved patient outcomes. Guidelines are generally produced by specialty societies and our young specialty has lagged other more established domains of medicine (GI, oncology, cardiology). The PECARN decision tool is a great example of knowledge translation (while not a CPG) that has been integrated into sites like med-calc and is used by ED providers across the country.  With the upcoming release of the Read more [...]