Carrots, sticks, and games for changing physician behaviors

New Year’s resolutions—sadly fading into the rear view mirror for many of us— are an exercise in breaking old habits and creating new ones. For example, I wanted to keep my kitchen workspace clean as I cooked—more like the professionals or at least the 9 year-old contestants on Master Chef Junior. But when I left home this morning, I had still had two used cutting boards, a salad spinner, and a bunch of mixing spoons and utensils strewn on my counter. Sigh. How many of you spent the first 2.5 months of 2015 working on a improving something in your life? And how many of you have been wildly Read more [...]

Top PAS Picks for the Pediatric Emergency Medicine Physician

PAS is just around the corner in San Diego, CA April 25th-24th.  With a program that reads more like a book, the options for learning and networking are endless.  The PEMNetwork is happy to recommend the following core meetings and fun workshops of particular interest to PEM. 1. The PEMNetwork meeting Saturday April 25th 1pm-2pm, Hilton Bayfront Hotel The PEMNetwork holds an in-person meeting only two times per year - at PAS and at the NCE.  These meetings are open to everyone with agendas based mainly on website improvement, newsletter topics, and mission reassessment.  Attending Read more [...]

Promotions and Academic Scholarship, Part III – Measuring Scholarship (publications)

Question: How many publications do I need to be promoted to assistant professor - associate professor - professor? Answer: Enough. This is a frustrating question to answer.  Part of knowing how scholarly you are means you have to keep track of publications.  Even though we know that multiple forms of scholarship exists, in the discipline of academic medicine, publications are still the gold standard.  We also know that not all publications are counted, ranked, or considered equally.  But most places do not offer specific guidelines, and your ability to be promoted (or at least know that Read more [...]
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Disruptive technology in PEM: A case for emergency ultrasound

Last week, a patient with systemic lupus arrived in the Emergency Department complaining of shortness of breath. She was mildly tachypneic and uncomfortable with any movement. A chest radiograph was ordered. While she waited, I did a quick bedside ultrasound (shown above), revealing a large right-sided pleural effusion, extending all the way to her axilla. Her bedside echo did not reveal a pericardial effusion. I went ahead and began planning her inpatient pleurocentesis. The CXR was done soon after and was read as possible effusion versus infiltrate of the right sided. How has my practice Read more [...]
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Answer: “This Is Spinal Tap.”

This post is in response to the post “This is Spinal Tap.” To summarize, this was a 3-week old boy who required a full septic work-up after he presented to the ED with a fever.   You performed a point-of-care ultrasound to help identify potential spaces to perform the tap and obtained 3 images. A                                                      B                                                      C   Thank you to everyone who took the quiz! 100% of you guessed correctly Read more [...]

Promotions and Academic Scholarship, Part II – Types of Scholarship

To view Part I, click here Today, we're going to discuss the types of scholarship - or, if you want to get really academic, as in the tweed jacket, brandy-swilling, elbow patches pontification academic - the domains of scholarship.  For those of us in basic sciences research, your type of scholarship is fairly linear and obvious: Kill rats and isolate their genetic whatever. Publish randomized control study research results like crazy. Get a zillion dollars in funding. For those of us not in basic sciences research, it's a little murkier.  In fact, even for those in Read more [...]

Getting testy: Parents who demand tests in the ED and doctors who may or may not order them

There are many demands in the emergency department. Perhaps the most important ones come from patients and their families. This post originally appeared on as a part of the Art of Medicine series and looks at those situations in which patients/parents are requesting - nay demanding specific tests. As I noted in a previous post in this series the ED is an emotionally charged environment. Often parents are seeking an answer as to why their child is ill. That answer may come in the form of a specific diagnosis or further elucidation as to the reason for particular symptoms. I'm sure Read more [...]