Big Picture of the Old Testament: Recent Episodes
Donald W. Crowe, MD
Contrarian ideas and commentary on important topics in emergency medicine drawn from the experience of 35 years of practice as an emergency physician. Published monthly, the lessons discussed will be controversial and relevant to the practicing clinician.
In the early 2000's a pharmaceutical giant began a marketing campaign that re-defined sepsis and its management. In this episode are review this sordid interaction between money and medicine.
During my 30 year practice of emergency medicine, sepsis has transitioned from being a descriptive term for a patient being overwhelmed by infection into a distinct disease process. Unfortunately this has lead to serious problems. In this episode I discuss my experience witnessing this transition and how is this change evolved.
Many patients present to our emergency departments with worrisome symptoms, but we physicians can find no objective evidence that they have disease. In this episode, I present a hypothesis to explain what is causing this confusing situation. By offering our patients an understandable explanation for what is happening to them we can more effectively reassure them and begin the journey toward relief.
Each day emergency physicians see patients whose potentially serious symptoms cannot be explained after comprehensive evaluations. These patients seemingly have invisible disease. Many such patients return repeatedly convinced they have, as yet, undiagnosed dire medical conditions. Just what is going on?
We must extract critical information from those who come to us despite difficult circumstances. In this episode I discuss lessons derived from taking 200,000 histories from patients and identify several questions that have helped me clarify confusing patient encounters.
We must extract critical information from those who come to us despite difficult circumstances. In this episode I discuss lessons derived from taking 200,000 histories from patients and identify several questions that have helped me clarify confusing patient encounters.
We must extract critical information from those who come to us despite difficult circumstances. In this episode I discuss lessons derived from taking 200,000 histories from patients and identify several questions that have helped me clarify confusing patient encounters.
Wouldn't it be great if there were a test available that could reliably tell the emergency physician how far down the slippery slope toward death the unstable patient before him/her had progressed? Oh wait, we have one. Why are we are being told not to use it?
Our specialty faces threats from without and from within. In this episode these threats are further examined and methods of defending our specialty and ourselves are discussed.
Although younger emergency physicians may not recognize it, our specialty is under siege. From the perspective of 30 years of practice I discuss how the primary skill which makes a specialists is becoming devalued in a misguided quest help us "improve our practice" by those who have other agendas.
Pressure is mounting for physician support for "medically assisted treatment" for those with addiction. Unfortunately, in actuality, this strategy results in disease perpetuation, keeping our patients dependent and sick. True recovery however is possible and enjoyed by millions. In this episode I outline the components of effective treatment of addiction and how the emergency physician can introduce these concepts when their patient expresses interest in achieving recovery.
Are emergency physicians missing an opportunity to diagnose a potentially life-threatening disease because we have no clear understanding of the nature of that disease? I believe that this is the case but that it doesn't have to be this way.
Despite what emergency physicians have been led to believe, treating symptoms is important...just ask your patients. What's more is that it is no one size fits all. In this podcast I reveal the secrets to pain management you won't hear elsewhere.
In this podcast I conclude my discussion of hypertension and describe management of patients whose only reason for coming to the emergency department is a disturbing reading from their home blood pressure monitoring devices.
In this podcast I conclude my discussion of hypertension and describe management of patients whose only reason for coming to the emergency department is a disturbing reading from their home blood pressure monitoring devices.
What if everything you thought you knew about something as basic as high blood pressure turned out to be wrong? In this episode I discuss my experience with a seismic shift in my understanding of hypertension and how this has fundamentally changed my practice.
Let the heresy begin! In this month's episode I discussed how my experience of running thousands of codes has convinced me that training hospital personnel in ACLS is doing more harm than good for our patients.
In this inaugural episode I discuss the concept of experience based emergency medicine practice. I also offer three important lessons learned from 35 years experience that have been essential in combating burnout.