EMCrit Rant – Risk in Emergency Medicine

Warning-This is not an ED Critical Care Podcast, it is a rant. Rants will be featured periodically and irregularly; feel free to ignore and delete them.

This one was spurred by a post by Chris Nickson, aka precordialthump.

The post led me to an incredible lecture by Dr. David Schriger given at the most recent All LA Conference. You should go and listen to this lecture:

Link to Dr. Schriger’s Talk at alllaconference.com

The issue of critical thinking in EM was once dear to my heart. I even wrote a book about it, when I believed that print publishing was not a bloated and dead enterprise.

But the flash and glamor of critical care soon eclipsed my love of critical thinking. However Dr. Schriger’s excellent lecture stirred up this old romance.

In this brief rant, I discuss three additional points that occurred to me as I was listening. But remember, you will be far better served using your time to listen to his lecture than my rant.


photo by Rionda


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  1. says

    G’day Scott,
    Rest assured, I’m a huge fan of ‘Emergency Medicine Decision Making’ since stumbling on it in the library at Royal Darwin Hospital a few years ago, and I continue to proselytize the book to everyone I meet – so I suspect you’ve got at least a few readers Down Under… It should be required reading for all emergency medicine trainees.

    BTW, great rant! Perhaps you should do it more often… Feeling better, mate?

    • emcrit says

      Thanks Chris

      I’m more and more convinced that I should just move down to Australia/NZ.

      And and I do feel better!

  2. R taylor MD says

    so true, so true, especially the “normal ekg” crap. I work in georgia and 20 year olds do not have normal ekg, evryone has lvh as htn is epidemic, great rant

  3. says

    Hi there!
    Excellent points, thank You!
    First time in years, following USA EM I felt that we in Slovenia/EU have at least something better in medicine already in place; like a GP in our ED, because people indeed are starting to abuse ED’s convenience…
    But problems regarding risk & Social Consensus over Aceptable levels of it are getting stronger, as is Fear of Lawyers… (that was truly bad US export ;-(
    all in all, I likes the format, please keep it all in one drawer & announcements.
    THX FOR GREAT WORK, gregor

  4. paul says

    stumbled across your blog and have been slowly going through them from your first entry. awesome stuff. trying to implement your material not just “downstairs” but downstairs in the community setting.

    this was a great rant. am impressed that a top-flight academic such as yourself would be willing to put up a rant that has such potential to be interpreted as whiny. absolutely agree with all of your points. very sad that your ideas are probably pipe dreams. we can all hope i suppose.

    the unfortunate loophole that gross negligence should remain a valid reason to sue an individual physician is what the lawyers will cling to, since the accusation, no matter how absurd, is apparently enough grounds to charge forward and throw the doc into the civil litigation woodchipper. and yet true gross negligence SHOULD be punished. so what the hell are we supposed to do?

    anyhow keep up the good work and i will try to comment in the future on one of your “real” posts… it’s just that this happens to be one of my “buttons.”


  5. Robert S. says

    Catching up on all the old emcrit podcasts, so sorry for the post necromancy.

    I’m commenting as a health care “consumer” as it were. I would love to see non emergency 24 hour clinics where I could go when a migraine failed to respond to my medications and get treated without tying up an ER bed, and ending up with $4k in bills (after insurance, and no diagnostic imaging)

    Shifting malpractice liability to the hospital end makes quite a bit of sense. One of the things our system simply does not account for right now is the various costs of reversing medical mistakes. If a mistake is made, there is no way for the patient to avoid potentially ruinous costs to fix the problem(s) created other than to go to court, and to go after the doctor, medical group, etc etc etc. On top of that given that medical boards, hospitals, and medical groups have proven themselves time and time again worthless in keeping bad doctors from harming patients. True negligence should not occur for a doctor. One single case of true negligence, of behaving with disregard for the patient, should result in the immediate revocation of a doctors licence. If we find a way to remove truly dangerous doctors, and not shift the costs of mistakes on to patients, then tort reform makes sense, without those two steps tort reform is just another way for malpractice insurers to screw those harmed.

  6. says

    It seems that the AllLAConference website is down, whether permanently or not is unknown. I’m quite interested in listening to his lecture; do you have a copy of it you could put up or send to me?


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