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:
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
Update:
Click through for Chris Nickson's Take
Listen to the Rant…
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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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?
Cheers,
Chris
Thanks Chris
I’m more and more convinced that I should just move down to Australia/NZ.
And and I do feel better!
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
thanks so much for the support
Scott
hi
do u recommend venous or arterial lactate?
either is fine, but no reason to get arterial if you don’t have an a-line
Scott
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
thanks for the support, Gregor.
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… Read more »
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… Read more »
I agree, there should be a system to address costs separate from medmal.
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?
Its been 8 years since this podcast. Do you still feel the same way? Has the proliferation of free standing EDs and urgent care centers helped?
My guess is no because they seem to siphon only those patients with the ability to pay up front.
only thing that has changed is the validation of chest pain rules to allow discharge of these patients.