Podcast of ExBEM

I once thought that having made a diagnosis and recommended  its treatment that I could now move to the next patient. Experience has taught me  however, that it is now that the crucial work begins.

Ready or not artificial intelligence is here. Does this mean that physicians are soon to be out of a job? On this episode I explain why our positions are secure, at least for now....

After a month to process my emergency appendectomy, on this episode I describe my "take aways" from my encounter, or should I say collision, with modern American medicine.

I have had little experience being a patient... until now.   On this episode I share what it was like on the other end of the stethoscope, or in my case the scalpel.

Hospital administration continually reminds me that emergency medicine is a business.  If so, this begs the question - what are we selling?  On this episode I describe why my recent experience suggests that what we are selling is not really what our patients are looking to buy.  

Enormous pressure is being applied to turn emergency departments and the specialists who run them into something the were not meant to be.   This shift in focus threatens both our medical system and our patients.   On this episode I describe these changes and their origins.

On this episode I present an epitaph for the Coronavirus pandemic. I describe how and why it ended and discuss how we were convinced to  make sacrifices and fight in a war that never existed.

After two episodes spent defining the problem, on this offering I outline a prescription to treat our sick society.  We have the tools, do we have the will to try something new? 

If recent events reflect an American society that has become sick, what is the illness affecting us and how did it arise?  On this episode I argue that our attempts to engineer a " Great Society" have collided with human nature and the results have not been those expected.  

Do recent events prove that our society is sick? I believe that they do.  Does 40 years of experience caring for sick individuals justify my comentary discussing why it is sick and what can be done to cure it?  Decide for yourself.

Emergency physicians report the highest levels of burnout among medical specialities.  So how am I still tolerating and even enjoying (sometimes) going off to work after forty years? On this episode I explain why I've been lucky.

Things seem to go more smoothly when the "voice of authority" can be trusted to guide us along.  But can it?  Not if opposing viewpoints are ignored or repressed.

Can insights inspired by butterflies help us avoid the chaos that too often reigns in our emergency departments? On this episode I discuss "the butterfly effect" and why respecting it can help protect emergency physicians and patients alike. 

An emergency physician must know what to do under trying circumstances.  But before this can be done , he must first know what is happening and  when to do something must be done. On this episode, I relate how I began to learn these skills working a part time job in medical school.

As I struggled to become an effective emergency physician, I realized that my only hope was to put into practice the many lessons I had learned along the way. I now realize that everything I needed to know, I did not learn in medical school alone. On this episode I discuss other experiences that gave me the tools that I now use every day in my practice, and for that matter, my life.

On this episode I kick off the fifth year of the podcast by reflecting upon what has made spending my adult life practicing emergency medicine a satisfying endeavor.  After several offerings recounting concerns about my specialty, it is time to celebrate some of the  reasons I go to work.

What percentage of the patients that we admit to the hospital do we harm?  On this episode I reveal why when those charged with making the decision to admit forget the answer to this question, our specialty and our whole medical system pay the price.

The hypothesis:  Emergency physicians are providing less effective care now than twenty years ago. The Proof: longer wait times, more overcrowding, more cost, less job satisfaction. Who's to blame: us (among others) In this episode I take a hard look inward and discuss where emergency medicine has sabotaged itself.  

Covid 19 has exposed a dirty little secret that emergency physicians have helped keep for decades- there is not enough to go around.  Unfortunately the way things are headed, those best equipped to deal with the reality of limited medical resources are being pushed  aside - with predictable consequences.

The specialty of Emergency Medicine sprang into being in order to fill a need.  I'm concerned that we've lost sight of that need as we train those to whom we will pass the torch.  On this episode I begin a discussion of how and why our specialty developed and why keeping our fragile medical system afloat rests on our shoulders.

Pretending that there exists an "opiate crisis" obscures our society's real, much more difficult health crisis. On this episode I discuss what these real problems are and why accepting the delusion that opiates are the issue is leading us down a treacherous path.

Overdose deaths have tripled since our society acknowledged and declared war on an "opiate crisis".  Not surprising since much bigger problems are to blame.   In this episode I outline why beginning with the false premise that opiates are to blame only obscures our understanding of our troubles and thwarts our efforts to achieve positive change.

Unquestionably Americans are tragically dying of drug overdoses each day. In this episode I explain why calling this an "opiate crisis" is a smokescreen that obscures the problem making it more difficult to solve and perhaps making it worse.

What will be the aftermath of the coronavirus pandemic? On this episode I offer predictions regarding what to expect as we survey the post Covid 19 landscape. The central theme : we ain't seen nothing yet...

One year ago there was no data or experience to guide us as we struggled to defend ourselves against the Covid 19 pandemic.  We therefore relied on our leadership's best guesses.  In this episode I argue that it is time for individuals use the lessons learned in 2020 to replace guesswork and decide for themselves how best to protect themselves and their families. 

In the year since the first patients with Covid 19 arrived in our emergency departments, physicians have learned some hard lessons about treating this disease.  In this second installment of my "state of the pandemic address" I discuss what works...and what doesn't.

Data collected in 2020 has allowed us to paint an objective picture of the Covid 19 pandemic that seems quite different than the portrayal fed to us by the mainstream media.  What this data shows and why it is distorted by the evening news are explored on this months offering.

The rate of successful resuscitation of patients having a cardiac arrest in the hospital have not improved during the last 40 years that hospital personnel have been relying on ACLS protocols.  In this episode I discuss why ACLS fails and what it will take to move forward.

Ever thought in detail about how people die?  I suppose that for most this morbid subject is not dwelled upon, but for 40 years it has been a big part of my job.  Experience has taught me that people die in many ways.  And this is a problem since most medical personnel are trained to understand one model of the dying process and it is one that they are unlikely to often encounter. On this podcast I outline a different scheme for understanding this process that will finally allow caregivers to progress beyond ACLS.

What happens when non emergency specialists provide recommendations to guide emergency care?  Spoiler alert: ...nothing good.  And no better (or worse) example of this exists than ACLS.

The Coronavirus Crisis is over.  The justification for its existence has evaporated.  Ignorance and fear have been replaced by data and reason.  All that was left was for someone to declare it dead. And on this episode I do just that.

As Americans struggle to return to normalcy, we are constantly told what we must do to be safe.  These instructions come at us from all directions and are numerous, wide-ranging, and inconsistent.  In this episode I reveal the secret to safety from Covid 19 (and everything else).

The media continues to sow fear by distorting the truth.  As the coronavirus pandemic predictably and inevitably spreads, the misconceptions resulting from these lies poisons rational decision making both in individuals and society as a whole.  Emerging evidence supports an understanding of the pandemic contrary to the doomsday scenarios popularized by  the TV and internet.  

As an old white guy , I haven't had to consider how racism has shaped me.  But an odd thing happened as I became agitated watching the recent unrest....I started to sense that the protesters might be right.   They compelled me to revisit my beliefs, and on this episode I discuss some that have crumbled under the scrutiny.   

Despite significant concerns, our nation is reopening.  Now is the time to employ the "doctors best test" as we share the environment with corona virus.  There will be rough water ahead, not simply a second wave.  But by allowing ourselves not to be certain we can adjust our course frequently and keep our heads above water.

Americans are asking "when is enough enough"?   If we are to successfully unlock our national lockdown , we must first unravel the twisted truths used to convince us to support this policy.  In this episode I illuminate the "little white lies" that became the wrong reasons for doing the right (and ultimately successful) thing.  

We see them on the newscasts, our emotionally distraught politicians, pleading for ventilators - our "missiles in the war against Coronavirus".  Without expanding our supply people will die.  So with enough of them people will live, right?  On this episode I reveal how this lie, that is being fed by the media to a public hungry to trust its leaders, is only likely to worsen outcomes.  

The internet and TV report that corona virus tests are crucial but also scarce - so they must give an advantage to individuals trying to survive the pandemic, right?  (kind of like having lots of toilet paper).  Testing is important but not for the reasons that the media implies and misconceptions about testing continue to abound.  So here is a reality check.

Whether or not it is the medias's intent to distort the truth, the fact that it does has left most Americans encumbered with misconceptions that block an effective understanding of all things Corona.  In this episode I discuss the lockdowns enforcing social isolation, that are necessary for now, but not for the reason that people have been led to believe. And why understanding the real reason is essential for moving forward.

If your window on the world is provided by popular media, then the chances are great that your initial contact with the Corona Crisis has left you infected with misconceptions about the pandemic.  In this presentation I discuss how  this happens and why being burdened with these misconceptions is harmful.

The Corona virus crisis has gripped, perhaps strangled our society. Is this event the unprecedented medical apocalypse that the evening news and our political leaders are portraying?  It is a big deal but some historical perspective is necessary to balance our understanding of this pandemic. I present observations from the trenches we are preparing as we face this unknown .

I have argued that high blood pressure is not a disease but a sign - so a sign of what , exactly?  In this entry I explain why it is difficult to convince my colleagues to abandon the idea that high blood pressure is an imminent threat and how I reshape my patient's thinking regarding this vital sign .

It widely acceppted that high blood pressure is bad and causes heart attacks, strokes and and host of other maladies. Although this idea has intuitive appeal and is so widely held as to have become "common knowledge", the problem is that this belief is wrong.  In this podcast I discuss how this fallacious idea distorts our understanding and ultimately harms our patients. 

To understand the mysteries of medicine we are taught basic concepts we then use construct cognitive frameworks that allows us to interpret information, make predictions and formulate interventions.  But what if the original concepts are wrong? Experience has proven to me that many dogmatically held beliefs in medicine are flawed and negatively impact patient care.  In this episode I begin an analysis of this important problem.

Can  a non critically ill patient's physical exam yield information that is not more precisely derived from laboratory testing, imaging, or other technology?  Certainly.  In this episode, I discuss aspects of the physical exam that remain not only clinically relevant, but essential to understanding a patients pathology.

If we are being honest, most emergency physicians will admit that our physical exams have become subservient to technology as we evaluate our patients.  Does this mean that the physical exam is now just an archaic ritual?  Not so fast, my friends.  In this episode I describe those aspects of my physical examination I still fine crucial as I care for critically ill patents.

The big reveal! The top two negative changes to befall the practice of emergency medicine are finally unveiled.  How these have evolved and why they constitute a powerful malignant influence is examined.  

I move on to discussion of the "big ticket item" changes that have impacted the practice of emergency medicine one the last four decades. I outline what drives these changes and how they errode the quality of care provided in our emergency departments .

Forty years of experience have allowed me to develop skills and acquire knowledge that make the practice of Emergency Medicine a bit easier.  Thank goodness for that, since many other factors have appeared through the years that have had the opposite effect.  So with this episode, let the bitchin' begin!

During four decades of emergency medicine practice much has changed. In this podcast I describe what my experience has taught are some of the most beneficial changes that have improved the day-to-day practice of emergency medicine.

The boogey man's voice that is forever urging us to tread cautiously is a part of us, so how can we escape his influence? We can't. But we can balance it, making it less oppressive and allowing us to practice more confidently and less defensively. I present several strategies that experience has taught me to accomplish this.