Our goal in diagnosing acute coronary syndromes is not to diagnose ST-elevations but coronary artery occlusions leading to myocardial infarction (OMI). In the past, we diagnosed heart attacks by looking for Q-waves, thus missing all the ST-elevations. EKG manifestations only are a marker for what's going on underneath. Within the broad bucket of NSTEMI, 25% … Continue reading Occlusion MI
Introduction to Quality Improvement
Quality Improvement is the business of making healthcare better. This is based on the same systems that drove Toyota to become a world leader in making cars. They concentrated on constantly making their processes better. Seems like the same should apply to healthcare. In fact, Paul Batalden said, “In healthcare everyone has two jobs: to … Continue reading Introduction to Quality Improvement
Understanding “Human Error”
Humans make mistakes. Any system that depends on perfect performance by humans is doomed to failure. In fact, the risk of an accident is more a function of the complexity of the system than it is the people involved. Humans are not the weak link in a process. We are a source resilience. We have … Continue reading Understanding “Human Error”
Fuzzy Matches in Google Sheets
When trying to build our curriculum inventory I needed to match thousands of strings in Google Sheets. Doing this manually would have been tedious and prone to error. The EQ function would fail if there was one character different, forget about objectives that had words shifted around. Here’s my script that outputs the percentage of … Continue reading Fuzzy Matches in Google Sheets
Infective Endocarditis
IE is an infection of native or prosthetic heart valves, endocardial surface or an indwelling cardiac device (such as a pacer or defibrillator). In recent years, we’re seeing it happen in older and more chronically ill patients. And more MRSA. The diagnosis is tricky because the presentation can be fairly subtle. You need a high … Continue reading Infective Endocarditis
How to Take Smart Notes
In his book1, Sönke Ahrens describes two things to improve writing productivity: Routines for writing A system for organizing notes and ideas He breaks down the daunting task of writing by pointing out: Writing a book or manuscript would be easy if someone gave you the first draft. Writing the first draft would be easy … Continue reading How to Take Smart Notes
True Grit: The Surprising, and Inspiring, Science of Success
The importance of perseverance Angela Duckworth's work suggests that perseverance is a predictor of success. During her graduate student days she created a "grit scale" which she subsequently tested throughout her career. She characterized "grit" as working hard and finishing what one begins and gives the example of Will Smith explaining in an interview that … Continue reading True Grit: The Surprising, and Inspiring, Science of Success
Non-Traumatic Lower Back Pain
Most of us will have lower back pain in our lives (80–90% lifetime prevalence) and it accounts for 2–3% of ED visits (so quite a bit). As with everything in EM, there are benign and serious causes and we need to differentiate between the two. The serious causes include diagnoses in the back and those … Continue reading Non-Traumatic Lower Back Pain
Single payer is not socialized medicine
I am not advocating for socialized medicine or even single payer, but it is important to distinguish between the two. The Economist this month had a great article on the different setups we see today. Private Insurance, Private Doctors In this system, private insurance pays private doctors. There is no interference from the government but … Continue reading Single payer is not socialized medicine
Graham-Cassidy Bill Doesn’t Add Up
The latest Republican health care bill meant to replace the Affordable Care act comes from Senators Bill Cassidy (LA) and Lindsey Graham (SC). This one presents a more substantial change to the way things are run. Most of this comes from an article in the 9/23/2017 issue of the Economist. The Federal government would play … Continue reading Graham-Cassidy Bill Doesn’t Add Up
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