EM Docs is evolving! The original intent was to share the joys and challenges of practicing emergency medicine. Currently, upon the writing of this article, there are 12,590 members, with 99 awaiting verification. EM Docs continues to be an oasis of wellness for emergency medicine physicians around the world by bringing us out of isolation and providing a safety net for one another. The educational aspect is growing. Knowledge translation is accelerating by creating a network of learners and educators. Some residency programs have started using EM Docs discussions as a springboard for academic discussions.
Physicians as CEOs
There has been much discussion on EM Docs regarding physician-led care. The top hospitals, according to U.S. News & World Report, are disproportionately led by physician CEOs.
Currently, too many decisions that affect patient care are made without physician input. For example, on EM Docs, our poll demonstrated that almost 100 percent of the time, when a physician determines that their emergency department has reached a dangerous level and is at an unsafe number of patients, the decision to divert is made by an administrator, someone with no patient care experience, someone who is not in the emergency department or able to see the surge of critical patients. The decision seems to be financial rather than based on patient safety. Many EM Docs feel this represents a conflict of interest.
Some EM Docs are currently studying for their MBAs, law degrees, and MHAs. Most agree that they would like to see people with medical know-how in charge. Many pointed out in our discussions that MBAs are a “dime-a-dozen” and it is more about experience, saying, “There is no MBA that can match what an MD [physician] with experience brings to the table.” One made the point that “the letters certainly open doors.” Carrie de Moor, MD, a board-certified emergency physician who is CEO of multiple freestanding emergency departments in Texas said, “Physician-owned and -led hospitals are proven more profitable with better patient experience. Medicine should be led across the board by doctors.” One EM Docs member said that her two-physician family chose a hospital partly because it was physician-led.
Success Stories of Lidocaine
So many EM Docs continue to share success stories in the quest to avoid opioids. The use of lidocaine for headache and for renal colic has gotten recent attention on the site. For headaches, you can nebulize 2 mL of 2% lidocaine (without epi) mixed with 1 mL of normal saline. For renal colic, administer 1.5 mg/kg of 2% lidocaine (maximum dose 200 mg) mixed with 100 mL of normal saline given over 10 minutes (or longer to avoid nausea and lightheadedness).
Tips for Getting Charts Done
EM Docs continue to “poll” one another for tips and tricks of the trade. One recent discussion was about suggestions for getting charts done during a shift to avoid staying late to finish them. Solutions? Scribes. Build macros and favorites. Chart as you go. Get two-thirds of the chart done after walking out of the room. Do the discharge papers when you do the chart for patients without a workup. For patients with workup, do orders, history of present illness, review of symptoms, physical examination, and initial medical decision making, save/share/pend the note, and finish at disposition. Only stray from this for unstable patients. Take a laptop into the room, ask a few open-ended questions, and do the orders and the note while patients talk. It keeps away distractions and nurses and staff asking you to do something else. If there is an emergency, the staff will find you. Patients are happy because they think you are transcribing every word.
Dr. Moody, founder of the EM Docs Facebook group, is president of the Tennessee College of Emergency Physicians and former emergency department chair for Mountain States Health Alliance.