Anyone who has taken the time to make it through my entire post on performance under pressure knows that I have spent a lot of time reading and thinking about stress and the ways it affects us in emergency medicine. I read hundreds of articles and books when preparing my lecture and post on the topic, which is why I was particularly surprised when I was asked to comment on the literature discussing gender differences in the stress response. Despite all my reading, I hadn’t come across a single paper on the topic. Continue reading “Tend and Befriend: Sex, gender, and performance under pressure”
Comparing adenosine to calcium channel blockers in the management of SVT
Hi sir. My name is Dr. Morgenstern. That racing feeling in your chest… it’s something we call SVT. That just means that you heart is going too fast. I’m going to get it slowed down for you. All that silly stuff we just did – getting you to blow in a syringe and raising your legs above your head – that sometimes works, but honestly, I have never seen it work myself. It’s time to stop asking you to “bear down” and move on to using medications to slow your heart down. Right now, your blood pressure is fine and you have no other problems, so we have a few options.
Option number one is a medication that works about 90% of the time, but it causes a horrible feeling when it is given. Some people describe it as chest pain. Others say is feels like they are going to die. Most people tell me it is the worst thing they have ever experienced.
Option number two is a medication that works closer to 100% of the time and doesn’t cause any pain at all.
Which would you prefer?
We all mistakes. It’s better to talk about them.
My heart is pounding. My stomach is in a knot. I can’t think straight.
I made a mistake. Continue reading “The conversation that extended my career”
My transition from medical student to practicing diagnostician was marked by one key realization: doctors don’t make definitive diagnoses. Many think that we do. Our patients are certainly under that illusion. But even at the best of times, the physician’s job to to determine the probability of disease. Continue reading “Communicating diagnostic uncertainty”
I don’t know how much of what I “learned” in medical school I have since forgotten. It is a lot. Probably more than I remember. I did great on exams, but then it was time to move on to a new semester and piles of new information took priority over the old. There was no time to review or consolidate.
At the time, this just seemed like the way that learning was done. It wasn’t much different from my undergraduate routine: cram for an exam, get the marks, and move on to another topic. This was the way medical school was structured. The expert educators behind my medical school curriculum obviously knew what was best for me – right?
But where is all that knowledge now? Why did it feel like I had to start all over again in residency? Why do the residents I teach now, fresh out of medical school and close to that wealth of information, so often struggle?
We spend so much time trying to learn medicine, but we never really learn how to learn. This post is basically a review of the book “Make It Stick” by Peter Brown, Roddy Roediger, and Mark McDaniel.1 I wish I had been given this book before starting medical school. Actually, it would have been more beneficial before starting university, or even high school. It explains clearly why learning seemed so easy but ephemeral. I had excellent marks throughout high school and university – but if you made me take an exam from any of my past courses right now, I would almost certainly fail. Is that really learning?
These are the key lessons I wish I had learned long ago: Continue reading “Making it Stick”
Survival lessons from the book “Deep Survival: Who lives, who dies, and why” adapted for the ED
“Deep Survival: Who Lives, Who Dies, and Why” by Laurence Gonzales is a book about life and death. It explores disasters – at the top of mountains, in the middle the ocean, in the most remote wilderness – and examines why some people live while others die. Gonzales concludes with book with some advice designed to help readers survive. As I read his advice, I was struck by how applicable it is to the practice of emergency medicine. These are his survival lessons, adapted for the ED: Continue reading “Survival lessons for the emergency department”