I am the Kwai Chang Caine of Emergistan

Good morning Emergistan!  I haven't posted in a long, long time.  But I'm going to try harder to post here, in addition to my www.edwinleap.com/blog site.  The reasons?  Well, there's a lot to say about Emergistan these days.  As the ACA collapses all around us, refugees are streaming across the border to Emergistan.  It's because they still can't get insurance, or because they have it but can't get doctors, or because their doctors always press the default 'we're too busy so just go to the ER' button.

Furthermore, there's always plenty of silliness to report here in Emergistan.  For instance, Electronic Medical Records increasingly causes misery.  I know of a hospital that changed to a new system, and the nurses were on the verge of tears and one of them was having violent dreams...all consequent to the shiny new system.  Charts done on EMR are beginning to resemble hieroglyphics but less decipherable.

In addition, I'm doing full-time locums work now, taking sabbatical from my job of 20 years.  I consider myself a reporter, roaming the land to look for wonderul stories, for shared goals and difficulties among healthcare providers, for clues on how to make it better and for problems and toxic policies that need to see the light of day. I'm the 'Kwai Chang Caine' of Emergency Medicine now.  (If you're old enough to remember the show Kung Fu with David Carridine.)

'When you can snatch the Lortab from my hand, grasshopper...'

And there's one more.  If all goes well I'll have a new book this year, a compilation with Emergistan in the title.  Something that will continue, I hope, to show the world what we do, why we do it, and give hope, laughter and insights to my fellow travelers.

So welcome to 2014 Emergistanis!  Let's travel the new year together.

Semper a Decem!

Edwin

Emergistani dietary habits:

The official food of Emergistan may well be MacDonalds.  In fact, there should be a special meal, the 'McEmergency Meal.'  It would have large fries, two double cheeseburgers, two milkshake and two large sweet teas.  The idea being, when you take a friend or family member to the ER, you'll want to eat.  And so will the patient!  I mean, a person can't be expected to wait around with 10/10 abdominal pain but without a snack, right?  Anyone who works in Emergistan has observed this phenomenon.  Followed by the negative labs, negative CT and most important question:  'How much longer?  I'm starving!'  (Meal would include a work-excuse prize, or coupon for disability evaluation.) 

Unique revenue streams in Emergistan

It's evident that America's emergency departments need some relief.  Perhaps the best 'relief' would come in financial support to increase the physical dimensions of the departments, as well as increasing staff, both nurse and physician.  But how to do it?  I have some thoughts.

Narcotics being one of the more cherished currencies of Emergistan, I submit that video poker machines with payouts in Hydrocodone or Oxycodone would be very effective at generating revenue.  The could also pay out in work excuses.  Or, for the big spenders, like the 'Million Dollar Slot' in Vegas, there could be machine now and then that pays out in the greatest gift of all:  complete disability.

If you think folks wouldn't plug their money into those machines, you haven't spent enough time in the ER.  They'd pass up Big Macs, Bath Salts and Crystal Meth for a shot at that golden ring!

Yes, I know, laws, rules, taxes, illegal, etc.  Blah, blah, blah!  A great idea is a great idea, no?

Any thoughts of your own? 

Edwin, Ambassador to Emergistan

In Emergistan, alcohol consumption is a national sport.  Last night I evaluated, observed and discharged numerous intoxicated college students.  The football game they had been attending was the sideshow.  Drinking was the main event!  However, dear doctors in Emergistan, remember this economic reality. 

Drunk college student = insurance = payment.  As annoying as they are, they're pretty easy money.

Another formula for students:

 Drunk college student = dangerously angry mother who drove 3 hours at warp speed to check on baby = lectures, threats and early rising on Sunday morning for church with mom despite life altering hangover. 

Repeat may result in spring semester job with highway department holding stop sign.

Remember, in Emergistan, one of our many mottos is:  'Only two drinks.'

Edwin

Emergistan travel tip for the day:

Patients who refer to Xanax as 'bars' or Lortab as 'tabs' may not have pure motives in receiving narcotics. 

One might reasonably alter their pain scale as follows:

Pain scale/2 - # of street terms used for drug = actual pain scale.

For example:  My pain is a ten!  Can I get some tabs?  (minus one) Some Blue Specs usually help when it hurts this much!  (minus two). 

Let's do the math:

10/2 -2 =
5 -2 =
3

Then decide if perhaps Tylenol or nothing is adequate.  Subtract more points as you see fit.

(Perhaps using modifiers based on previous experience, such as multiplcation by 0, as in 'you get 0 pain medications!')

Your travel guide,

Edwin

Emergistan travel tip for the day, 11/13/12

While Emergistan is a fascinating and fun place, take a break now and then.  I've had several days off lately.  Not one of my children has asked me for narcotics, my wife has not asked for a work excuse and I am calm.  Most of my muscle aches are gone and I'm learning not to eat non-stop.  A thing I often do when I'm on duty in Emergistan. 

In summary:  Emergistan is a fun place to work.  But don't forget to cross the border back to normality now and then.  There are actually happy places and healthy people, and it's good to be around them.

Welcome to Emergistan!

Dear readers, some of you know me by my other blog, www.edwinleap.com/blog.  I post there frequently, on a wide variety of topics.  But I realized that I need a place to focus on the world of emergency medicine, and by extension, the greater universe of medicine.

So this is the place.  I will be posting observations on life in medicine, bizarre happenings in the ER, politics, culture and other topics. 

I will also be detailing what I fear may be the gradual collapse of medicine as we know it. What it will be transformed into remains to be seen.  But I have a bad feeling about this, as the saying goes.

Hopefully, this blog will also inspire you to be proud citizens of Emergistan and buy some of my meager offerings from the Republic of Emergistan store:

www.republicofemergistan.com.

Have a great day!

Edwin Leap, MD