Video Interview – Rob Rogers – Part 1

Great messages for medical students, interns and new EM residents!

Are you ready to meet the genuine people behind the professional?

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

Our guest is Dr. Rob Rogers.

Trained in Emergency Medicine and Internal Medicine, Rob Rogers currently practices Emergency Medicine at the University of Kentucky’s Chandler Hospital in the Department of Emergency Medicine. An innovative medical educator on the cutting edge of creativity, he shares his knowledge on the monthly medical education Medutopia Podcast. Rob co-founded The Teaching Institute and in 2014 created The Teaching Course at The University of Maryland. As a passionate medical education enthusiast, podcast evangelist, learning choreographer, and entrepreneur, Rob works tirelessly to change the world of medical education by reinventing it.

The full interview is 24 minutes long and includes many advice on life, wellness, and our profession. We will be sharing short videos from this interview. However, the full interview will be published as an audio file in our Soundcloud account. 

This interview was recorded during the EACEM2018 in Turkey. We thank EMAT.

The interview was recorded and produced by

Arif Alper Cevik

Elif Dilek Cakal

Murat Cetin

iEM Weekly Feed 14

Welcome to iEM Weekly Feed!

Sharing is caring!

With this feed, you do not miss anything. You will find all published blog posts and chapters during this week. Click the “title” or “read more” to open each page you interested in.

Stabbing LLQ Pain

A 19-year-old female presents to the emergency department (ED) complaining of 48 hours of worsening, stabbing left lower quadrant abdominal pain. The patient notes an

Read More »

Video Interview: Tracy Sanson – Part 3

Are you ready to meet the genuine people behind the professional? iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts

Read More »

Video Interview: Tracy Sanson – Part 2

Are you ready to meet the genuine people behind the professional? iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts

Read More »

A Week Before!

iEM Weekly Feed 13

Welcome to iEM Weekly Feed! Sharing is caring! With this feed, you do not miss anything. You will find all published blog posts and chapters

Read More »

44% Female Contributors in iEM

62 out of 142 contributors are female professionals. iEM Education Project We have 62 female contributors (emergency medicine doctor, resident, intern, medical student) out of

Read More »

Video Interview: Tracy Sanson – Part 1

Are you ready to meet the genuine people behind the professional? iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts

Read More »

My Road to Emergency Medicine

Helene Morakis Vice-President of the International Student Association of Emergency Medicine MS4 at Queen’s School of Medicine Incoming EM resident at the University of British

Read More »

Five Tips About Well-being During and After Medical School

Even the best of us suffer from burnout from time to time. It is utterly human as training in medicine is very demanding itself and

Read More »

What Was Hot In February?

Communication is the key!

Reflections by Vijay Nagpal and Bret A. Nicks While many believe the environment of care is the greatest limiting factor as opposed to quality communication,

Read More »

Medical students’ ultrasound training – SURVEY

There are many studies showing benefits of ultrasound training about understanding anatomy, pathologies and improving clinical decision making. Countries show different approaches to implementing ultrasound

Read More »

Kunafa Knife and Play Dough for Ultrasound Training

Around two years ago, Prof. Abu-Zidan came with a plastic triangular shape spatula to one of our morning meetings. He said that Alper, I found

Read More »

Welcome!

International Emergency Medicine (iEM) Education Project is an international, non-profit project, endorsed by International Federation for Emergency Medicine (IFEM) and supported by emergency medicine professionals

Read More »

Shock

by Maryam AlBadwawi Introduction Shock, in simple terms, is a reduced circulatory blood flow state within the body. The inadequate circulation deprives the tissues of its

Read More »

Chest Pain

by Asaad S Shujaa Introduction Chest pain is one of the most common symptoms presented in the emergency department (ED), and it is worrisome because

Read More »

Poisonings

by Harajeshwar Kohli and Ziad Kazzi Case An 18-year-old, previously healthy female, presents to the Emergency Department with nausea, vomiting, and tremors. She states 45

Read More »

Abdominal Pain

by Shaza Karrar Case Presentation A 39-year-old female presented to the emergency department (ED) complaining of right-lower-quadrant (RLQ) pain; pain duration was for 1-day, associated

Read More »

List of Sections and Chapters

International Emergency Medicine Education Project’s book is “iEM for Medical Students/Interns” and consist of 130 chapters written by 127 international contributors. Emergency physicians, residents, interns and

Read More »

Stabbing LLQ Pain

A 19-year-old female presents to the emergency department (ED) complaining of 48 hours of worsening, stabbing left lower quadrant abdominal pain. The patient notes an intermittent, foul-smelling vaginal discharge for the past week. She also endorses fever, nausea, vomiting, dyspareunia, dysuria, and generalized fatigue. The patient is sexually active with one male partner and uses combination OCPs in conjunction with inconsistent utilization of condoms. She denies vaginal bleeding, fevers, jaundice, vomiting, constipation, or diarrhea. Her last menstrual period (LMP) ended 16 days ago and was typical of her usual menses. The patient has a history of menarche at 14 and coitarche at 17. She denies any use of tobacco but admits intermittent alcohol and marijuana use. She has no past medical or relevant family history. There are no known drug allergies.

Physical exam reveals a well-developed female in mild discomfort but no acute distress. Her vitals are unremarkable except for a temperature of 38.5 and a heart rate of 102. Her abdominal exam reveals moderate tenderness to palpation, worse in the left lower quadrant, with no rebound tenderness. There is no costovertebral angle tenderness, Rovsing sign or McBurney point tenderness. External genitalia is unremarkable. A pelvic exam demonstrates foul purulent discharge in the vaginal vault emanating from the cervical os with no visible blood products. Cervical motion tenderness and pain on palpation of bilateral adnexa are present. Left adnexa is more tender and has a palpable mass on it.

Want to learn more?

Video Interview: Tracy Sanson – Part 3

Are you ready to meet the genuine people behind the professional?

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

Our guest is Dr. Tracy Sanson.

Dr. Sanson is a practicing Emergency Physician. She is a consultant and educator on Leadership development and Medical education and Co-Chief Editor of the Journal of Emergencies, Trauma and Shock; an Emergency Medicine international journal.

Part 3

The full interview is 10 minutes long and includes many advice on life, wellness, and our profession. We will be sharing short videos from this interview. However, the full interview was published as an audio file in our Soundcloud account. 

This interview was recorded during the EACEM2018 in Turkey. We thank EMAT.

The interview was recorded and produced by

Arif Alper Cevik

Elif Dilek Cakal

Murat Cetin

Video Interview: Tracy Sanson – Part 2

Are you ready to meet the genuine people behind the professional?

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

Our guest is Dr. Tracy Sanson.

Dr. Sanson is a practicing Emergency Physician. She is a consultant and educator on Leadership development and Medical education and Co-Chief Editor of the Journal of Emergencies, Trauma and Shock; an Emergency Medicine international journal.

Part 2

The full interview is 10 minutes long and includes many advice on life, wellness, and our profession. We will be sharing short videos from this interview. However, the full interview was published as an audio file in our Soundcloud account. 

This interview was recorded during the EACEM2018 in Turkey. We thank EMAT.

The interview was recorded and produced by

Arif Alper Cevik

Elif Dilek Cakal

Murat Cetin

iEM Weekly Feed 13

Welcome to iEM Weekly Feed!

Sharing is caring!

With this feed, you do not miss anything. You will find all published blog posts and chapters during this week. Click the “title” or “read more” to open each page you interested in.

44% Female Contributors in iEM

62 out of 142 contributors are female professionals. iEM Education Project We have 62 female contributors (emergency medicine doctor, resident, intern, medical student) out of

Read More »

Video Interview: Tracy Sanson – Part 1

Are you ready to meet the genuine people behind the professional? iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts

Read More »

My Road to Emergency Medicine

Helene Morakis Vice-President of the International Student Association of Emergency Medicine MS4 at Queen’s School of Medicine Incoming EM resident at the University of British

Read More »

Five Tips About Well-being During and After Medical School

Even the best of us suffer from burnout from time to time. It is utterly human as training in medicine is very demanding itself and

Read More »

A Week Before!

iEM Weekly Feed 12

Welcome to iEM Weekly Feed! Sharing is caring! With this feed, you do not miss anything. You will find all published blog posts and chapters

Read More »

iEM Newsletter – February 2019

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project

Read More »

Against Medical Advice and Elopement

In certain circumstances, patients may request to leave prior to completion of their medical evaluation and treatment. In this situation, it is essential for the

Read More »

ICON360: Tracy Sanson – Full Interview – Audio

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the

Read More »

Professionalism and social media

Some reflections by Dr. Amila Punyadasa It seems like nearly everyone, certainly from the Generations Y and Z, is using Facebook or Twitter these days

Read More »

What Was Hot In February?

Communication is the key!

Reflections by Vijay Nagpal and Bret A. Nicks While many believe the environment of care is the greatest limiting factor as opposed to quality communication,

Read More »

Medical students’ ultrasound training – SURVEY

There are many studies showing benefits of ultrasound training about understanding anatomy, pathologies and improving clinical decision making. Countries show different approaches to implementing ultrasound

Read More »

Kunafa Knife and Play Dough for Ultrasound Training

Around two years ago, Prof. Abu-Zidan came with a plastic triangular shape spatula to one of our morning meetings. He said that Alper, I found

Read More »

Welcome!

International Emergency Medicine (iEM) Education Project is an international, non-profit project, endorsed by International Federation for Emergency Medicine (IFEM) and supported by emergency medicine professionals

Read More »

Shock

by Maryam AlBadwawi Introduction Shock, in simple terms, is a reduced circulatory blood flow state within the body. The inadequate circulation deprives the tissues of its

Read More »

Chest Pain

by Asaad S Shujaa Introduction Chest pain is one of the most common symptoms presented in the emergency department (ED), and it is worrisome because

Read More »

Poisonings

by Harajeshwar Kohli and Ziad Kazzi Case An 18-year-old, previously healthy female, presents to the Emergency Department with nausea, vomiting, and tremors. She states 45

Read More »

Abdominal Pain

by Shaza Karrar Case Presentation A 39-year-old female presented to the emergency department (ED) complaining of right-lower-quadrant (RLQ) pain; pain duration was for 1-day, associated

Read More »

List of Sections and Chapters

International Emergency Medicine Education Project’s book is “iEM for Medical Students/Interns” and consist of 130 chapters written by 127 international contributors. Emergency physicians, residents, interns and

Read More »

44% Female Contributors in iEM

62 out of 142 contributors are female professionals.

iEM Education Project

We have 62 female contributors (emergency medicine doctor, resident, intern, medical student) out of 142. This is 44%, and we need more. Please share with your colleagues, students. We need you!

How to be a contributor!

Video Interview: Tracy Sanson – Part 1

Are you ready to meet the genuine people behind the professional?

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

Our guest is Dr. Tracy Sanson.

Dr. Sanson is a practicing Emergency Physician. She is a consultant and educator on Leadership development and Medical education and Co-Chief Editor of the Journal of Emergencies, Trauma and Shock; an Emergency Medicine international journal.

Part 1

The full interview is 10 minutes long and includes many advice on life, wellness, and our profession. We will be sharing short videos from this interview. However, the full interview was published as an audio file in our Soundcloud account. 

This interview was recorded during the EACEM2018 in Turkey. We thank EMAT.

The interview was recorded and produced by

Arif Alper Cevik

Elif Dilek Cakal

Murat Cetin

iEM Weekly Feed 12

Welcome to iEM Weekly Feed!

Sharing is caring!

With this feed, you do not miss anything. You will find all published blog posts and chapters during this week. Click the “title” or “read more” to open each page you interested in.

Video Interview – Rob Rogers – Part 1

Great messages for medical students, interns and new EM residents! Are you ready to meet the genuine people behind the professional? iEM team proudly presents

Read More »

iEM Weekly Feed 14

Welcome to iEM Weekly Feed! Sharing is caring! With this feed, you do not miss anything. You will find all published blog posts and chapters

Read More »

Stabbing LLQ Pain

A 19-year-old female presents to the emergency department (ED) complaining of 48 hours of worsening, stabbing left lower quadrant abdominal pain. The patient notes an

Read More »

A Week Before!

Video Interview: Tracy Sanson – Part 3

Are you ready to meet the genuine people behind the professional? iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts

Read More »

Video Interview: Tracy Sanson – Part 2

Are you ready to meet the genuine people behind the professional? iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts

Read More »

iEM Weekly Feed 13

Welcome to iEM Weekly Feed! Sharing is caring! With this feed, you do not miss anything. You will find all published blog posts and chapters

Read More »

What Was Hot In January?

List of Sections and Chapters

International Emergency Medicine Education Project’s book is “iEM for Medical Students/Interns” and consist of 130 chapters written by 127 international contributors. Emergency physicians, residents, interns and

Read More »

Abdominal Pain

by Shaza Karrar Case Presentation A 39-year-old female presented to the emergency department (ED) complaining of right-lower-quadrant (RLQ) pain; pain duration was for 1-day, associated

Read More »

Respiratory Distress

by Ebru Unal Akoglu Case Presentation A 40-year-old female with a history of diabetes mellitus presents with a complaint of 6 days cough and muscle

Read More »

Chest Pain

by Asaad S Shujaa Introduction Chest pain is one of the most common symptoms presented in the emergency department (ED), and it is worrisome because

Read More »

Shock

by Maryam AlBadwawi Introduction Shock, in simple terms, is a reduced circulatory blood flow state within the body. The inadequate circulation deprives the tissues of its

Read More »

Emergency Medicine: A Unique Specialty

by Will Sanderson, Danny Cuevas, Rob Rogers Imagine walking into the hospital to start your day – ambulances are blaring, the waiting room is clamoring, babies

Read More »

Choosing the Emergency Medicine As A Career

by C. James Holliman The specialty of Emergency Medicine (EM) is a great career choice for medical students and interns.  In August 2013, I celebrated

Read More »

PoCUS – RUSH Protocol

by Rasha Buhumaid Why use POCUS in undifferentiated hypotension? Hypotension is a high-risk sign which is associated with increased morbidity and mortality rate. The differential

Read More »

How to read head CT

by Reza Akhavan and Bita Abbasi For a standard approach to read head/brain computed tomography (CT) scan, one should adhere to systematic algorithms. The predefined

Read More »

iEM Newsletter – February 2019

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project that you kindly contributed, supported or showed your interest.

Content

Project Contributors

0
Countries
0
Contributors

We reached 141 contributors from 19 different countries in February. Our recent contributor is Vicky Noble from USA. Dr. Noble is the vice-chair for academic affairs and the residency program director at University Hospitals in Cleveland Ohio where she is starting the hospital-wide point of care ultrasound program for the system. She is a Professor at Case Western Reserve School of Medicine. She is a former chair of the ACEP Ultrasound Section, has been on the boards of the World Interactive Network Focused on Critical Ultrasound (WINFOCUS), Point of care Ultrasound in Resource-limited Environments (PURE) and the American Institute of Ultrasound in Medicine (AIUM). 

She is the president-elect for the Society for Ultrasound in Medical Education (SUSME). She is the co-author of the Manual of Emergency and Critical Care Ultrasound textbook, now in its second edition. Her research interests include lung ultrasound, ultrasound volume assessment and technology solutions to guide ultrasound interpretation as a means to broaden access to diagnostic ultrasound. With over a decade of experience in teaching ultrasound and starting ultrasound programs now at two facilities she can give advice on research, starting a program and ultrasound program administration as well as international training efforts. She is a true evangelist for the technology.

ICON360 interview series continues with Dr. Noble. Stay tuned!

Posts Published In February

iEM Weekly Feed 14

Welcome to iEM Weekly Feed! Sharing is caring! With this feed, you do not miss anything. You will find all published blog posts and chapters

Stabbing LLQ Pain

A 19-year-old female presents to the emergency department (ED) complaining of 48 hours of worsening, stabbing left lower quadrant abdominal pain. The patient notes an

Video Interview: Tracy Sanson – Part 3

Are you ready to meet the genuine people behind the professional? iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts

Video Interview: Tracy Sanson – Part 2

Are you ready to meet the genuine people behind the professional? iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts

iEM Weekly Feed 13

Welcome to iEM Weekly Feed! Sharing is caring! With this feed, you do not miss anything. You will find all published blog posts and chapters

44% Female Contributors in iEM

62 out of 142 contributors are female professionals. iEM Education Project We have 62 female contributors (emergency medicine doctor, resident, intern, medical student) out of

Video Interview: Tracy Sanson – Part 1

Are you ready to meet the genuine people behind the professional? iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts

My Road to Emergency Medicine

Helene Morakis Vice-President of the International Student Association of Emergency Medicine MS4 at Queen’s School of Medicine Incoming EM resident at the University of British

Five Tips About Well-being During and After Medical School

Even the best of us suffer from burnout from time to time. It is utterly human as training in medicine is very demanding itself and

iEM Weekly Feed 12

Welcome to iEM Weekly Feed! Sharing is caring! With this feed, you do not miss anything. You will find all published blog posts and chapters

iEM Newsletter – February 2019

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project

Against Medical Advice and Elopement

In certain circumstances, patients may request to leave prior to completion of their medical evaluation and treatment. In this situation, it is essential for the

ICON360: Tracy Sanson – Full Interview – Audio

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the

Top Reads In February

Free iBook

A free book (ibook and pdf) for EMERGENCY MEDICINE CLERKSHIP Students (iEmergency Medicine for Medical Students and Interns – 2018, Version 1) will be shared through iem-student.org in March. STAY TUNED! or better REGISTER on the sidebar to get email alert or follow us on social media. 

February Website Usage

Visiting Countries
104
Visitors
2,268
Views
5,351

Overall Website Usage

0
Countries
0
Visitors

Against Medical Advice and Elopement

In certain circumstances, patients may request to leave prior to completion of their medical evaluation and treatment. In this situation, it is essential for the last health care professional caring for the patient to document clearly why the patient left and attested that the patient had the mental capacity to make such a decision at that time (Henry, 2013). While some electronic documentation systems have templates in place to assist with this documentation, Table 2 provides basic information for against medical advice (AMA) discharge documentation that can be used to create a uniform template (Henry, 2013; Siff, 2011; Levy, 2012; Devitt, 2000).

What to do?

Interventions in the ED Discharge Process

DomainIntervention
ContentStandardize approach
DeliveryVerbal instructions (language and culture appropriate)
Written instructions (literary levels)
Basic Instructions (including return precautions)
Media, visual cues or adjuncts
ComprehensionConfirm comprehension (teach-back method)
ImplementationResource connections (Rx, appointment, durable medical supplies, follow-up)
Medication review

An attempt should be made to provide the patient with appropriate discharge instructions, even if a complete diagnosis may not yet be determined. Include advice for the patient to follow up with his physician, strict return precautions, and concerning symptoms that should prompt the patient to seek further care. It should also be made clear that leaving against medical advice does not prevent the patient from returning to the emergency department for further evaluation if his symptoms worsen, or if he changes his mind. Despite a common notion to the contrary, simply leaving against medical advice does not automatically imply that physicians are immune to potential medical liability (Levy, 2012; Devitt, 2000). If a patient lacks decision-making capacity to be able to adequately understand the rationale and consequences of leaving AMA and his condition places him at risk for imminent harm, involuntary hospitalization is warranted. In unclear circumstances and if available, psychiatry can assist in determining capacity, especially in the case of patients with mental health conditions.

Elopement is a similar process where patients disappear during the care process. While it is difficult to provide discharge paperwork for these patients, documenting the actions taken to find the patient is essential (e.g., searching the ED, having security check the surrounding areas). In addition, attempt to reach the patient by phone to discuss his elopement and any additional care issues or concerns. Documentation of these attempts or any additional conversation is very important (Henry, 2013; Siff, 2011).

To Know More About It?

References

  • Brooten J, Nicks B. Discharge Communications. In: Cevik AA, Quek LS, Noureldin A, Cakal ED (eds) iEmergency Medicine for Medical Students and Interns – 2018. Retrieved February 27, 2019, from https://iem-student.org/discharge-communications/
  • Henry GL, Gupta G. (2013). Medical-Legal Issues in Emergency Medicine. In Adams (Ed.), Emergency Medicine Clinical Essentials, 2nd Ed; 1759-65. Philadelphia, PA: Elsevier.
  • Siff JE. (2011). Legal Issues in Emergency Medicine. In Tintinalli’s (Ed.), Emergency Medicine, 7th Ed; 2021-31. McGraw-Hill.
  • Levy F, Mareiniss DP, Lacovelli C. The Importance of a Proper Against-Medical-Advice (AMA) Discharge. How Signing Out AMA May Create Significant Liability Protection for Providers. J Emerg Med. 2012;43(3):516-520.
  • Devitt PJ, Devitt AC, Dewan M. An examination of whether discharging patients against medical advice protects physicians from malpractice charges. Psychiatr Serv. 2000;51:899-902.

ICON360: Tracy Sanson – Full Interview – Audio

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

In this episode, we shared the full interview of Dr. Tracy Sanson. 

Who is Dr. Sanson?

Dr. Sanson is a practicing Emergency Physician. She is a consultant and educator on Leadership development and Medical education and Co-Chief Editor of the Journal of Emergencies, Trauma and Shock; an Emergency Medicine international journal. A frequent speaker for Emergency Medicine programs, Dr. Sanson also serves as a core faculty member for the American College of Emergency Physicians. Dr. Sanson has consulted and lectured nationally and internationally on administrative and management issues, leadership, professionalism, communication, patient safety, brand development, personal development, womenäó»s issues and emergency medical clinical topics for a wide range of health care organizations. Dr. Sanson’s experience spans 20 + years in Emergency Medicine Education and ED management and leadership development. She has held director positions in the US Air Force, University of South Florida and TeamHealth for the past 15 + years. Dr. Sanson trained at the University of Illinois at Chicago for medical school and her emergency medicine residency. She is well versed in leadership, patient safety and medical management issues having served on TeamHealth’s Medical Advisory Board, Patient Safety Office Division Director and faculty in their Leadership Courses. (resource: https://feminem.org/author/tracy-sanson-md/)

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

The interview was recorded and produced by

Arif Alper Cevik

Elif Dilek Cakal

Murat Cetin

Professionalism and social media

Some reflections by Dr. Amila Punyadasa

It seems like nearly everyone, certainly from the Generations Y and Z, is using Facebook or Twitter these days for one reason or another. Although not a fan myself, I do concede that when used with prudence, social media and the Internet is an invaluable resource for teaching and learning. It can support physicians’ personal expression, improve camaraderie and improve the dissemination of public health messages. Equally, it risks broadcasting unprofessional content online that reflects poorly on individuals, their affiliated institutions, and the medical profession alike.

Just saw an 18-year-old unmarried G5P0, with Chlamydia, herpes, and gonorrhea. Disgusting!

Hypothetical tweet

Physicians' SOCIAL MEDIA USE

 physicians must be cognizant of patient confidentiality and privacy and monitor their Internet presence

For example, let us consider a hypothetical tweet from a female doctor to her colleague describing a recent patient: ‘Just saw an 18-year-old unmarried G5P0, with Chlamydia, herpes, and gonorrhea. Disgusting!’ This tweet would have contravened a few of Wilkinsons (2009) so-called ‘behaviors inherent to good medical professionalism.’ This doctor should have had “respect for her patients’ diversity” and shouldn’t have been so judgmental (in this case, about the patients alleged sexual promiscuity and lifestyle). She also should have upheld patient confidentiality (as although the patient’s name wasn’t tweeted, the descriptors used about her obstetric and sexual histories would surely have made her easily identifiable amongst her friends and family who might have come across this tweet). The doctor should have, in my opinion, had better regard for professional boundaries and exercised greater judgment and discretion.

Defining unprofessionalism online and policing it has been challenging. However, with the increase in awareness of such occurrences, regulatory bodies have published various documents in an attempt to regulate physician’s activities on social media sites. The General Medical Council (GMC) has attempted to do exactly this with its paper. It warns against the blurring of boundaries between ones public and private lives and advices that privacy on these sites cannot be guaranteed. Furthermore, it stresses that physicians must be careful with regards to patient confidentiality, elaborating that although one piece of information may not breach confidentiality by itself, together, a few may certainly do so.

In summary, physicians must be cognizant of patient confidentiality and privacy and monitor their Internet presence to ensure that information posted is both accurate and appropriate. With regards to interaction with patients through social media, again, this interaction should fall within the boundaries of established professional norms. If a physician feels that such an interaction transgresses such norms, he/she should report the matter to the relevant authorities. Finally, it is imperative that physicians realize that inappropriate online interactions may have a negative impact on their reputations and that of their institutions, career advancements, and, perhaps most damning, may serve to undermine public trust in the medical profession as a whole.

To learn more about it

References

Siedel Test

A 42 years old male, presents to the ED 1 hour after he was hammering a nail onto a wooden shelf, where the nail flew and strike his left open eye. In an attempt to help, his friend immediately removed the nail. After that, he has been having severe sharp pain and blurry vision in his left eye. On examination, the left eye had poor visual acuity, and he could only perceive light and movement. The pupil was fixed, dilated and non-reactive to light. Right eye examination was normal.

819.2 - eye penetran trauma 2 -siedel sign
819.1 - eye penetran trauma 1

How would you approach to this patient?

To learn more about it, read chapters below.

Read "Eye Trauma" Chapter

Read "Red Eye" Chapter

Quick Read

Globe rupture

It is an ophthalmologic emergency, consisting of a full-thickness injury in the cornea or sclera caused by penetrating or blunt trauma. Anterior rupture is usually observed, as this is the region where the sclera is the thinnest. Posterior rupture is rare and difficult to diagnose. It can be diagnosed through indirect findings such as contraction in the anterior chamber and decrease in intraocular pressure (IOP) in the affected eye. If there is a risk of globe rupture, a slit lamp test with 10% fluorescein must be conducted. Normal tissue is dark orange under a blue cobalt filter; a lighter color is observed in the damaged zone due to a lower dye concentration. Ultrasonography (USG) can be useful in making a diagnosis, especially with posterior ruptures. Computed tomography (CT) sensitivity ranges 56–75%. In cases of anterior globe injuries, USG use, and if there is a risk of a foreign metal body, magnetic resonance imaging, are contraindicated. Prompt ophthalmology consultation is required. While in the emergency department, tetanus prophylaxis, analgesics, bed rest, head elevation, and systemic antibiotic therapy are required. The most commonly preferred antibiotics are cefazolin and vancomycin. Age over 60 years; injury sustained by assault, on the street/highway, during a fall, or by gunshot; and posterior injuries are indications of a poor prognosis.

Siedel test

Seidel test is used to detect ocular leaks from the globe following injury. If there is penetration to the eye, aqueous leakage happens. However, the fluid is clear and hard to identify. Therefore, non-invasive test “Siedel” is used for better visualization of this leakage. Fluorescein 10% is applied to the injured eye, and the leakage becomes more prominent.

To learn more about it, read chapters below.

Read "Eye Trauma" Chapter

Read "Red Eye" Chapter

Communication is the key!

Reflections by Vijay Nagpal and Bret A. Nicks

While many believe the environment of care is the greatest limiting factor as opposed to quality communication, literature would suggest otherwise. Establishing a positive patient-provider relationship is essential for patient care. One must recognize that while you may not be able to solve the patient’s condition or chronic illness, using effective communication skills and providing a positive patient experience will assuage many patient fears (Mole, 2016). Keep in mind, in general, patients remember less than 10% of the content (what was actually said), 38% of how you say it (verbal liking), and 55% of how you look saying it (body language) (Helman, 2015).

Patients remember

What you say
Web Designer 10%
How you say it
38%
How you look saying it
55%

Effective provider communicators routinely employ these 5 Steps

1

Be Genuine

We know it. People can sense the disingenuous person – whether it is a gut feeling or through other senses. Try to see the situation from the patient’s perspective, and it will ensure that you are acting in his best interest and with integrity.

2

Be Present

As emergency providers, we are interrupted more than perhaps any other specialty. However, for the few moments that we are engaged with the patient or his family, be all in. If there is a planned interruption upcoming, make it known prior to starting a discussion. Be focused on them and the conversation; value what they have to share. At the end of your encounter, briefly summarizing what the patient has told you can help to reassure the patient that you were listening and also give them the chance to clarify discrepancies.

3

Ask Questions

To effectively communicate, one must listen more than he talks. After introducing yourself, inquire about the patient’s medical concern; give them 60 seconds of uninterrupted time. Most patients are amazed and provide unique insights that would otherwise not be obtained. Once the patient has provided you with his concerns, begin asking the specific questions needed to further differentiate the care needed. By asking questions and allowing for answers, you make it about them and give them an avenue to share with you what they are most concerned about, enabling you to address those concerns.

4

Build Trust

Given the nature of the patient-provider relationship in emergency medicine, building trust is essential but often difficult. Building trust is like building a fire; it starts with the initial contact and builds with each interaction. Trust is also built on engaging in culturally acceptable interactions (Chan, 2012) such as a handshake, affirming node, hand-on-shoulder, or engaging posture.

5

Communicate Directly

Ensure that at the end of your initial encounter you have established a clear plan of care, what the patient can expect, how long it may take, and when you will return to reassess or provide additional information. Doing this also allows the patient to be more involved in his care and ask further questions regarding his workup and treatment plan. Additionally, helping the patient to understand what to expect while in the department can help to alleviate fear associated with unannounced tests or imaging studies, especially when these tests may require him or her to be temporarily taken out of the department (e.g., a trip to the CT scanner).

Many of these concepts have been identified in patient satisfaction and operational metrics. In one study, wait times were not associated with the perception of quality of care, but empathy by the provider with the initial interaction was clearly associated (Helman, 2015). In addition, patient dissatisfaction with delays to care is less linked to the actual time spent in the ED and more with a to set time expectations about the care process, a perceived lack of personal attention, and a perceived lack of staff communication and concern for the patient’s comfort.

To learn more about it

References

  • Nagpal V, Nicks BA. Communication and Interpersonal Interactions. In: Cevik AA, Quek LS, Noureldin A, Cakal ED (eds) iEmergency Medicine for Medical Students and Interns – 2018. Retrieved February 15, 2019, from https://iem-student.org/communication-and-interpersonal-interactions/
  • Mole TB, Begum H, Cooper-Moss N, et al. Limits of ‘patient-centeredness’: valuing contextually specific communication patterns. Med Educ. 2016 Mar; 50(3):359-69.
  • Helman A. Effective Patient Communication. Available at: http://emergencymedicinecases.com/episode-49-patient-centered-care/ Accessed December 18, 2015.
  • Chan EM, Wallner C, Swoboda TK, et al. Assessing Interpersonal and Communication Skills in Emergency Medicine. Acad Emerg Med 2012; 19:1390-1402.