November 20, 2018

Khans’ Commandments

Here’s something that should come as a shock to no one: bouncebacks are dangerous. Patients are distressed or ill enough to feel that whatever was done for them the first time, wasn’t enough. Beyond just managing patient expectations, you have to ask yourself: “What could
April 12, 2018

Until Proven Otherwise

The Case A 30 year old woman gave birth to a baby after nearly 20 hours in labor. Three days later she started having fever, chills, and abdominal pain. At this point, there really isn’t any need to provide additional information as the ‘diagnosis until
December 14, 2017

Supervising APPs

I get a lot of questions from residents and new attendings about the liability ER physicians take on when co-signing charts for APPs (advanced practice providers, aka nurse practitioners/physician assistants). To start, a small disclaimer: local practices vary and there are certain guidelines that many
November 14, 2017

Too Low to Go

A 50-year-old insulin-dependent diabetic was found unresponsive by family. He was taken to the ED and suffered a seizure upon arrival. His blood glucose level was 14. D50 was administered, his sugar level stabilized, and he was discharged home. He returned to the ER less
July 16, 2017

A Series of Unfortunate Events

This is a real [reported] story of a lawsuit involving an ED physician in Ohio. — The summary: Michael Cleveland was grocery shopping when he had an apparent heart attack. He was taken to a hospital where, after resuscitative efforts, the ED doctor pronounced him dead.
July 7, 2017

Putting your License on the Line

We work in a high-risk field. The very nature of emergency medicine and the types of patients it attracts is litigious. A 2011 study published in the New England Journal of Medicine found that EM had a higher than average risk of malpractice. It states:
April 9, 2017

A Baffling Malpractice Settlement

A recent verdict in a New Jersey medical malpractice case has me shaking my head in bewilderment. Here’s the setup: A 2 month old infant was brought to the ER. Mother reported that the child was unable to straighten his leg and would cry when
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