The Functions of ED Charting Jim Roberts MD, an emergency physician, writer, an entertaining speaker and humorist describes the medical record for an ED visit this way: The medical record serves to produce a permanent document that serves to memorialize all the details of a stressful encounter between a group of strangers, some of whom have to prove that they did everything possible to assure the best outcome. ...The only way you can get paid. Medicare and Medicaid and BC/BS know more about charting than you do, and they make their own rules! "As any lawyer knows, the ED chart certainly possesses miraculous powers to make them rich beyond their wildest dreams" There is some truth to his observations...by Shari Welch, MD

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I was always good at standardized tests. It’s the real-life tests in the ED that I botch. Over the years I compiled a list of my “wrong answers”. See how well you do on the following questions. 1. A mother brings her 4 year old daughter to the ED with a small laceration on her forehead. She asks for a plastic surgeon. You respond; A. "No way I’m calling plastics for this." B. "Ma’am, let’s be honest here; your daughter is really not that pretty." C. "You’re kidding, right?" D. "We handle lacerations like this all the time; but if you want, I can call Plastics for you."...by Steven Colucciello, MD

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Gregory L. Henry, MDAs I sit here looking at the website’s comments on the NBC News piece on CPR presented last night, I am reminded that the only thing new in the world is the history that you do not know.  I have no idea what the big hoopla is about the fact that mouth to mouth breathing doesn’t work.  In infants and children breath for them, it is probably the problem.  In adults, it isn’t the problem.  Everybody’s data for the last 10 years has said blowing in their mouth makes no difference.  I don’t know about you but the thought of having to blow in the mouth of people I do not know in an era of strange and unusual diseases, is not appealing.  The Japanese, the Swedes and the Koreans all have papers that say the same thing.  It doesn’t matter what you do in breathing for patients, the outcome is the same.  There is a very select group of people who I think deserve CPR.  CPR was never intended for grandma at 90 with cancer and about to die anyway.  Where this came from, I have no idea.  Television has portrayed CPR as something that works.  Nothing could be further from the truth.  It warms my heart to see that there is finally some intelligent discussion about this entire process.  CPR has become a business in the United States and not a rescue technique.  Heaven forbid the American Heart Association and the Red Cross would have to change their programs to conform to scientific fact.  The truth of the matter is if you need CPR your changes of walking out of the hospital are incredibly small.  Let’s bring some rationality to this endeavor.

Emergency Medicine is about risk management. What we enjoy, and do well, is use clinical skills and reasoning to solve diagnostic and therapeutic puzzles. Sometimes there is relative certainty (for example, a straightforward injury), but generally we are dealing with probabilities. We "rule out" and send home with various degrees of confidence but rarely with complete certainty. That’s how our system works, and it almost always serves patients well...by Sue Ieraci, MD

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