The ED Graveyard Shift

Emergency Department of Edinburgh Royal Infirm...
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So I just finished a 10hour overnight shift in the emergency department and it wasn’t as bad as I thought it would be. It was fairly quiet, slow but steady, and starting off, I did forget to ask a few of the questions I should have, although I saw patients in a reasonable amount of time.

Before going in, I was pretty nervous since I would be the only one there besides the attending to take care of anyone/anything that walked through the door,and as confident as I am on the inpatient unit or in the neonatal ICU, the ED and the primary care settings really get me nervous. It’s partly a matter of efficiency since the inpatients will be there for you to get to when you get to, whereas outpatient, you have to get the data you need and give the answers you’re supposed to give within a set period of time; you have to be comprehensive within that limited time frame.

For a detail-oriented person such as myself, although the patients, in general, are healthier in the outpatient setting than the inpatient setting, I get caught up in trying to ask ALL of the questions. I also tend to be a little too patient-centered and let them lead the discussion, instead of asking the questions I need to ask to have a working knowledge of the situation. Thus, I usually come away unsatisfied because I took forever and still missed things.

However, all in all, I did reasonably well, and have gained a little bit of confidence. Now just 2 more nights and then a brief respite for Thanksgiving!

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The Cloud and Medicine

 

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I recently finished an elective in pediatric infectious disease elective, and just prior, was gifted an iPad 2. Combined with a portable keyboard, it became one of the most useful tools in my medical arsenal. I was able to type notes and save them with Dropbox, increasing efficiency since I type more quickly (and more legibly) than I write, enhancing note taking during lectures, and allowing me to reference textbooks while discussing a patient.

Many of my colleagues made mock-fun of me, but as Bryan Vartabedian writes on 33charts, the future of medicine is in physicians embracing technology. Another resident on this elective with me does not, using an old Blackberry without any of my “essential” medical applications (such as Medscape), and even he became smitten with using Dropbox to synchronize our notes. As this is a relatively new field, I’ve made sure to attempt to be HIPAA-compliant by only using patient initials and bed numbers in my notes.

Combined with applications like Dragon Dictation (free!), I can see how the old-style dictation into a phone that someone subsequently transcribes and sends back to the hospital will become obsolete. DD is pretty accurate for “regular” speaking, but its attempts at medical-speak are pretty humorous. Radiologists routinely use real-time dictation systems, but I’m sure both of these approaches have a hefty cost associated with them. A relatively small initial investment of an iPad and some as-yet-unwritten medical dictation system could revolutionize things, especially considering all the other functions it can serve.

I love living in the future.

Transcribing dictation with a Dictaphone wax c...
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