Episode 51 Effective Patient Communication – Managing Difficult Patients
If you believe that coping with some of the people we deal with in emergency medicine is difficult or impossible, you’re not alone. We all feel this way from time to time. Managing difficult patients can be a challenge to the health care provider and to the entire ED. The hostile aggressive patient, the demanding patient, the know-it-all, the excessively anxious patient, and the incessant complainer, are some of the folks that we need to know how to manage effectively. If we fail to handle these patients appropriately, they may receive suboptimal care, grind patient flow to a halt, and delay care of other patients. If the staff has to deal with a multitude of these patients on a given shift, there’s a sort of swarm-based escalation in frustration and sometimes, unfortunately, a total breakdown of effective patient communication and care. But don't fret. In this one-of-a-kind podcast on effective patient communication and managing difficult patients, Dr. Walter Himmel, Dr. Jean-Pierre Champagne and RN Ann Shook take us through specific strategies, based on both the medical and non-medical literature, on how we can effectively manage these challenging patients. As a bonus, we address the difficult situation of breaking bad news with a simple mnemonic and discuss tips on how to deliver effective discharge instructions to help improve outcomes once your patient leave the ED.
Episode 50 Recognition and Management of Pediatric Sepsis and Septic Shock
Kids aren't little adults. Pediatric sepsis and septic shock usually presents as 'cold shock' where as adult septic shock usually presents as 'warm shock', for example. In this episode, a continuation of our discussion on Fever from with Ottawa PEM experts, Sarah Reid and Gina Neto, we discuss the pearls and pitfalls in the recognition and management of pediatric sepsis and septic shock. We review the subtle clinical findings that will help you pick up septic shock before it's too late as well as key maneuvers and algorithms to stabilize these patients. We cover tips for using IO in children, induction agents of choice, timing of intubation, ionotropes of choice, the indications for steroids in septic shock, and much more.....
Episode 49 Effective Patient Communication, Patient Centered Care and Patient Satisfaction
If you believe that coping with some of the people we deal with in emergency medicine is difficult or impossible, you’re not alone. We all feel this way from time to time. We all work in stressful environments where it may feel as though we have too little time for effective patient communication, patient centered care and patient satisfaction. You and your patients may often have mismatched views of what’s important. You may have a specific medical agenda and they might have a very different agenda. Then there’s the difficult patient – we all know who these people are – the hostile aggressive patient, the demanding patient, the know-it-all, the excessively anxious patient, and the incessant complainer, among others. If we don’t know how to handle these patients appropriately, they may receive suboptimal care, grind patient flow to a halt, and delay care of other patients. And of course, if the staff has to deal with a multitude of these patients on a given shift, there’s a sort of swarm-based escalation in frustration and sometimes, unfortunately, a total breakdown of effective care. These frustrations don’t only come out when we’re presented with multiple sequential difficult patients, but for some of us, the more we practice, the more we become desensitized to the needs of all of our patients and their families and, we run the risk of destroying the doctor-patient relationship, as well as making most of our patient interactions frustrating, unsatisfying, – even detrimental to our health and the outcomes of our patients. How you communicate in the ED can improve patient outcomes and enhance job satisfaction, yet there is little education on patient centered care for EM practitioners. After listening to this episode, it is my hope that what you learn from the literature and from expert opinion,and then apply to the way you communicate with your patients, will effectively make you a happier health care professional. Dr.Walter Himmel, Dr. Jean Pierre Champagne and RN Ann Shook guide us in this round table discussion on effective patient communication, patient centered care and patient satisfaction – this has evolved my practice into what I perceive as a higher level of personal satisfaction as well as patient care….I hope it will do the same for you.
Episode 48 – Pediatric Fever Without A Source
Have you ever seen a child in your emergency department with a fever - he asks sarcastically? At the ginormous community hospital where I work, we see about 25,000 kids each year in our ED and about half of them present with fever. Yes, there still exists fever phobia in our society, which brings hoards of worried parents into the ED with their febrile kids. For most of these kids it's relatively straight forward: Most kids with fever have clinical evidence of an identifiable source of infection – a viral respiratory infection, acute otitis media, gastro, or a viral exanthem. However, about 20% have Fever Without a Source despite your thorough history and physical exam. A small but significant number of this 20% without an identifiable source of fever will have an occult bacterial infection - UTI, bacteremia, pneumonia, or even the dreaded early bacterial meningitis. These are all defined as Serious Bacterial Infections (SBI), with occult UTI being the most common SBI especially in children under the age of 2 years. In the old days we used to do a full septic work-up including LP for all infants under the age of 3 months, but thankfully, times have changed in the post-Hib and pneumoccocal vaccine age, and we aren’t quite so aggressive any more with our work-ups. Nonetheless, it's still controversial as to which kids need a full septic workup, which kids need a partial septic workup, which kids need just a urine dip and which kids need little except to reassure the parents. In this episode, with the help of Dr. Sarah Reid and Dr. Gina Neto from the Children's Hospital of Eastern Ontario, we will elucidate how to deal with fever phobia, when a rectal temp is necessary, how to pick out the kids with fever that we need to worry about, how to work up kids with fever depending on their age, risk factors and clinical picture, who needs a urinalysis, who needs a CXR, who needs blood cultures and who needs an LP, and much more....
Episode 47: Evidence Based Medicine from NYGH EMU Conference 2014
Dr. Walter Himmel (the 'walking encyclopedia of EM') gave a fantastic talk from North York General's Emergency Medicine Update Conference in Toronto, which have edited into a podcast with key commentary and summaries. Dr. Himmel eloquently shows us, through absolutely stunning personal cases, how evidence based medicine can be appropriately or inappropriately applied in real practice, resulting in major outcome differences for your patients. He elucidates the importance of clinical experience, patient values and ED resources in helping apply the medical literature to your practice. He reviews the essence of critical appraisal, the hierarchy of evidence and how to keep up with the emergency medicine literature. The famous NINDS thrombolysis for stroke trial is distilled down to a few key considerations and the NEJM transfusion for upper GI bleed trial from last year is dissected, analyzed and then applied to Dr. Himmel's personal cases, to help us understand exactly how to apply the literature to our daily practice. Blog post and written summary prepared by Keerat Grewal, edited by Anton Helman July 2014
Episode 46 – Social Media and Emergency Medicine Learning
In early June of this year I caught up with Dr. Rob Rogers of iTeach EM and The Teaching Course, Dr. Ken Milne of The Skeptics Guide to EM and Dr. Brent Thoma of Academic Life in EM and Boring EM at the Canadian Association of Emergency Medicine Conference in Ottawa to chat about the evolution of Social Media & Emergency Medicine Learning. In this podcast, we discuss how Social Media can enhance your career, tips on how to get the most out of FOAMed without getting overwhelmed by the volume of material, swarm-based medicine, tacit knowledge sharing, the flipped classroom, the use of FOAMed in emergency medicine training curricula, how Twitter, Google+, Google Hangout and Google Glass have changed the face of medical education, and much more.
