EvidenceCare: A Great New Information Tool for the ED

I walked through the halls of the 2016 ACEP Scientific Assembly, marveling at both the new and names-you-know companies that are guaranteed to help me gain control of my time, my practice, or my destiny and be a better, more informed physician.
As EM physicians we have to be focused on unearthing just the information necessary to make swift and thorough, often life-saving, decisions regarding a patient’s health and well-being. Responding at the pace necessary to keep up in a busy ER requires us to keep a ton of information in our heads or know where to go at a moment’s notice.
I came across an EM doc at ACEP who clearly understands, and sympathizes, with our need for accurate, useful information to apply in the chaos of the ED.  As a resident at the University of Virginia, Brian Fengler spent a year researching Pulmonary Embolism and publishing a protocol that was relied upon by many. A few years later, Dr Fengler was working in a busy ER and was faced with a woman who had a massive PE…and was 36 weeks pregnant. He knew exactly what to do for the patient but was puzzled as to the risks to the baby. He did what we do, and turned to Dr. Google for a consult. After 10 minutes of digging, he didn’t find anything more than he already had in his head. He took a chance and made a decision to treat the patient aggressively. Fortunately, it was the right move for that patient and her child. But, just as 80% of the decisions we all make in the ER every day, it wasn’t evidence-based. It was an educated guess. Is that the kind of medicine we want to practice?
Fengler didn’t. He never wanted to face the uncertainty he felt that day again. He went about creating a tool that helps docs like us put our fingers on the guidelines and evidence we need, specific to the patient we are seeing, in about 30 seconds. And, he built it to work how we think. I got to see his tool, EvidenceCare, at ACEP and was at once impressed and covetous.  I wanted to be able to use it!

The treatment guide-lines on EvidenceCare been authored by the best in the business… it’s like taking DeBlieux, Kline, or Mattu to work with you. Even better is the way it helps us connect with our patients by translating treatment recommendations into a language and format that makes sense to them…something that is proven to double patient satisfaction.

Furthermore, the treatment pathway you use on EvidenceCare can be imported into your EMR note to show why you made the decision you did!
Over the decades I have become acutely, sometimes painfully, aware that all the information I need to serve my patients isn’t in my head. While I firmly believe that there are things we should memorize, the volume of information we need to use on a daily basis requires that we use various tools to help us.  In fact, a physician friend made the great point that we should be able to access those tools when we take boards, since practice doesn’t occur in a sterile vacuum.  I couldn’t agree more.

So I encourage you to take a look at EvidencCare, for your own personal use or for your facility.  I’ve been using it and find it simple and elegant. And if you read the blog regularly you know I don’t pitch products very often, so that should tell you something.

EvidenceCare content is free.  But if you subscribe to EvidenceCare using the discount code LEAP, you get 33% off the premium edition which allows you to accrue CME, offers a shared decision make tool for use with patients, and allows you to paste information into the EMR as I mentioned above.

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Edwin

Everyone is a treasure (The Gospel in a Lost Bracelet)

Here is my column in today’s Greenville News

http://www.greenvilleonline.com/story/opinion/contributors/2016/09/25/commentary-everyone-treasure/90846720/

The Gospel in a Lost Bracelet
My wife lost a charm bracelet about a month ago. She was shopping in Easley, and she thinks it came unhooked and fell to the ground. We haven’t found it, despite her asking at the stores and restaurant she visited.
If someone picked it up, they would have seen charms of various sizes and shapes. Some from distant places, some representing times in the lives of our children. It’s a lovely bracelet that she has had for decades. However, it’s a bit worn with time. It hasn’t been polished in a while. It’s still precious to my bride, but for reasons a stranger could never fully appreciate in what appears a trinket.
I was thinking about this at work one day; about how easily we miss the value of others. I have seen this demonstrated as I have watched married couples, late in life, come to the hospital. They attend as closely as they can to their cherished partners. They hold hands, they stroke hair, they speak in sweet tones and say things like, ‘there’s my beautiful girl!’ Or ‘hey handsome!’ Even in the midst of their mate’s profound dementia, they are gentle and loving. Even though the ravages of time and illness have left their spouse with babbling speech, or a body twisted from stroke.
It may not even be the aged, but the young; with scars, burns, amputations, infections. The families of wounded service-members understand this well. When we come to them, as strangers, we sometimes fail to see the truth. What we see as shattered and unlovely is only a dim reflection. Who they are, their value, is perceived through the loving eyes of those who ‘see them as they are.’ We strangers certainly have no concept of the treasure trove of stories and wisdom, memory and meaning in the people we often see only in terms of illness and injury.
I have also seen this in the adult parents of addicts. Worried fathers and mothers who come to the hospital from across the town, or across the country. They hover over their children despite the emotional pain, the fortunes spent on rehab and legal fees. They are so happy to see that wayward, prodigal child that they ignore the lies, the violence, the profanity and derision hurled at them as they try to help. Many times I’ve wanted these patients to simply go to jail and stay there. Their manipulation and narcissism being more than I can tolerate.
Ah, but I cannot see them as they are seen by those who love. I cannot know them before the drugs and alcohol, when they had joy, when they were charming or kind. Even if they were always hard to handle, I cannot know the innate, irrevocable love, the hopes and dreams their parents (spouses, siblings) have carried for decades, through trial after trial. The remembrance of school days, vacations, triumphs, romance and dreams.
My vision is sometimes clouded because these people appear worn. They have cirrhosis, hepatitis, HIV, chronic wounds. They have handcuffs and warrants; they have lived hard lives. But that’s not how they look to those who continually lose them, and find them again, hoping at last to see the cycle broken. They are precious gems, covered in dust and dirt, lying in life’s sediment, as families try to find them and polish them. It’s easy to ask ‘why do their parents keep helping?’ To which they answer, ‘how could I stop? This is my child.’
And in considering all of this, from bracelets to drug abuse, I understand better than ever what this kind of love actually is. This kind of profound worth and care of the beloved, do you know what it is? This is the Gospel of Jesus. It’s a love that will live and die for the objects of its affection. It knows the value of everyone, for it created them, and imbued them with it. It’s a love that knows all of their stories of sorrow and pain. And never, ever, stops pursuing them until the end of time.
If we want to stop struggling with ‘isms’ and ‘phobias’ and all the rest, if we want to stop the endless, exhausting arguments of political parties, all the attempts to assert control, all of the ‘othering’ based on ideology, science, faith, race, education, geography or anything else, this Gospel is the best place to start.
Because everyone is a treasure. If only to God. May He open our eyes.

PS Reward for the bracelet!

Christmas is Rooted in Imperfection

This was my column in Sunday’s Greenville News.  Merry Christmas my dear friends!

http://www.greenvilleonline.com/story/opinion/contributors/2015/12/20/christmas-rooted-imperfection/77441958/

Christmas appears, if we believe the marketing, to be a season for the rich, happy, safe and whole. The time when vast, intact families of beautiful, healthy people gather around lavish feasts and exchange mountains of gifts, all while understanding ‘the real meaning of Christmas.’ Children come home from college, husbands and wives embrace, grandparents sit quietly around the fire attended by grandchildren and even the dogs have shiny coats, pawing open their toys from palatial pet stores. Outside the window snow falls and Santa slips away with a smile. I love it! Except, it isn’t always that way. In fact, it isn’t mostly that way.

Maybe that’s why it started the way it did. Humble and dusty, in a shed for animals, with poor parents, traveling far from home and having a baby whose identity and destiny were, at the least, overwhelming. Christmas started in a place where poverty was not merely widespread but baseline. Riches, means, these were the outliers. When Christmas is temporally perfect, that’s grand. But Christmas is for those struggling. At Christmas, Jesus is born into the midst of difficulty and brokenness, not into a palace.

Furthermore, the Christ child came to a people with a clear cultural memory of slavery, in a time when they were subject to the vast power of almighty Rome. He came in a time when being forced into slavery, because of debt, crime or conquest, was simply a fact of all too many lives. It is comical that those who object to Christianity use the term ‘slave religion.’ Of course it is. It was and is a slave religion because it cared for the slaves (and others nobody wanted), embraced them, and because Jesus himself said came, among other missions, ‘to proclaim liberty to the captives.’

And of course, we are slaves and captives still. Slaves to the illusion that politics (or worse, politicians) will redeem the world. Slaves to possessions. Captive to the idea that only money matters, and that with enough money every person will be good, healthy, kind and just if only we can shuffle it around adequately. Slaves to the beliefs that we can control everything, that success is all and that education and intelligence somehow excuse us from trouble. Captives all around, though the shackles are prettier than the heavy iron of old days. But they hold us still.

Jesus was not born so that we could have a nice holiday, although I love Christmas as many of us do. He was born, launched into this world, a teacher, healer, deliverer, redeemer. And this is very important for all of those whose lives are broken at Christmas. I’ve seen them over and over. Christmas can be a time of grieving, worry, fear, sickness, loss, mourning and loneliness as surely as it’s a time of beauty and wonder. And why not? It fits the story. Angels and heavenly songs attend the infant King, born into a place of trouble and suffering, point-counterpoint.

So then, move past the limited accounts we have of that first Christmas. Watch the Gospels after Christmas and see the child become a man. He healed the possessed, the blind and lame. He taught mercy and turned human judgment upside down time after time. He raised the dead. And he forgave sins, which is maybe the one thing we find the most objectionable of all (because it would mean we have to believe in sin and our own guilt).

Trouble at Christmas is especially hurtful, simply because we want everything to be just right. But we must not be ‘troubled at the trouble.’ Christmas happened, and happens, exactly because of trouble. The world needed more than kind words and beautiful ideas. It needed a deliverer, who would plop right down in the midst of every dark thing that binds and wounds us.

I hope that everyone has the perfect Christmas, with loved ones and prosperity all around. But most of the world won’t. Which is, beautifully and ironically, exactly why Christmas happened. And why the man Jesus, years later, said in John 16:33, ‘I have said these things to you that in me you may have peace. In the world you will have tribulation. But take heart; I have overcome the world.’

If that’s not a Christmas greeting for everyone, nothing ever was.

Merry Christmas.

Giving thanks for modern medicine

Giving thanks for modern medicine.  This is my November column in the SC Baptist Courier.

http://baptistcourier.com/2014/10/wholly-healthy-giving-thanks-modern-medicine/

My father-in-law was one of 17 children. Twelve lived to adulthood, five dying of assorted illnesses that were difficult to treat in the remote hills of West Virginia. My grandmother told tales of her baby brother, who died of diphtheria in the early 20th century, around the age of two, and in the hills of Appalachia. Not long ago I took care of a patient paralyzed by polio as a child, bedridden to this day in the late years of her life.

I’ve walked many a cemetery. I recommend it; particularly for the young. A cemetery, coupled with a little knowledge of history, is a great opportunity for perspective. And in the remote sections of almost any graveyard, we can find so many stories, implied but not told outright. A young woman, ‘cherished wife and mother,’ lies by ‘infant son.’ A young man, with the letters US or CSA on his stone, was laid to rest in 1863. He may well have died in battle, or did later of his wounds, or of one of the infections that ravage every war. The elderly in those hallowed places are rare before this century. Some lived to their 80s or 90s. But many passed in their youth, or in what we consider middle age.

There were no cardiac catheterization labs for heart attacks. There were no ventilators to support the sick through the gasping struggles of heart failure. There were no antibiotics for the gangrene from a simple puncture. There were no vaccines to protect children from infections we have for so long taken for granted. The deaths of mothers, and infants, during delivery was painfully common. There were no helicopters to take the wounded from the battlefield (or car crash or farm accident) to safer, cleaner places. Spend time among the dead, and say their names as a way of honoring their memory. And then, consider your blessings.

For all that we complain about the perceived inadequacy of our healthcare, it wasn’t so long ago that death stalked us much more effectively than now. And while we should always try to improve, we must keep the past in mind. The past when pneumonia was a death sentence, adult or child. The past when dehydration from cholera was devastating and uncontrollable. The past when the Black Plague decimated one third of our European ancestors. The past when the flu, with no vaccine available, killed 50 million worldwide, as recently as 1918.

Among the many things we can be thankful for this Thanksgiving, let us include the healthcare advances made possible by dedicated doctors, nurses and paramedics; by brilliant researchers and applied scientists; by politicians who provided encouragement and funding for public health initiatives. And let’s not forget the efficiency of industries that produced the products that have prolonged and improved our lives.

Ultimately, let us be thankful that God has given humans the knowledge and skill to pull back the curtain on death and to find the way to ease so much suffering and save so many lives.

But best of all, let us give thanks that Jesus Christ put an end to the power and fear of death once and for all, by vaccinating us against the permanence of death.

And that’s a reason for celebration.

 

Banning books…and everything else

“Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience. They may be more likely to go to Heaven yet at the same time likelier to make a Hell of earth. This very kindness stings with intolerable insult. To be “cured” against one’s will and cured of states which we may not regard as disease is to be put on a level of those who have not yet reached the age of reason or those who never will; to be classed with infants, imbeciles, and domestic animals.”
C.S. Lewis, God in the Dock: Essays on Theology (Making of Modern Theology)    

Lately I’ve noticed that some of the hospitals where I work have banned sugary drinks. Physicians, nurses, patients and their family members can’t possibly tell what’s good for them, you know. Many schools have done the same thing, in an attempt to encourage the kids to drink juice, milk and water. There are, it seems, lots of people who know what’s best for everyone else.

But then, it’s not just food, is it? Although I’m no fan of smoking, I’m amazed that smoking bans are in place almost everywhere. It won’t be long until smokers have to leave not only the building, city and county, they’ll have to leave the atmosphere.

It’s all a little ironic since so many Americans, who are violently opposed to tobacco, are all on board with legalization of marijuana. (Maybe they’re part of the brownie cartel…wait, some schools have banned brownies. Dang it!)

But sugar and nicotine aside, let’s look at other bans. There’s the recent 9th Circuit Court of Appeals ruling from California. Some rascally kids wore American flags to public school on Cinco de Mayo. They were told to change and a legal kerfuffle ensued. Quick summary of litigation: the court says that they can, in fact, be banned from wearing clothes emblazoned with the Red, White and Blue. If they wore them, hurt feelings might ensue, and we all know how uncomfortable that can be!

In like fashion, many conservative speakers have been all but forbidden to speak at colleges and universities. Former Secretary of State Condoleeza Rice canceled plans to speak at the commencement ceremonies at Rutgers University this year, because of protests from bright, tolerant students whose parents are paying vast sums for them to learn to appreciate different cultures and opinions. The students were upset over Ms. Rice’s former involvement in the war in Iraq.

Also this year, Brandeis University was planning to give an honorary degree to Sudanese-American Ayaan Hirsi Ali, a women’s rights activist and critic of Islam (and of the genital mutilation of women, of which she knows first hand). Brandeis decided it might not be a good idea because Ali had also, apparently, caused unpleasant hurt feelings among those she criticized, in a manner inconsistent with Brandeis University ”core values” (of which one appears to be don’t criticize female genital mutliation).

The list of persons asked not to speak at our open-minded institutions of higher education grows every year. But it isn’t just a problem in the hallowed halls of academia. Consider the wailing and gnashing of teeth that happened a couple of years ago when it was discovered that Chick-Fil-A, that iconic restaurant of the South, was owned by people opposed to same sex marriage! Why, boycotts were organized by thousands upon thousands of people…who never went there in the first place. (And the restaurant experienced record sales in a reverse protest of unparalleled chicken eating and sweet ea drinking…that’s my kind of political engagement!)

In addition, earlier this year, Internet giant Mozilla fired it’s CEO, Brendan Eich, when it was learned that he had once (privately) donated to the campaign against Proposition 8, which would have banned same sex marriage in California. (Remember kids, no business should control your body…they should only control your mind and opinions!)

It’s all more and more common, as control of others becomes institutionalized in schools, courts, government and business. It’s just that the magnificent irony is that as I wrote this last week, it was ‘Banned Book Week.’ This is the time when people typically take shots at stodgy conservatives for wanting to limit access to works like ‘Lolita,’ or even ‘The Hunger Games.’ (The Bible is not infrequently banned. Recently it was even temporarily removed from Navy guest lodges. But I guess it’s all the sex and violence.) Now, I’m opposed to banning books. It’s silly and only makes people want to read the book even more. Which, of course, makes it a great marketing ploy. (Did I tell you my latest book was banned?  Yep! Buy it and strike against oppression!  http://www.amazon.com/s/ref=nb_sb_noss_1?url=search-alias%3Daps&field-keywords=life%20in%20emergistan&sprefix=life+in+e%2Caps  )

However, what I want to know is this: doesn’t this seem inconsistent? We live in a country all misty-eyed over banned books, but thrilled to crush and divert any opposition to behaviors or thoughts that might run counter to popular opinion or wound someone’s infantile sensibilities, or might allow an individual the freedom to do, or believe, whatever he or she wants.

It’s an old ‘straw-man’ argument against the church that all we want to do is control people. That our goal is to take the fun out of life by banning sex, booze or dancing. That’s ridiculous! Catholics and Evangelicals have more kids than atheists, so short of virgin births somebody is having sex. And many Christians do drink; they just don’t make eye contact in the liquor store. As for dancing? Not so much a ban as the fact that white evangelicals are just so bad at it; and probably should be banned by a federal dancing commission.

There are indeed some controlling Christians who go too far. I agree. And for those within the faith, there are certainly things we’re prohibited by God from doing. We sometimes do them anyway, to our spiritual and physical peril, but that’s what repentance is all about.

However, I think controlling Christians have lost the lead. Christians have been far outpaced by the controlling lawyers, health-advocates, professors, politicians, community organizers and legions of politically correct busy-bodies who never tire of telling the rest of us what we can’t do.

The good news is they’ll still let us read ‘The Catcher in the Rye’ and other naughty books. As long as the titles don’t offend anyone, the content is multicultural, tolerant, multi-ethnic, and free of gender bias and nationalist tendencies and printed on recycled, dolphin-safe paper.

And as long as while we read those works, we’re drinking Diet Coke.