Lots of folks say “you must be brave” when they find out I work in the ER.

It’s true that I don’t (usually) get upset at the sight of blood. But there are plenty of things that scare me.

A non-exhaustive list of things this emergency physician is afraid of:

Because I’ve seen a child choke on a hot dog or grape that wasn’t cut lengthwise.
Door slamming

Because I’ve had to repair way too many fingertip amputations in little kids.
Throwing sticks

Because one time I saw a kiddo lose their eye after an innocent game with a sibling.
Jumping on the trampoline with your dog

Because...just don’t do it. It’s a bad idea.

Because I’ve seen healthy kids, pregnant women and adults die from influenza.
Infant suffocation from unsafe sleep

Because I’ve held a mom as she crumpled in my arms and screamed when I told her we have tried everything to no avail.

Because I’ve had to tell a parent I couldn’t reverse what happened in the blink of an eye to the beautiful child with the sun-kissed still-damp curls.
Gunshot wounds

Because I’ve seen way too many bodies, families and communities torn apart in milliseconds.

Because I’ve seen how it robs vibrant and proud patients of their voice and independence.
Heart attacks

Because I’ve seen patients stay at home while their heart muscle is died and they developed disabling heart failure because they are worried their insurance will say it “wasn’t an emergency” and deny their claims.
Chemical dependency

Because I’ve seen patients suffer and die because they cannot access lifesaving treatment.

Because I’ve held the hand of a spouse and parent talking on the phone to their young child and holding it together so they can figure out how to tell them they only have one parent now.

Because I’ve struggled to treat the pain and suffering of patients and their families who bravely support their loved one, knowing they are losing them too soon and powerless to change the course.

Because I’ve cared for patients who have died OF COVID. Because I’ve cared for patients whose spouses died OF COVID. Because I don’t want to be the link in the transmission chain that leads to someone else’s death. Because I don’t want to risk leaving my kids orphaned.
I’m afraid of these things because they are real risks.

Some are big risks. Some are small.

Some are common and cause temporary pain and suffering.

Some are small risks but disastrous with permanent damage.
Many things about our health cannot we cannot control. It’s hard to accept. But some things we can.

We cut the hot dogs (lengthwise!).

We wear helmets and seatbelts.

We get flu shots.

We have a system at the pool.

We have a no slamming doors rule.
Please know that COVID-19 scares the doctors and nurses and other healthcare workers.

We are afraid.

Because we have witnessed what it can do if you or your loved ones get severe COVID. We know that money, power and fame can’t purchase a cure.
The good news is that we know what helps to prevent infection and spread.

Wearing a mask. Distancing. Avoiding large indoor gatherings. Hand hygiene. Quarantining, even when it is inconvenient. Supporting patients who don’t have the resources to isolate or shield their elders.
Don’t confuse recklessness and hubris with bravery or bad luck.

Let’s keep normalizing compassion and care for for one another and save lives.

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More from @amychomd

9 Aug
As teachers go back to school, I think it's important that they learn from what we have learned in hospitals. I will share some things and hope others chime in with their best tips.

#MedTwitter #NurseTwitter #teachertwitter
First of all, if folks have any potential symptoms, they need to get tested and STAY HOME.

Common symptoms:
*Shortness of breath
*Sore throat
*Muscle aches
*Loss of taste/smell
*Nausea, vomiting, diarrhea

Unfortunately, though, we cannot effectively screen out all of those with active infections because some don't get severe symptoms.

Some folks who are infected are:
*Minimally symptomatic

However, we believe they can still spread infection.
Read 23 tweets
17 Mar
(Author unknown)

This post is for my healthcare workers, docs, surgeons, Nurses, aids, and ems, but also support staff.

There is no emergency in a pandemic
You as a healthcare worker are a force multiplier. Your training and experience is invaluable moving into this crisis. So, you're going to be faced with some very difficult moments. You're going to have to put your needs first.
I'm speaking specifically about PPE and your safety
If you're an ICU nurse, or an ICU doc, and you become infected, not only are you out of the game for potentially weeks (or killed) But your replacements could be people without your expertise.
Read 13 tweets
13 Feb
“But in taking their cause to politicians, doctors have waged an extraordinary on-the-ground stealth campaign to win over members of Congress. Their professional credentials give them a kind of gravitas compared with lobbyists who are merely hired guns.”

Thanks @NPR for the encouragement to keep going! Sometimes democracy does actually work. Sometimes citizens meeting with their legislators & explaining #EMTALA and the unintended consequences of certain policies to our safety net and emergency care system works.
It’s definitely not a “stealth campaign” though! One of our meetings with an aide was standing in the hall today 😂. We’ve published, done podcasts and tweeted ad nauseam since no journalists seem to care about the details or anything but lurid headlines.
Read 13 tweets
22 Dec 19
Not true @ezraklein. Doctors are not the enemy to “fight.” We aren’t a “problem.” And patients trust us because we devote 7+ years to rigorous, exhausting training and we actually take care of them. We provide invaluable services. Unlike their insurance company.
Uwe Reinhardt wrote: “If we...cut that take-home pay [of all physicians] by, say, 20%, we would reduce total national health spending by only 2% in return for a wholly demoralized medical profession to which we so often look to save our lives.”forbes.com/sites/physicia…
Uwe Reinhardt: Physicians are the central decision makers in health care. A superior strategy might be to pay them very well for helping us reduce unwarranted health spending elsewhere.”
Read 7 tweets
10 Dec 19
I read it. It sounded familiar - like it was ghostwritten by one of the lobby groups I’ve come to know quite well. The ones that take advantage of poor understanding of the financing and business of healthcare...and EMTALA. I’ll share some different data. 1/n
I work in MN, the state with the lowest rate of OON billing. My independent practice (50years old) doesn’t balance bill charges to the <2% OON patients we see. Yet we expect the benchmark you advocate for to drive us out of business. healthsystemtracker.org/brief/an-exami…
A little tutorial on how private practice docs are paid:We don’t get a salary like docs in academia.We aren’t paid by hospital. Our pay is based on reimbursement - what the government/insurers/patients pay us. No patients, no pay. No paying patients, no pay.
Read 25 tweets
17 Oct 19
@teampelosi @EnergyCommerce @WaysMeansCmte @EdLaborCmte @SenateHELP Over 100 physician specialty societies & state medical societies are urging you to solve surprise billing with #IDR. drive.google.com/file/d/1YdR6HF…
A chorus of independent physicians (not PE companies or the people who surprise bill) recognize the danger of a benchmark solution and are asking you to listen.
"Simply put, certain proposed solutions for surprise billing will kill you or someone you love."linkedin.com/pulse/your-chi…
The health policy "experts" you have heard from don't want to tell you about EMTALA. You MUST understand EMTALA in order to understand how new benchmark regulation would cede #RateSetting power to #BigInsurance at the expense of patients & the safety net.
Read 32 tweets

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