May 25, 2020

Rebellion in EM 2019: Got Milk? via Jenny Beck-Esmay, MD

“You’re working a shift in whatever the lower acuity version is of your department. So maybe it’s fast track, maybe you call it an urgent care. Whatever it is, it’s a unit where they take doctors, who trained for 7 or 8 years to become expert resuscitationists, and make us spend all day seeing sniffles, sore throats and chronic back pain in a manner that I can only assume was designed specifically to make us all exceptionally crazy. But, either way: that’s where you’re working. You’ve taken care of a young woman, you’ve treated her ailments, you’ve decided what’s wrong with her. And you’re deciding you are going to prescribe a few medications for her and send her on her way. You’ve answered all of her questions and you are walking out the door, your hand is on the door handle and she says “Oh, but doc, did I tell you I’m currently breastfeeding my 6-month old baby? Can I even take these medications?” And your heart stops. And you freeze. And your hand is still on the door handle. And the first thought that goes through your head is “Oh my God, I have no idea.” Because you, like most of us, had one lecture on medications in pregnancy and lactation back in your second year of medical school and you have no idea what you learned. That’s your first thought. “Oh my god, I have no idea.” Your second thought is “Oh my god, I have 8 more patients that just got triaged, while I had that thought. What am I gonna do?” Your third thought then is that you breathe a sigh of relief and you go “It’s ok, I’ve got an ED pharmacist. I’ll just ask her.” But then you’re horrified again because you realized it’s Saturday! And while you work in a 24/7/365 emergency department, your department has decided to staff this one crucial member for just business hours from Monday through Friday. And you think “That’s terrible.” And now you’re back to horror. Because, again, you don’t know what to do. And another 8 patients have been triaged and they all have chronic back pain and they’re asking why they haven’t been seen yet. And you’re still in that room and your hand is still on the door. Now you think “I don’t know. I don’t know.” “Honestly lady, I don’t know, you probably should just pump and dump.” Out of an abundance of caution we always just revert back to “You should pump and dump.” But I’m going to argue that that’s probably not the best strategy.” ...Read More