Phraseology for Crucial Communications

It's nice to have a few scripts and templates when talking with others.   Here are a few useful phrases for you to use:

“May I Speak Freely?”

“My purpose in talking with you is …” (a mutual goal)

“When you … I feel . . . ” (action you are giving feedback on – something they can change)

“I imagine that …” (positive intent/benefit of the doubt)

“And because we both want …” (common goal)

“I need …” (specific alternative behavior requested)

Most importantly, affirm him or her as a person

~Dr. Jay Kaplan's Lecture at ACEP Scientific Assembly, Boston 2009.

Take Action

I came across this parable, while reading, "Action! Nothing Happens Until Something Moves," by Robert Ringer.

Every morning in Africa, a gazelle wakes up.  It knows that it must run faster than the fastest lion or it will be killed.

Every morning in Africa, a lion wakes up.  It knows that it must run faster than the slowest gazelle or it will starve.

It doesn't matter whether you're a lion or a gazelle; when the sun comes up, you'd better start running.




"Whatever you can do, or dream you can, begin it. Boldness has genius, power and magic in it." ~Goethe 

Non-Medical Advice for Young Emergency Physicians

I was browsing through AAEM's Commonsense Journal (Sept/Oct 2012 Issue PDF) last week and came across a brilliant article by Dr. Andy Walker.  He is a mentor for young EM physicians and offers these points of advice:

Live beneath your means.  Save 15-20% of income if you are employed. Save 25-30% if you are an independent contractor.  Stay out of debt and pay off debt as quickly as possible. EPs should have at least 6 months of income saved, as ER jobs are inherently unstable.  Money may not buy happiness, but it does buy freedom - and freedom is pretty damn good.  Save your money.

Rent, don't own. There will be surprises and you will be in a stronger position if you can pick up and leave.  Especially, rent for the first year.

Insure wisely.  You absolutely need disability insurance, as you are far more likely to become disabled than to die early. Get "own occupation" disability insurance.  If you do get life insurance, get term insurance.  

Be a faithful and disciplined investor.  Start investing early and time will be on your side. Diversify widely. Educate yourself.  He recommends books by John Bogle, the founder of Vanguard. 

Participate in organized medicine. The biggest enemy of physicians is their own sense of hopelessness. But a difficult fight is not an impossible fight. Join your state medical society. Join AAEM today. 

I'd also like to add a couple of things:

Be happy now. You have arrived.  Stop getting trapped in thinking, "I'll be happier, once I get the BMW, house, etc."

Seek balance. Residency can be extreme and now is the time to focus on your health, family, friends, fun, leisure.

Be Yourself

"Be Yourself," is something frequently said and heard. But to be yourself, you have to know who you are. Take time to reflect on your life and how you came to be where you are right now.

What are your values? What do you want people to say at your funeral? What makes you different?

Emergency Haikus

What's causing the pain?
Myocardial infarct.
Transfer to cath lab.

Trouble with sleeping?
Worries and anxiety.
ER is open.

Can't move your right side?
And your speech doesn't make sense?
Head CT and then....

The spider bit you
Redness, swelling, and fever.
Here's doxcycline.

Vaginal bleeding.
What is causing this problem?
Not your period.

Dr. Raul Ruiz for Congress in 2012

During the CAL/ACEP Scientific Assembly in La Quinta, CA in 2009, Margaret Salmon MD, MPH (a close friend and co-intern) told me, "Sam, you have to meet my friend from Harvard."  This was my first meeting with Raul Ruiz and would not be the last. 

Sometimes, life surprises you with these incidental meetings that seeds the beginnings of life long friendships.  Raul's story is awe-inspiring.  He comes from a family of immigrant farm workers from the Coachella Valley desert.  To get into college, he went to his neighbors' doors and made a promise, "Help me pay for college.  I promise to come back here and make a difference."

Not only did he make it to college, but he went to Harvard and graduated with three degrees (MD, MPH, MPP).  Afterwards, he went on to complete an emergency medicine residency and an international medicine fellowship.

Now, he is a community ER doctor back in the Coachella Valley desert and Associate Dean at the University of Riverside School of Medicine.  He made a promise many years ago and kept it.

When Raul told me he was running for Congress, it just made sense to me.  He is the kind of leader that I want to see helping create laws and addressing disparities.  Raul is an emergency doctor who has the back ground in public health and public policy tools to make a positive impact.

Would you like to see someone who understands medicine, policy, and public health to help create legislation?

Do you want to have someone in Congress who keeps his promises?

Please make a donation to Dr. Raul Ruiz.  Even $5 makes a difference in this grassroots campaign. Here's the link: www.drraulruiz.com 

Raul Ruiz, MD, MPH, MPP

International Ultrasound Resources

INTERNATIONAL ULTRASOUND RESOURCES
By Dr. Sachita Shah

BOOKS : Obviously there are many within our specialty, but these are
some ultrasound books outside of EM that have pertinent info for
practice in low resource settings and/or are written for generalist
health care providers

1) Cristoph Dietrich, MD, and colleagues have published a freely
downloadable, online full color textbook, including special chapters
on US in HIV and tropical diseases. It is an in depth resource that is
made more for experienced clinician-sonographers, and written in high
level /technical english. Great work and so inspiring that it is free!
Please check it out at this link: http://www.efsumb.org/ecb/ecb-01.asp

2) Ultrasound: A Practical Approach by William Marks.  http://www.amazon.com/Ultrasound-Practical-Approach-William-Marks/d...

3) Training in Diagnostic Ultrasound Essentials, Principles and
Standards, WHO Study Group report.  http://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&cod...

4) Manual of Diagnostic Ultrasound in Infectious Tropical Disease
(covers abdomen only, available by amazon too)  http://www.wfumb.org/publications/books.aspx

5) Partners In Health Manual of Ultrasound for Resource Limited
Settings (free, electronic book in pdf, simple english, point-of-care
approach to abd/ob/dvt/skin/procedures etc)  www.pih.org/publications/c/manual


COURSES:
1)  Short Course on Abdominal Ultrasound in Tropical Disease  
http://www.tropicalultrasound.org/
This course  (YEARLY, April, Italy)is designed for clinicians who wish
to acquire basic skills in ultrasound of the abdomen and a general
overview of Ultrasound in Tropical Medicine. Imaging specialists who
want to acquire knowledge in the field of Infectious Diseases and
Tropical Medicine can benefit from this course as well. It is also
designed for MDs who plan to work in tropical/resource poor areas or
who are already experienced in field work but need to refine their
skills in this diagnostic tool.

2) Clinical Ultrasound in Tropical Infectious Diseases  
http://www.georgiahealth.edu/ems/COM/InternationalMed/Peru.html
Join the faculty of the Instituto de Medicina Tropical, Alexander von
Humboldt, Cayetano Heredia, Lima, Peru; the Center of Operational
Medicine, Section of Clinical Ultrasound, Georgia Health Sciences
University; and the University of Pavia, Division of Infectious and
Tropical Diseases, IRCCS S. Matteo Hospital Foundation as they co-host
the first Clinical Ultrasound in Tropical Infectious Diseases course
in Lima, Peru, October 21-26, 2012. Providers with experience and/or a
special interest in clinical tropical medicine or infectious disease
with ultrasound experience are invited to attend. This unique course
consists of lectures, demonstrations, and small-group clinical rounds
for live ultrasound scanning.
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Dr. Sachita Shah is Assistant Professor at UW Division of Emergency Medicine in Seattle.  She completed her US fellowship at Alameda County Medical Center-Highland Hospital.  She is the first author of "The Partners in Health Manual of Ultrasound for Resources Limited Resources." (See the link in number 5 above)