Reflections Day 2: the ER is the Gate

This is the fifth time I have seen the film detailing the Michael Skolnik story and I still must fight back tears each time. It’s also amazing how much I learn with every viewing. Every bad outcome starts with an initial conversation and as an ER physician, many of the initial conversations occur on my turf. I wonder how many times I have told patients diagnoses that changed their lives and lost them to follow up, which is inherent in the emergency medicine profession.

I think back on times when I obtained “informed consent” from worried family members for patients on whom I really wanted to perform procedures. I remember my almost-first lumbar puncture, when the patient changed his mind and although verbally consenting, refused to sign the consent form in the end. I walked away so angry with the patient for not letting me perform the procedure, unable to log it towards my graduation numbers. Now I reflect and realize that if I were in the same situation, I wouldn’t want a needle in my back either!

The story of Michael Skolnik reminds me that the ER is the place where many lives change and it is our job to make sure that things don’t spiral out of control from the get-go. Discharging patients with correct follow up, though sometimes overlooked, is crucial to getting the correct management and avoiding bad outcomes.