Liz Calhoun, MD, MPH, FAAEM
@ecalhoun21
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EM physician | @drexelemergency alumna | @TempleEM alumna | @aaeminfo WiEM Chair-Elect | All opinions my own & not reflective of my employer
Philadelphia, PA
Joined July 2011
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Pinned Tweet
@3rdRockUS
has it right. Well worth the read.
The
#EMmatch
was a disaster bc
#EM
leaders failed
#EPs
and
#residents
, says
@3rdRockUS
. He says EM must not open new residencies, corral NPs & PAs, & pressure ACEP
@EmergencyDocs
to divest itself of corporate medicine. And that
@RobertMcNamar12
was right.
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@melissacc2020
@tweetmommybop
Because it might seem unrelated to you, but it is not to us (need to know for meds, imaging, risks for certain illness, etc.).
Dislocated shoulder? Influenza? Headaches? Chest pain? It matters.
We’re not asking just because.
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If you are an EM doc who has never practiced outside of a tertiary care center… it shows.
Transfers for a specialist I don’t have shouldn’t take 3 physicians, multiple insults, “I would just send them home,” and 60+ minutes.
Yes or no. Please don’t waste my time.
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661
To the physician on the other end of the transfer line: please just say “yes” to the easy ones.
My patient needs a specialty I don’t have tonight. They already see a specialist at your hospital for this. You’re 15 minutes away. You have beds.
I didn’t expect pushback.
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@crockett_teresa
@melissacc2020
@tweetmommybop
You ask. And if you don’t trust my answer, then I’m not the person who should be caring for your emergency.
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@medlife_kels
Happened to me at the start of intern year! (I blame the poppy seed muffins at the orientation breakfast buffet ;)
… I think they stopped serving them after that 😂
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I’m sorry that it’s more work for you.
I am not going to transfer the patient to a hospital in my network that is further away.
This is in the best interest of the patient.
I’m tired, too. Please, just say yes.
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IDK who needs to hear this, but:
I trained at two programs, both ranked very highly on my list. I re-interviewed at several others on my list (and several that weren’t).
Seven years, eight hospitals, and two programs layer, let me say this:
GO WITH YOUR GUT.
#match2024
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@SaltyEMNY
Conversely, if your ED Covid test was positive, you have COVID. I have yet to see a false positive (particularly when you have symptoms).
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@acweyand
A near-daily conversation I have:
“You’re sexually active, not on birth control, and you don’t use condoms. Are you trying to get pregnant?”
“No.”
Over and over and over. I blow a lot of minds in my 2 minute sex ed discussion.
Not surprised but sad.
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@AlanaKinrich
I had a patient last year where OB came to do the perimortem.
I was amazed at how fast they got the baby out. But more amazed at how fast they closed. That will be the rate limiting step for me😬
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@Gabby_Brauner27
Tbh I hate pain scales.
I’ve heard “15/10” for a papercut and 2/10 for sickle cell acute chest, writhing on the bed.
I prefer the “Improved Pain Scale” or “Art Pain Scale.” (Kidding, mostly.)
Just tell me you are in pain. Low-Med-High if you must.
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So sad to hear of another safety-net hospital closing. Sending ❤️ to all the faculty and staff, especially the residents.
To say we are all devastated at Tufts Children’s is an understatement.
In the midst of a pandemic, for-profit healthcare has destroyed a sacred legacy, and obliterated a decades-long commitment to the most vulnerable kids in Eastern Mass and ultimately most of New England.
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@AndyCrCl
“The patient in bed x who came in for toe pain has a hemoglobin of 8.
Wait, I mean their potassium is 8. Their hemoglobin is 5. But they’re stable.”
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@HelliOOAK
@melissacc2020
@tweetmommybop
Pain medications, imaging, anesthesia risk, sedating medications.
If I’m asking, I genuinely need to know.
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@pulmtoilet
YES.
Also, to be clear, it was the sub-specialist on the line who was condescending and insulting.
But yes, I hate having to say, “you don’t get to say that until you have physically seen them.”
EKG to IC: “not impressed.”
Bedside: “he’s going to code.”
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@plbiddle1
@B52Malmet
It wasn’t eradicated. If it was, we wouldn’t be talking about this. They came close, but there were several countries that prevented global eradication.
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@Caulimovirus
Truly location dependent.
It’s always fun to ask our residents/students “hey, what about their malaria risk?” when they present a patient with flu-like symptoms.
Our ED diagnoses it several times a month.
I work in Pennsylvania.
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@Zoe_Beausoleil
It gives you exposure to things you might not otherwise see, and appreciation/empathy for your colleagues who ARE working 24h shifts.
If your team isn't engaging you at 3am, that's a different problem.
Medical school is about dipping a toe into the breadth of medicine.
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@Suburbanbella
I’m absolutely floored at whomever told her that she didn’t have a case for malpractice. The paralysis (!!) aside, she received an NSAID which absolutely made the SAH worse. Crazy.
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@mattlecuyermd
Felt it tonight. Tried to transfer a kiddo. Needed more than ED care but not PICU. No beds at 6+ hospitals.
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@HalstedMD
@StanfordMed
@pppforpatients
@Rebekah_Bernard
Well, I probably wouldn't be getting into medical school these days... silly me for thinking that the person with the most education should lead the team.
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@AshleyGWinter
Even if COVID were to disappear completely tomorrow, I I foresee wearing a mask indefinitely for my patient encounters. If nothing else, I haven’t been sick in months.
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@olsonplanner
Type-A aortic dissection. Story was opposite of textbook. Normal labs, EKG, CXR, vitals, exam. Pain improved with massage. Couldn’t shake my gut feeling. CTA was positive.
Flown out. Got a text he lived neuro-intact despite prolonged time on bypass.
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@Fred_Chu
@pjputh
@mcsassymd
@KurteL10
If it's a farmer saying that, call the ICU before you place orders.
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@CTPsychResearch
@melissacc2020
@tweetmommybop
The number of pregnancies I’ve seen in women who have told me that there is no possible way they could be pregnant would shock you.
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@JulieTVieth
Can I like this twice? I wish residents got more exposure to community transfers as well. (No, it doesn’t count when you call within your own system!)
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@fuzzymittens
So unhappy in his big new city house without a backyard…
But the local golden retriever rescue won’t let us adopt, because we don’t have a fenced in yard.
3 walks a day, weekly “run time,” a dedicated dog walker, and a roof deck. Terrible life he has 😂
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@KurteL10
And please, update ME, and not only the nurse. You can tell them too— but we have different questions. I’m the one that consulted you; please give me the courtesy of a direct response. You’ll still have to talk to me, and I will be more annoyed when I call.
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@efunkEM
I had a patient with a cervical spine EA that caused acute LE paralysis. Radiology gave me so much pushback about scanning the whole spine. I would have missed it if I had only scanned L/S like they wanted.
If you suspect it, scan everything!
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@VPrasadMDMPH
Mild or asymptomatic hepatitis C can lead to cirrhosis or liver cancer.
Mild or asymptomatic EBV can lead to MS, lymphoma…
We have no idea what kind of havoc SARS-CoV-2 is going to wreak b/c it hasn’t been around long enough.
Suggesting mild disease is nbd is irresponsible.
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On my first overnight shift at Temple as an EM senior resident, we had 12 level 1 trauma activations in 8 hours. All were GSWs. None were mass shootings. Sadly, the number of people injured or killed by gun violence in Philly this weekend is not an anomaly.
This is 4 hours of traumas at my hospital...
There is NO internal consistency for lawmakers who believe in the sanctity of life so much to ban abortion, but not enough to fight for gun control.
FYI, GSW = Gun Shot Wound.
#ThisIsOurLane
#DoctorsForGunSafety
#GunControlNow
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@AlanaKinrich
I was considering thrombolytics, so closing was a real consideration. If I wasn’t, I wouldn’t close either.
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@fuzzymittens
What gets me is “you should have worked,” or “you should have gone to public school.”
My scholarships made undergrad and grad school cheaper than public school. I went to a state medical school. I’ve earned a paycheck every year since I was 10, including med school. 350k.
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Come and see six fabulous speakers as I lead the "Six Docs Walk Into a Shift Show" talk at
@aaeminfo
SA 2023!
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Final year resident/fellow checklist:
✔️ own-occupation disability insurance
✔️ medical contract attorney to review your offer (s)
These should be planned and saved for. At the expense of other things. It will pay dividends in the long run.
Physician friends -
I mean it.
Get own occupation disability insurance from an independent agent as soon as you can reasonably afford it!
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@embasic
I disagree. Some people need to hear it. Just like we say “dead” and not “passed away.”
If I think it will be an issue, someone will explain what will happen (final exam, pronouncement) and ask if they want to stay or leave. Then I make a point to say “I’m sorry but _ has died.”
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@IR_Doctor
What? No.
We still do this. Totally in our scope of practice. I actually left a job because I was frustrated (among other things) that my colleagues stopped doing procedures.
Know that if I call you, I need YOU; I have tried and failed.
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@AshleyGWinter
Me to a 22 y/o guy I’m admitting for DKA for the second time this month: “you know, if you keep this up, your junk is going to stop working.”
Him: “it already has” 😳
I can’t share this story enough with my young diabetic patients.
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@MegWeis
@greenhousemd
Antibiotics don’t kill viruses. The younger the infant, the riskier it is to have a fever (ie may need to be admitted/in the icu). Irritability is a warning sign. Treating blindly without a source leads to antibiotic resistance. And on and on…
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You will be well trained. Find your people and hold on to them. We are happy to have you. Welcome to EM.
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@JeromeAdamsMD
Remember the date! I stopped asking for the date, just the month and year, after I had to keep checking my watch for the right answer.
(I also never know what day of the week it is.)
🤦🏻♀️
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@embasic
Omg. No.
And also, you shouldn’t be allowed to place IJs if you aren’t credentialed to place a chest tube as well.
One of the scariest memories of residency was hearing that there was a dropped lung in the ICU… and there wasn’t anyone in house to place the CT.
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I am eternally grateful to both programs who trained me and guided me as a physician.
But that gut instinct (which was also felt by my husband) led me to my best friends. My mentors. My crazy co-residents who seem to know when I’m in Mexico and reach out then.
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@SassyPsychDoc
@joshmcgoo
That’s (one of the) reasons it’s a bad drug. It doesn’t provide pain relief for everyone (tl;dr there’s a biological reason you can’t pre-test for).
It also can have very harmful side effects.
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@DocAroundThClok
Good shift? *watches Scrubs*
Bad shift? *watches Scrubs*
You can tell my mood by my episode choice.
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@olsonplanner
You’re assuming an inspection will actually catch all major issues. (Ask me how I know they don’t. 😬)
I think it’s important to research your builder and home history, regardless of whether or not you get an inspection.
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@emily_fri
All. The. Time.
“Hi, I’m admitting a 19 year old with sepsis secondary to pyelo. Lactate cleared, cultures sent, abx started. Vital signs normalized after Tylenol/fluids.”
“But they’re 9 weeks pregnant… can you admit to GYN or transfer for OB?”
No.
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@CJJonesMD
Sometimes we transfer for a direct admit to a service. Sometimes we do an ED-ED transfer. If you need a specialist, the consultant may come to evaluate in the ED before dispo. It depends on the patient and resources needed.
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@joshmcgoo
Don’t worry. For oral boards, you only have to know dosing for common medications. Even on boards you get a phone a friend! Keep up that esoteric exam trivia 😉
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@tnicholsmd
Yes, when I intubate a person I don't expect to live (and they are still semi-conscious), I tell them that they are not alone and that we are taking care of them, just before we push RSI meds. Even when I think they may eventually be extubated, I try and say something before RSI.
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@Dallas_Holladay
I took a pay cut this year and lost a lot of cushy benefits. I’m leaps and bounds happier.
Ask people who have changed jobs what interview questions they wish they had asked in retrospect.
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@joshmcgoo
I was a “keep my head above water” gal. I read about cases and topics I was weak on. Random Rosh where I could. Reviewed EKGs (check out the ECG stampede app and Mattu’s books). I bought one of the abbreviated versions of Tintinellis to skim on important topics. 1/
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@DrRissman
Worked a shift in the ED as a student. Febrile. Hoarse. Rigors. No one sent me home. No one offered to let me make up the shift (assumed I couldn’t because I was a rotator). Poor eval.
Dropped from my rank list— if that’s how you treat students, what about the residents?
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@SaltyEMNY
Don’t forget about the massive explosion of EM residency programs… in cities and states that already had them 😑
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@seferbamidbar
@TripleThreat_MD
When Hahnemann closed, ACGME was whatever “less than helpful” is. Having good faculty makes all the difference.
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@DrCasteelEM
Time to orders or time out of department?
3 minutes. DKA.
Fingerstick = high
POC CC panel
PH 6.8
Bicarbonate 5
AG > 20
Urine ketones
“Hi ICU? I have an admit for you…”
(It was my co-resident in the unit we staffed so quick admits were preferable ;)
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@kacohen88
@GamerEMDoc
@emresidents
Pretty sure serving was the only reason I got into residency.
But I would argue that it’s not the customer service experience that is most important, but the ability to multi-task, work odd shifts, prioritize, disposition, handle intoxication, and juggle general chaos. 🙃
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@emergencyemily
Ask your PD for an alumni list. Reach out to people (in places where you might like to be) and ask if they are hiring or know anyone who is. It's easiest to get a job through connections.
Also, it's early. Most of my friends didn't sign until the spring. Plenty of time.
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If you do not know how scary today's
#EMTALA
hearing is for Emergency Physicians, then maybe this will be a wakeup call.
I don't provide elective abortions. (TY to the OB-GYNs who do.) I just want to take care of my patients with medical emergencies without risk of imprisonment
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@RetroAlleyCat
@olsonplanner
@SPuro88
It sucked. It still sucks. It’s the f’d up gift that keeps on giving.
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@Armanvirabov
Vacation.
Oh, like something you get credit for?
ENT, preferably outpatient ENT. Look in as many ears as possible until you know what’s normal, what’s middle ear fluid, and what is realllly AOM.
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@kjdelay1
Should it? Probably not. Does it?
I didn’t realize the extent that I was unhappy at my last job until I turned off at the same exit and almost had a panic attack.
Was I unhappy before? No. Am I much happier now? Absolutely.
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@NeedSomeReality
@embasic
Ha. NO.
Like any life saving procedure, the best person to perform it is the physician credentialed to perform the procedure.
Key word there.
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@GeriDeac
@PhysicianDoodle
You are correct, it is a systems problem.
You don’t need to contribute to it.
You are literally putting people’s lives at risk.
Please try to understand where we are coming from. It’s not sustainable.
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@thanh_neville
Add in patients who are already terminal/moribund, and yes. I struggle, too.
I once had a family write me a thank you note after I helped their elderly mom pass peacefully on a morphine gtt instead of a prolonged code and resus.
I read it after the codes on the hard ones.
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@HofkampMichael
@AlanaKinrich
We’re fully expected to know how to do this. This is why we are the specialists in resuscitation.
I’m grateful that I had OB last time and was able to watch them.
I no longer have OB backup. It’s on me, and I’m damn sure I will do EVERYTHING possible to save my patient.
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@dremilyportermd
@tmprowell
I can’t speak on why such a weird amount was collected (or required to be collected), BUT:
Acute uncomplicated appendicitis gets admitted to observation status, not inpatient (at least in the adult world). It’s not same day surgery, but also not a full admission.
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@CanuckManMD
Palliative Care! Thank you for coming and having the hard conversations with our patients.
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@HemeIsABlast
You can say no if you don’t have capacity or the appropriate staff. Given overcrowding these days, I’ve been turned down due to lack of space.
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@OsinskiReflex
@olsonplanner
But many physicians don’t qualify for PSLF. Huge groups are left out. (EM as a speciality has low rates of doctors that qualify as most are not direct non-profit employees.)
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@pjtomaselli
@ACEPNow
You would think that after he proposed the EDUCATE Act banning DEI in medical education, they would have rescinded their invitation… to speak on advocacy. Another reason why ACEP does a poor job of representing our specialty as a whole.
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@olsonplanner
Working less is what will keep most of us out of long term care.
Less stress = better health outcomes.
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@blondemedSJW
The reality is that our patients will die because every hospital is not a tertiary care center. I’ve lost ruptured AAA, GSW to the chest, etc despite having surgery in house and being within a 15 min drive/5 min flight of 3 separate level 1 trauma centers.
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@AineYoreMD
@roto_tudor
They are starting to make mid-career fellowships so you don’t have to go back and be a traditional fellow :)
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@smuramed
@RodGerardo
@RockyJedickMD
@CriticalCareNow
@JCRStreams
@jasoncsho
@drsiyabmd
@JeremyHLevin
@BradGoldbergMD
@NAndersonMD
@grahamwalker
Sadly, not too different from a weekend *without* a mass shooting in Philly 😭
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@ScottKeeney7
@blondemedSJW
Haha I did get a call about an elevated Cl one time. It was 140.
Of course his Na was 180… among other issues… but sure, let’s call about the chloride first.
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@jonathanstea
@CaulfieldTim
@doritmi
@EdzardErnst
@tnicholsmd
@RyanMarino
@DrLindaMD
@NY_Tuck
I guess I was hallucinating every time I coded a “young, healthy” person… including the pregnant one 😭
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@KatyWyszynski
Patients who are sent over for asymptomatic HTN are sent over for the physician’s comfort. Without symptoms/signs of end organ damage, I’m not doing anything you can’t do in office.
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@cubsfanwhit
Aww thank you for writing this! My ICU work mom just moved away. She was the best... I learned SO much from her!
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“ The agreement ensures that Freedman… won’t get rich from turning the safety-net hospital into condos, as… others thought would happen.”
THANK GOD.
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Justice Sotomayor asks Idaho’s lawyer if it’s true that the state’s ban would prevent abortion in a situation where a woman would otherwise lose an organ or have serious medical complications. Idaho’s lawyer admits it would prevent abortion in those circumstances. “Yes,” he said.
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Come support WiEM at AAEM’s Scientific Assembly in New Orleans!
@aaeminfo
More WiEM fundraisers!
@aaeminfo
Thank you to our generous donors:
@WholePhysician
@BOMBAS
@greencloudappa1
@BeneFITMedical
@RewinedCandles
and vcoterie!
*in person at SA only*
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@blondemedSJW
All of my asymptomatic HTN d/c instructions: “throw away your blood pressure cuff.”
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@pulmtoilet
One night (at Miz), I got our grumpiest GI doc to come in at 2am for a scope on an unstable patient. (Also the sickest patient I’ve ever seen tbh.) Only time it has ever happened on one of my patients.
It might be my biggest accomplishment ever.
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