Prescription for SHIFT work: tips for Emergency Medicine

Ideally, medical care should be provided by a well-rested and nourished provider to one patient at a time through the course of their treatment, with separate time dedicated to teaching. Emergency medicine challenges this concept. The ED consists of shifts around the clock, managing multiple patients without a break but with constant interruptions, where patients…

Missed cauda equina syndrome

Cauda equina syndrome (CES) is an inherently challenging diagnosis to make. It is a needle in a haystack, with back pain being very common but CES being very rare. It carries devastating consequences for the patient and high medico-legal risks for providers. A few weeks ago Steven Chiverton, a 39-year old man, was left paraplegic…

Cellulitis over/underdiagnosis

A patient presents with a red swollen leg. Discharge with oral antibiotics or admit for IV antibiotics? Not so fast.   An recent article highlights the error rate of “cellulitis” diagnoses: Costs and consequences associated with misdiagnosed lower extremity cellulitis. JAMA Dermatol 2016 Nov 2, E1-6. In this retrospective cross-sectional study of patients admitted from…

missed ACS

Missed ACS is a common source of medico-legal cases. In the Canadian Medical Protective Association’s 2010 article Delay in diagnosis of ACS, they identified 292 ACS related medico-legal cases in the previous decade, and identified common problems: “incomplete history, delay in testing, incomplete testing, and misinterpretation of diagnostic tests.   What’s the scale of the…