Category Archives: the business of health care

EKG tracing

Reliable keys to identify a medical emergency

A larged medical insurance company received criticism for its handling of some emergency room (ER) claims recently. If, after review of an ER visit the company determines the condition was not a true emergency, it will deny payment for the visit, making the patient responsible for the full amount.

Critics, including patients, doctors, and hospital administrators fear this endangers patients , who may be harmed by avoiding  emergency room care for financial reasons.

You may consider an  emergency to be any medical condition which 

  • is new , sudden, and/or unexpected,
  • worse than usual or uncontrolled,
  • of unknown origin,
  • not responding to treatment,
  • not improving or resolving,
  • interrupts normal life.

However, to physicians and other health care personnel, the definition of an emergency is more specific.

An emergent medical condition is one that, if not treated promptly 

  • Threatens life
  • Threatens one or more limbs
  • Threatens vision/hearing/speech/mental function/ function of any major internal organ or organ system
  • Threatens long term and/or permanent bodily harm
Minutes matter with heart emergencies

Minutes matter with heart emergencies

In the United States, a federal law known as EMTALA defines a medical emergency as

“a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual’s health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.”

Some examples of emergent conditions include 

  • Sudden or new  changes in heart function, like a myocardial infarction (heart attack), arrhythmia (abnormal heart rate or rhythm) or congestive failure (poor pumping capacity)
  • Brain conditions including stroke, head trauma, seizure, psychosis
  • Pulmonary (breathing) dysfunction including pulmonary embolus (blood clot), severe pneumonia, asthma or COPD
  • Multiple trauma, including extensive burns , multiple fractures, or trauma to any major organ like the liver or kidneys
  • Chemical changes in the blood; for example high /low blood sugar, low blood potassium, low platelets,
  • Severe depression and/or anxiety
  • Drug and alcohol overdoses

a person having blood pressure measured

SYMPTOMS of an emergency  include

  • Shortness of breath, or difficulty breathing, especially if not associated with exertion
  • Uncontrollable bleeding
  • A seizure, especially in a person with no previous diagnosis of seizures
  • Sudden or severe loss or difficulty with vision, hearing , speech, or other functions such as swallowing, thinking, walking, passing urine or stool
  • Fainting, passing out, loss of consciousness, severe dizziness
  • Hallucinations, confusion, thoughts or threats of harm to self or others
  • In a pregnant woman- any of the above plus loss of fetal movement
  • Persistent/severe nausea/vomiting/diarrhea
  • Severe pain, especially if it prevents or inhibits body function

Certain groups of people are more at risk of significant illness with any of these symptoms, so emergency care should be sought sooner than later. They include

  • infants up to age 2
  • elderly-most medical references still call this over age 65
  • pregnant women
  • people with suppressed immune systems as from cancer chemotherapy, HIV, malnutrition, other drugs

Chest pain must always be taken seriously, even if mild.

Although in persons under 40 years old it is less likely due to a heart attack, there are other life threatening conditions that can occur in this age group. Again, especially if it is associated with any of the other symptoms, it is emergent.

Learn more about common heart diseases at this previous post

Exploring -when HEARTS break

While on a mission trip to Panama, my husband had a near emergency when a board flew into his leg causing a deep gash; our medical team members took care of the injury right on the clinic site, and he recovered without permanent damage

While on a mission trip to Panama, my husband had a near emergency when a board flew into his leg causing a deep gash; a local surgeon was working with our medical team , and with their help he sutured the wound at the small rural church where we were holding clinic; his leg has healed well, just a scar to remind us of the adventure.


Helicopters transport of emergency patients can make the difference between life and death.

You should not call your doctor’s office or answering service, your mother, your best friend, or post a question on social media (which I have seen done!)

If it’s not an emergency but is urgent, then the next best options are calling your doctor’s office or going to an urgent care clinic. Posting on social media is still a bad choice. Do you really want your “friends” giving you medical advice about something they know nothing about?

We doctors don’t expect you to diagnose your condition before coming to the ER or the office, and insurance companies either. With using the above guidelines, if you even suspect your problem is an emergency, you are wise to seek help.

Dr. Esther Choo, an ER physician shares

6 Tips for Getting the Most Out of Your Emergency Room Visit



Hospital sign- 5 miles to help.

Is it an emergency? Insurer makes patients question ER visit






I appreciate your  sharing this  information  on your social media pages.

And follow Watercress Words for more information, instruction, and inspiration to help you explore the HEART of HEALTH .




Helicopter landing at a hospital to deliver a critically ill person.


the word BLOG

What doctors want you to know about healthcare

If you want to know what doctors think, and more importantly, how they feel about their jobs, read KevinMD.

(This post has affiliate links.)

Founded by Dr. Kevin Pho in 2004, this blog features articles by thousands of doctors, representing multiple specialties, ages, genders, ethnicity and practice setting. They write on multiple topics related to health, the science, practice, business, and politics of medicine, the doctor-patient relationship, and anything else even remotely related to medicine and health care.

On KevinMD  you will not find detailed infographics, slick images, or cute printables. Rather you will find stories filled with raw emotion as physicians  candidly share the horrific  struggles, the occasional remarkable successes, and the everyday grind  of providing healthcare to hurting, needy, sometimes demanding, occasionally grateful patients. And you will hear from patients whose experiences with physicians and the healthcare system range from sublime to horrendous.

You may not like or agree with some of the things you read there-I often don’t and I’m a doctor myself. That’s part of the point of this blog. We physicians are not homogenous. We are individuals with different stories to tell from differing points of view, based on background, training,  and experience.

The blog is divided into sections based on broad categories of topics –

physician, patient, policy, tech, social media , meds, conditions.

Some of the articles are directed to patients while others are physician oriented. I encourage you to read some of both, in addition to the ones I am sharing here.

Many of the physician authors write their own blogs, so it is a good place to explore and discover other health bloggers that you may enjoy.

How doctors feel about relationships with patients-

Dr. Jennifer Lycette , an oncologist who blogs at The Hopeful Cancer Doc, offered her take on a situation that I have encountered more than once myself.

Don’t call me “Mrs.” Call me “Doctor.”


“To address a female physician as “Mrs.,” even if she is married, is to imply that despite all her professional accomplishments, her worth is reduced to her marital status. It ignores all the hard work that went into earning the title of “Doctor,” and denotes, whether intentional or not, that a female physician is somehow less deserving of the title than a male physician.”Dr. Oglesby nametag







 How patients feel about communicating with doctors

Martine Ehrenclou is a patient advocate.  She is the author of Critical Conditions: The Essential Hospital Guide to Get Your Loved One Out Alive and The Take-Charge Patient.

She submitted an interesting piece on a controversial topic, that of patients recording their visits with doctors, either with or without permission.

“patients are in fact secretly recording conversations with their doctors without asking permission first.

Talk about a blow to the doctor-patient relationship.

I understand the hesitation to ask permission to record an office or hospital visit with a medical provider as I experienced it myself. But secretly recording is a violation of trust. Why would any patient surreptitiously tamper with the relationship with their doctor, something that is considered the cornerstone of quality care?’

Documenting information your doctor gives you is essential because it’s just too easy to misunderstand or forget the medical information conveyed. “

She offers these

Tips to remember what the doctor tells you.




How doctors think about treating illness

Dr. Eileen Sprys is a family physician who wants you to know

When you have a cold, why I’m not giving you an antibiotic

“I want you to know that as a physician, I feel a pang of insecurity, guilt, and sadness when a patient tells me they’re upset because I won’t write an antibiotic.  I don’t want you to be sick or miserable.

I understand how inconvenient and sometimes life altering a cold can be. I desperately, desperately wish that I had a cure for your cold, but none of us do.

I also want you to know that for every antibiotic I over-prescribe, that I run the unnecessary risk of making someone even more sick, even to the point of hospitalization or death. I went into medicine to help you and to relieve your suffering with integrity — and that by giving you antibiotics without indication, I am betraying my own purpose.”




What doctors want you to know but don’t have time to tell you

a vision refractor

An ophthalmologist is a physician (doctor of medicine, MD, or doctor of osteopathy, DO) who specializes in the medical and surgical care of the eyes and visual system and in the prevention of eye disease and injury.

Dr. Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor. This article originally in the HealthZette reveals

8 things doctors secretly want to tell their patients

Number 8 is “I’m only human.”

 “We have our good days and bad days just like anyone else. We try to always have a smile on our faces, be upbeat and cheerful. But we, too, are affected by life’s challenges — work, family, finances, health, and so on. Don’t be too quick to judge and criticize!”

What doctors do away from their practice

KevinMD does have a few photos, and even some videos. I enjoyed this one by physician-comedian Brad Nieder, MD who blogs  at the The Healthy Humorist. In this clip he explains how he learned to eat less.



After you explore KevinMD, please come back and leave a comment about a post you especially liked, learned something from, or maybe disagreed with.