The Last Touchpoint

Dr. Matt Wetschler’s story represents the best and the worst of our healthcare system. Matt tells us about his near fatal injury, his miraculous recovery (thanks to modern medicine), and the complications with billing that plagued him for months after his accident. Matt’s story is one of several in the recent media highlighting the issue of “surprise billing”, and a subset of this issue referred to as “balance billing”. Drawing from his health policy background, Matt helps us understand balance billing and how patients are affected. Then, Dr. Tom Sugarman joins us to further explain the complexities of surprise billing. He shares how he and others are advocating at the national level to change the billing process, and offers some potential solutions going forward. 

This is a hot button issue! Please remember that the opinions expressed in this podcast may not represent those of UC Davis or the University of California. 

Have you had any experiences with surprise billing? As a health care provider, how do you address this issue with your patients? What potential solutions do you envision? Send us your comments and feedback on social media at @empulsepodcast, or on our website, ucdavisem.com

Please subscribe and rate us on iTunes – it helps us reach more people! 

Registration is now open for UC Davis Emergency Medicine Update: Hot topics 2019! November 5-9 at the Kahala Hotel and Resort in Honolulu, Hawaii

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guests:

Dr. Matthew Wetschler, Emergency Physician with a Masters in Public Health and Health Policy, motivational speaker, and practicing artist in San Francisco, CA

Dr. Tom Sugarman, Chair of Emergency Medicine at Sutter Delta Medical Center in Antioch, Senior Director of Government Affairs for Vituity, and active member and former President of Cal ACEP

Media Credit:

Opening audio is from a short film by Scott Fitzloff. Watch the video in its entirety at www.matthewwetschler.com

Resources:

More on Dr. Matt Wetschler’s personal experience with billing via CNBC

Since his accident, Matt (AKA the Resurrection Artist) has rediscovered his passion for art. More on his story and his work at MatthewWetschler.com

Dr. Wetschler recommends the book An American Sickness, by Elisabeth Rosenthal.

AMA Issue brief explaining balance billing 

ACEP policy on balance billing

ACEP Commitment to Best Practices for EM Practice Groups

President Trump’s recent comments on ending surprise medical billing

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

With Great Power Comes Great Responsibility

In our January episode, #thisisourlane, we spoke with Dr. Garen Wintemute about firearm violence, and discussed the immediate and passionate social media outpouring from physicians in response to an NRA tweet. In this episode, we dive deeper into the topic of physician advocacy, and, more specifically, the role of social media in advocacy. Our guest, Dr. Megan Ranney, is an emergency medicine physician, educator, and digital health and public health researcher, and is an avid social media user herself. She discusses the power of social media to affect change, and offers some tips for how to make your voice heard, and how to navigate some of the pitfalls. Listen through to the end for thoughts from some other well known EM physicians, including Drs. Mike Gisondi, Steve Bird, and Nikita Joshi.

How do you use social media? What do you think about health care professionals using social media for advocacy? Tell us how you’re getting involved – or why you’re staying away! Find us on social media as @empulsepodcast, or on our website, ucdavisem.com

Please subscribe and rate us on iTunes – it helps us reach more people! 

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guest:

Dr. Megan Ranney, Associate Professor of Emergency Medicine at Brown University, Chief Research Officer at AFFIRM Research

Featuring:

Dr. Harrison Alter, Research Director for the Highland Department of Emergency Medicine and Founder and Executive Director of the Levitt Center 

Dr. Mike Gisondi, Vice Chair of Education for the Department of Emergency Medicine at Stanford University

Dr. Vishnu Parthasarathy, Emergency Medicine Resident at UC San Diego

Dr. Steve Bird, President of SAEM, Vice Chair of Education at UMass Medical School

Dr. Linda Herman, Emergency Medicine Residency Program Director at Kaweah Delta

Dr. Nikita Joshi, Emergency Medicine Faculty at Alameda Health System

Resources:

AFFIRM Research

Mayo Clinic 12 Word Social Media Policy

Cyberbullying in Academic Medicine: A Framework for Managing Social Media Attacks.

Cain J, Linos E, Chretien KC. Acad Med. 2019 Mar 26. doi: 10.1097/ACM.0000000000002649. [Epub ahead of print]

Twitter as a tool for communication and knowledge exchange in academic medicine: A guide for skeptics and novices.

Choo EK, Ranney ML, Chan TM, Trueger NS, Walsh AE, Tegtmeyer K, McNamara SO, Choi RY, Carroll CL. Med Teach. 2015 May;37(5):411-6. doi: 10.3109/0142159X.2014.993371. Epub 2014 Dec 19.

It’s Time for More Physicians to Embrace Advocacy, a Scientific American blog post by Dr. Angira Patel, March 13, 2018.

ACEP Firearm Safety and Injury Prevention Policy Statement

What You Can Do

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

EM Pulse Live Edition: WR SAEM Day 2 Wrap-up

EM Pulse Live Edition: WR SAEM Day 2 Wrap-up

It was another exciting day at the Western Regional SAEM conference in Napa, CA! This episode recaps Day 2, including the Western EM Challenge and some fantastic plenary speakers. Highlights include time management for EM physicians, social emergency medicine, care for LGBTQI patients, the future of medical education, exercise in medicine, and building your social media brand.

The conference is trending of social media – follow #WRSAEM19, @wrsaem19, and, of course, @empulsepodcast for all the details.

How did we do? This is a new type of podcasting for us and we’d love your feedback! Hit us up on social media or at ucdavisem.com

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guests:

Dr. Linda Herman, Emergency Medicine Residency Program Director at Kaweah Delta 

Dr. Harrison Alter, Research Director for the Highland Department of Emergency Medicine and Founder and Executive Director of the Levitt Center 

Dr. Mike Gisondi, Vice Chair of Education for the Department of Emergency Medicine at Stanford University

Dr. Angela Jarman, Assistant Professor of Emergency Medicine at UC Davis

Dr. Rachel Bentzen, Assistant Professor of Emergency Medicine and Sports Medicine at Oregon Health Science University

Dr. Nikita Joshi, Emergency Medicine Faculty at Alameda Health System 

Dr. Jim Holmes, Professor of Emergency Medicine at UC Davis and WR SAEM 2019 Conference Chair

Resources:

Nasca TJ, Thomas CW. Medicine in 2035: Selected Insights From ACGME’s Scenario Planning. J Grad Med Educ. 2015;7(1):139-42.

Kuppermann N, Dayan PS, Levine DA, et al. A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections[published online ahead of print, 2019 Feb 18]. JAMA Pediatr. 2019;10.1001/jamapediatrics.2018.5501. doi:10.1001/jamapediatrics.2018.5501

Kuppermann N, Ghetti S, Schunk JE, et al. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. N Engl J Med. 2018;378(24):2275-2287. 

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

EM Pulse Live Edition: WR SAEM Day 1 Wrap-up

This is a first for us! We’re podcasting live (or nearly live) from the 2019 Western Regional Society for Academic Emergency Medicine Annual Meeting in Napa, California. In this episode, we re-cap Day 1 of the conference, featuring the Advanced Airway Lab with Dr. Erik Laurin, Wellness in Academic EM with Dr. Andra Blomkalns, Experience in a Mass Shooting with Dr. Austin Johnson, The Value of Scholarship with Dr. Steve Bird, and much, much more!

The conference is trending of social media – follow #WRSAEM19, @wrsaem19, and, of course, @empulsepodcast for all the details.

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guests:

Dr. Erik Laurin, Professor of Emergency Medicine at UC Davis

Dr. Andra Blomkalns, Professor and Chair of the Department of Emergency Medicine at Stanford University

Dr. Austin Johnson, Assistant Professor is Emergency Medicine at UC Davis

Dr. Steve Bird, Vice Chair of Education at UMass Medical School

Dr. Jim Holmes, Professor of Emergency Medicine at UC Davis and WR SAEM 2019 Conference Chair

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

“Hot” Off the Press: Infant Fever Rule

“Hot” Off the Press: Infant Fever Rule – Episode 15

Talking about neonatal fever makes most people hot under the collar! Fortunately, PECARN is on the case. Their latest paper was just published TODAY in JAMA Peds: A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. In this month’s episode, we learn about some the challenges of having a febrile infant – from a mom’s perspective. Then we discuss when, why, and how to apply the latest PECARN rule with the notorious DNK, also known as Dr. Nate Kuppermann! 

What is your approach to the febrile infant? What are some of the hardest parts about providing care to our hot little ones? We want to know! Share your thoughts on social media, @empulsepodcast, or on our website, ucdavisem.com

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guest:

Dr. Nate Kuppermann, Pediatric Emergency Physician, Professor and Chair of the UC Davis Department of Emergency Medicine, Founding Chair of the PECARN Steering Committee

Resources:

A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections

Nathan Kuppermann, MD, MPH1; Peter S. Dayan, MD, MSc2; Deborah A. Levine, MD3; et al. JAMA Pediatr. Published online February 18, 2019. doi:10.1001/jamapediatrics.2018.5501

Validation of the “Step-by-Step” Approach in the Management of Young Febrile Infants.

Gomez B, Mintegi S, Bressan S, Da Dalt L, et. al. Pediatrics. 2016 Aug;138(2). pii: e20154381. doi: 10.1542/peds.2015-4381. Epub 2016 Jul 5.

Management of the Febrile Young Infant: Update for the 21st Century. 

Woll C, Neuman MI, Aronson PL. Pediatr Emerg Care. 2017 Nov;33(11):748-753. doi: 10.1097/PEC.0000000000001303.

Accuracy of Complete Blood Cell Counts to Identify Febrile Infants 60 Days or Younger with Invasive Bacterial Infections. 

Cruz AT, Mahajan P, Bonsu BK, Bennett JE et. al. JAMA Pediatr. 2017 Nov 6;171(11):e172927. doi: 10.1001/jamapediatrics.2017.2927. Epub 2017 Nov 6.

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Ski and CME! Join us for the,UC Davis Emergency Medicine Winter Conference, March 4th-8th at the Ritz Carlton in Lake Tahoe, CA.

Come play and learn with us at the Western Regional SAEM Annual Meeting, March 21-22 in beautiful Napa, CA! #WRSAEM19 

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

#Thisismylane– Episode 14

#Thisismylane– Episode 14

If you work in the ED, you’ve likely seen your fair share of victims of gun violence. Though mass shootings have brought this issue into the public eye, firearm violence has been a public issue in our country for decades. In this episode, you’ll hear some powerful stories from providers about their experiences with people killed and injured by firearms. Then, we talk with researcher and expert, Dr. Garen Wintemute, about trends he’s seen, and discuss how we, as physicians and medical providers, can be part of the solution. 

Clearly this is a charged and complex topic. Let’s respectfully share our thoughts on how we can help prevent gun violence. We want to know! Share your thoughts on social media, @empulsepodcast, or on our website, ucdavisem.com. 

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guest:

Dr. Garen Wintemute Professor of Emergency Medicine, Susan P. Baker-Stephen P. Teret Chair in Violence Prevention at UC Davis, and Director, Violence Prevention Research Program  

Resources:

UC Davis Violence Prevention Research Program Toolkit: What You Can Do to Stop Firearm Violence https://health.ucdavis.edu/vprp/WYCD.html

Annals of Internal Medicine commitment and op ed: What You Can Do to Stop Firearm Violence http://annals.org/aim/pages/commitment-to-stop-firearm-violence

Speak For Safety

Video of Garen Talking about gun retailers taking a hard line against illegal gun sales: https://health.ucdavis.edu/publish/facultybio/search/faculty/242

Ski and CME! Join us for the,UC Davis Emergency Medicine Winter Conference March 4th-8th at the Ritz Carlton in Lake Tahoe.

Come play and learn with at the Western Regional SAEM Annual Meeting, March 21-22 in beautiful Napa, CA! #WRSAEM19 

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

While this is a UC Davis EM podcast and many of the voices you hear today, including our own, are those of UC Davis EM Physicians, the opinions expressed may not be those of the UC DAVIS institution and Health System.  

Bonus Episode: 2018 in Review

Bonus Episode: 2018 in Review

Happy New Year! 2018 was a big year for us, thanks to all of you! Here we are, almost 365 days since publishing our first episode, so let’s take a moment to reflect on our first year. We’re closing in on 30,000 downloads and have listeners in all 50 states, 2 territories, and 94 countries. We’ve been featured by several local news outlets, and one of our favorite EM blogs, lifeinthefastlane.com. And we even won an eHealthcare Leadership award! Wow. We are so grateful to you all for listening, subscribing, supporting, rating, reviewing, and sharing! 

In this episode, Sarah and Julia recall some of their moments – see below for links to the episodes mentioned. We look forward to bringing you many more great episodes in 2019!

What were your favorite moments? Did a particular episode resonate with you? Let us know on social media, @empulsepodcast, or at ucdavisem.com. 

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Episodes Referenced:

Pot Tarts

Sold for a Chrysler 300

The Game has Changed

Don’t be a Jerk

The Price of Beauty

Toddlers Will Sell Their Souls for Stickers

Last Stand in Santa Rosa

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Ski and CME! Join us for the UC Davis Emergency Medicine Winter Conference, March 4th-8th at the Ritz Carlton in Lake Tahoe.

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Last Stand in Santa Rosa – Episode 13

Last Stand in Santa Rosa – Episode 13

Imagine you’re working a shift in the Emergency Department when a fast moving wildfire hits. What would you do if you found out your home was burning? Or your family was in danger? And how do you react when the Fire Department tells you they are making a last stand a block away from your hospital? This situation is all too real for many physicians and providers affected by devastating wildfires in California. In this episode, we follow the story of the 2017 Santa Rosa fires from the perspective of three Emergency Physicians, Dr. Josh Weil, Dr. Suzy Fitzgerald, and Dr. Dane Stevenson. Their powerful story, and the lessons learned from their experience, are guaranteed to improve your personal and professional disaster preparedness. 

Please also consider donating to ongoing relief efforts following the 2018 California wildfires through the Red Cross. 

Do you know your hospital’s disaster plan? Do you have a personal plan? Have you lived through a disaster? Share your experience with us on social media, @empulsepodcast, or on our website, ucdavisem.com. 

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guests:

Dr. Susan Fitzgerald, Emergency Physician at Kaiser Santa Rosa and Emergency Management Physician Lead in the Diablo Service Area; Kaiser Permanente Northern California (KPNC) Regional Emergency Management Drill and Training Director and the Pediatric Surge Planning Chair for the KPNC Regional Emergency Management Committee.

Dr. Joshua Weil, Emergency Physician at Kaiser Santa Rosa and Assistant Physician-in-Chief for Hospital Operations; Member of the American Red Cross Board of Directors, Board Chair for the Ceres Project, and Medical Director for the Jewish Community Free Clinic in Santa Rosa. Dr. Weil has been involved in major disaster relief efforts in the US and internationally, including Sri Lanka, Louisiana, Haiti, and the Philippines.

Dr. Dane Stevenson, Emergency Physician at Kaiser Santa Rosa, with a Fellowship in Geriatric Emergency Medicine from UC Davis.

Resources:

ACEP Disaster Medicine Resources

American College of Emergency Physicians Disaster Medicine resources, policies, and public training, including hospital disaster preparedness self assessment tool and hospital evacuation plan template. 

“Healing and History after fire & Weil-Mollard Household” 

Dr. Josh Weil and his wife, Claire Mollard, share their story on YouTube

The story of Josh’s goats! on NPR/Capitol Public Radio

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Ski and CME! Join us for the UC Davis Emergency Medicine Winter Conference, March 4th-8th at the Ritz Carlton in Lake Tahoe.

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

 

Toddlers Will Sell Their Souls for Stickers – Episode 12

Toddlers Will Sell Their Souls for Stickers – Episode 12

Caring for kids in the ED can be challenging – they often can’t (or won’t) tell you what’s wrong or where it hurts; they may have trouble sitting still during an exam or procedure; and their screams put everyone on edge. But let’s think about it from their perspective. It must be pretty confusing and frightening at times. Did you ever have to go to the ED as a kid? Do you remember what it was like? We ask some kids to share their thoughts and experiences. Then we get some valuable tips from the experts – Child Life Specialists, Pediatric ED Nurses, and Pediatric Emergency Medicine Physicians, including our own Dr. Julia Magaña. Learn what you can do to improve the ED experience for both you and your young patients. 

What tips do you have for taking care of kids in the ED? Did you try any of the things we mentioned in this episode? If so, did they work for you? We want to know! Share your thoughts on social media, @empulsepodcast, or on our website, ucdavisem.com. 

Hosts:

Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guests:

The kids: Isa, Jordan, Benny, Katelyn, Wesley and Elia

UC Davis Department of Emergency Medicine Child Life Specialists, Nurses and Pediatric Emergency Medicine Physicians.

Resources:

DistrACTION Cards that Julia mentioned

Information and protocols for using intranasal medications at www.intranasal.net

Wong-Baker FACES pain scale

FLACC Score for pain in infants

ACEP Guidelines for Procedural Sedation and Analgesia in the Emergency Department (2013)

An Evidence-Based Approach to Minimizing Acute Procedural Pain in the Emergency Department and Beyond.

Ali S, McGrath T, Drendel AL. Pediatr Emerg Care. 2016 Jan;32(1):36-42; quiz 43-4. doi: 10.1097/PEC.0000000000000669. Review.

Patient- and family-centered care of children in the emergency department.

Dudley N, Ackerman A, Brown KM, Snow SK; American Academy of Pediatrics Committee on Pediatric Emergency Medicine; American College of Emergency Physicians Pediatric Emergency Medicine Committee; Emergency Nurses Association Pediatric Committee.

Pediatrics. 2015 Jan;135(1):e255-72. doi: 10.1542/peds.2014-3424.

Ten Practical Ways to Make Your ED Practice Less Painful and More Child-Friendly

Amy L.DrendelDO, MS*SaminaAliMDCM, Clinical Pediatric Emergency Medicine

Volume 18, Issue 4, December 2017, Pages 242-255

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Ski and CME! Join us for the UC Davis Emergency Medicine Winter Conference, March 4th-8th at the Ritz Carlton in Lake Tahoe.

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

The Price of Beauty

Heartbeat: The Price of Beauty

As Emergency Physicians, we pride ourselves on recognizing and treating life-threatening conditions. But what if we’re missing important diagnoses and we don’t even know it? In this Heartbeat, we explore acute and chronic silicone syndromes, two potentially serious conditions caused by injecting liquid silicone into the body. Dr. Nick Gorton, previously featured on Episode 8: Don’t be a Jerk! and the LGBTQI, MD Heartbeat, joins us again with advice on how to diagnose and manage these conditions that predominantly affect women, especially transgender women. 

Are these diagnoses new to you? Have you seen and treated either of these conditions? Let’s continue the conversation on social media @empulsepodcast or at ucdavisem.com.

Host:

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis

Guest:

Dr. R. Nick Gorton, Emergency Physician at Sutter Davis, and Primary Care Physician at the Lyon-Martino Clinic in San Francisco. 

Resources:

Silicone Pumping Harm Reduction Pamphlet

Dying to be a Woman trailer by TransLatin@ Coalition

TRANSLINE national online transgender medical consultation service – free and confidential. 

Lyon-Martin Health Services, San Francisco, CA.

Silicone embolism syndrome: a case report, review of the literature, and comparison with fat embolism syndrome.

Schmid A, Tzur A, Leshko L, Krieger BP.

Chest. 2005 Jun;127(6):2276-81. Review.

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Join us in Maui for Emergency Medicine Hot Topics! November 6-10, 2018.

Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Dr. Nick Gorton

Dr. Sarah Medeiros